Diffuse Lung Disease |

Clinical Investigation of Asbestos-Induced Diffuse Pleural Thickening With Respiratory Compromise FREE TO VIEW

Daisuke Nojima, MD; Nobukazu Fujimoto, MD; Katsuya Kato, MD; Katsuyuki Kiura, MD; Mitsune Tanimoto, MD; Takumi Kishimoto, MD
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Department of Hematology, Oncology and Respiratory Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan

Chest. 2013;144(4_MeetingAbstracts):477A. doi:10.1378/chest.1701704
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SESSION TITLE: Occupational/ Environmental Lung Disease Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM

PURPOSE: We aimed to demonstrate the clinical features of asbestos-related diffuse pleural thickening (DPT) with severe respiratory compromise, especially focusing on the association between benign asbestos pleurisy (BAP) and DPT.

METHODS: We conducted a retrospective study of consecutive subjects with asbestos-related DPT referred to Okayama Rosai Hospital and Okayama University Hospital. DPT was diagnosed in subjects with pleural thickening more than 5 mm on chest X-ray, extending for more than a half of lateral thoracic wall (LTW) in the cases of unilateral DPT, or more than a quarter of LTW in the cases of bilateral DPT. The subjects should be followed up at least for 6 months after diagnosis of DPT.

RESULTS: There were 27 patients between 2003 and 2012. All of them were male. The median (range) age at development of DPT was 74 (63-92) years. The occupational exposure to asbestos included 8 in dockyard, 5 in heating trade, 4 in construction, each 2 in demolition work and asbestos product industry, and each 1 in furnace installation, electric work, paint, plumbing, welding, and shipman. Fifteen patients presented cough at the first visit and 15 presented MRC grade 2 dyspnea. Twenty-one patients had bilateral disease at presentation. The median vital capacity percentage was 49.8 (31.2-70.7). The median latency of development of DPT from first asbestos exposure was 49 (37-64) years. Fifteen patients had presented with pleural effusion preceding the diagnosis of DPT and median duration from the pleural fluid accumulation to the development of DPT with severe respiratory compromise was 28.2 (5.6-255.3) months. The median survival time of DPT was 36 (4.0-85.0) months. There were 5 cases died of respiratory failure, and one died of lung cancer.

CONCLUSIONS: Our results indicate that DPT could develop after the long latency from occupational asbestos exposure. About half of DPT with severe respiratory compromise had a history of BAP. Severe respiratory compromise was induced in several months or even after 20 years from BAP.

CLINICAL IMPLICATIONS: DPT is probably under- recognized. It may cause dyspnea, chest pain, and respiratory failure. The incidence of this disease is expected to be rising, so more physicians would be involved in its management.

DISCLOSURE: The following authors have nothing to disclose: Daisuke Nojima, Nobukazu Fujimoto, Katsuya Kato, Katsuyuki Kiura, Mitsune Tanimoto, Takumi Kishimoto

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