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Gareth J. Wynn, MBChB; Peter M. Turkington, MD; B. Ronan O'Driscoll, MD
Author and Funding Information

Salford Royal University Hospital Salford, UK

Correspondence to: B. Ronan O'Driscoll, MD, Department of Respiratory Medicine, Salford Royal University Hospital, Stott Ln, Salford M6 8HD, UK: e-mail: ronan.o'driscoll@srft.nhs.uk


Dr. Turkington is the Chief Investigator for a research project, with a £50,000 grant from the Pfizer Foundation, on the early diagnosis of COPD and targeted smoking cessation. He has given six lectures per year to primary care staff with honoraria from various pharmaceutical companies (AstraZeneca, GlaxoSmithKline, and Pfizer). Dr. Wynn and Dr. O'Driscoll have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).


© 2009 American College of Chest Physicians


Chest. 2009;135(6):1694-1695. doi:10.1378/chest.09-0291
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To the Editor:

We thank Naccache and colleagues for their interest in our article.1 Although in our series there was a predominance of patients with a history of exposure to coal dust, we agree that many different types of inhaled dust can cause anthracofibrosis.

Two large series of anthracosis and anthracofibrosis have been reported since the publication of our article. At the 2008 Meeting of the European Respiratory Society, Sigari and Mohammadi2 described 738 Iranian patients with anthracosis, of whom 37.5% (277 patients) had bronchial stenosis consistent with anthracofibrosis. Almost half of the patients were female nonsmokers, and it was suggested that the condition was caused mostly by domestic wood fires used for cooking. The male patients included farmers, manual workers, miners, and bakers.

Kim and coworkers3 have described 333 patients in Korea with anthracofibrosis, which was diagnosed between 1998 and 2004, of whom only 33% had a history of pulmonary tuberculosis and all of whom had a history of long-term exposure to biomass smoke. This is in keeping with the original report by Chung et al4 from Korea on 28 patients with anthracofibrosis, of whom 20 were women with a history of exposure to wood smoke (compared with 17 of the 28 patients who had pulmonary tuberculosis).

These newly reported cases would support the suggestion that many different dusts (both occupational and domestic) can cause anthracofibrosis. In the developing world, there is certainly an association with tuberculosis. However, due to the use of biomass cooking methods, there may be many more cases than are presently recognized. In the United Kingdom, and in other countries with a strong coal-mining heritage, coal is likely to be the most common industrial dust to which patients with anthracofibrosis have been exposed. In other industrialized countries, the pattern of exposure will no doubt vary based on the predominant industry. This is eloquently illustrated in the recent report by Naccache et al.5

Wynn GJ, Turkington PM, O'Driscoll BR. Anthracofibrosis, bronchial stenosis with overlying anthracotic mucosa: possibly a new occupational lung disorder; a series of seven cases from one UK hospital. Chest. 2008;134:1069-1073. [PubMed] [CrossRef]
 
Sigari N, Mohammadi S. Anthracosis.Accessed April 2, 2009 Available at:http://www.ersnet.org/learning_resources_player/abstract_print_08/files/344.pdf.
 
Kim YJ, Jung CY, Shin HW, et al. Biomass smoke induced bronchial anthracofibrosis: presenting features and clinical course. Respir Med. 2009;103:757-765. [PubMed]
 
Chung MP, Lee KS, Han J, et al. Bronchial stenosis due to anthracofibrosis. Chest. 1998;113:344-350. [PubMed]
 
Naccache JM, Monnet I, Nunes H, et al. Anthracofibrosis attributed to mixed mineral dust exposure: report of three cases. Thorax. 2008;63:655-657. [PubMed]
 

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References

Wynn GJ, Turkington PM, O'Driscoll BR. Anthracofibrosis, bronchial stenosis with overlying anthracotic mucosa: possibly a new occupational lung disorder; a series of seven cases from one UK hospital. Chest. 2008;134:1069-1073. [PubMed] [CrossRef]
 
Sigari N, Mohammadi S. Anthracosis.Accessed April 2, 2009 Available at:http://www.ersnet.org/learning_resources_player/abstract_print_08/files/344.pdf.
 
Kim YJ, Jung CY, Shin HW, et al. Biomass smoke induced bronchial anthracofibrosis: presenting features and clinical course. Respir Med. 2009;103:757-765. [PubMed]
 
Chung MP, Lee KS, Han J, et al. Bronchial stenosis due to anthracofibrosis. Chest. 1998;113:344-350. [PubMed]
 
Naccache JM, Monnet I, Nunes H, et al. Anthracofibrosis attributed to mixed mineral dust exposure: report of three cases. Thorax. 2008;63:655-657. [PubMed]
 
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