Pleural plaques in smoking-associated fibrosis and pulmonary asbestosis

Our plain-English summary of Pleural plaques in smoking-associated fibrosis and pulmonary asbestosis, by R.G. Sangani, A.J. Ghio, J.E. Parker (International Journal of Chronic Obstructive Pulmonary Disease, 2015).

The study

• Authors: R.G. Sangani, A.J. Ghio, J.E. Parker
• Journal: International Journal of Chronic Obstructive Pulmonary Disease
• Published: 2015;10:869-70
• Type of article: Letter, Comment
• Read it: PubMed · Publisher · Free full text

In plain English

This item is not a research study. It is a letter to the editor and the original authors' reply, both about an earlier study by Bledsoe and colleagues on telling asbestosis apart from smoking-related lung scarring (fibrosis). That study had 24 cases with an International Labour Organization (ILO) chest X-ray profusion score of 1 or more. The letter writers noted that only six showed asbestosis under the microscope. Of the other 18, 16 had a significant smoking history and two had unknown smoking status. The letter writers asked whether people with asbestosis had pleural plaques more often than those with smoking-related fibrosis. In reply, Bledsoe and colleagues reported that chest X-rays showed pleural plaques in 5 of 6 (83%) cases with microscopic evidence of asbestosis and in 13 of 18 (72%) cases without it. They also reported that average potential asbestos exposure was 25 years in each group. The reply authors concluded that mild fibrosis attributed to asbestosis on chest X-ray may not be reliably distinguished from other causes, such as smoking, even in people with asbestos exposure and pleural plaques.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Letter to the editor commenting on a published study, followed by the original study authors' reply; no new study was carried out
• Who was studied: The letter and reply discuss the cases in the Bledsoe et al study. These were cases referred for consultation in pulmonary malignancy, including 24 cases of pulmonary fibrosis with an ILO profusion score of 1 or more. Of these, six had histopathologic evidence of asbestosis and 18 were most consistent with smoking-related fibrosis.
• Exposure: Asbestos exposure, with a mean potential exposure duration of 25 years in each group, and cigarette smoking. No fiber types are named.
• Main results:
  • The study had 24 cases with an ILO profusion score of 1 or more. The letter itself prints 'profusion score of 1'; the reply describes the same cases as having a profusion of 1 or more. As summarized by the letter writers, only six of these cases showed histological evidence of asbestosis.
  • As summarized by the letter writers: of the remaining 18 cases, 16 had a significant smoking history and two had unknown smoking status.
  • As summarized by the letter writers: radiographic pleural plaques were seen in 82 (44%) of all cases in the Bledsoe et al study.
  • Reply: on chest radiograph, pleural plaques were found in 5/6 (83%) of cases with histopathologic evidence of asbestosis and in 13/18 (72%) of cases without it.
  • Reply: in most cases, smoking-related fibrosis could not be excluded as the cause of the interstitial fibrosis. The reasons given were tissue appearance consistent with smoking-related fibrosis and the absence of asbestos bodies.
• The authors' conclusion: The reply authors concluded that mild pulmonary fibrosis attributed to asbestosis on chest radiograph may not be reliably distinguished from other causes of interstitial fibrosis, such as smoking, including in patients with asbestos exposure and pleural plaques. The letter writers stated that the study's results support further evaluation of a role for cigarette smoking in interstitial fibrosis.
• Limitations the authors state:
  • The reply authors noted that detecting pleural plaques by chest radiograph is not entirely sensitive or specific.
  • The reply authors noted that pleural plaques may obscure assessment of underlying lung disease on chest radiograph.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Asbestosis, Lung cancer.

Medical terms in this study, explained in our Lexicon: Pleural Plaques, Fibrosis, Asbestosis.

Related studies

• Smoking-associated fibrosis and pulmonary asbestosis — J.R. Bledsoe, D.C. Christiani, et al. (2015)
• Asbestosis: interstitial pulmonary fibrosis and pleural fibrosis in a cohort of asbestos insulation workers: influence of cigarette smoking — R. Lilis, I.J. Selikoff, et al. (1986)
• Interaction of asbestos, age, and cigarette smoking in producing radiographic evidence of diffuse pulmonary fibrosis — K.H. Kilburn, R. Lilis, et al. (1986)
• Cigarette smoking, asbestos, and pulmonary fibrosis — W. Weiss (1971)
• Cigarette smoking does not produce or enhance the radiologic appearance of pulmonary fibrosis — K.H. Kilburn (1981)
• Pulmonary function, smoking habits, and high resolution computed tomography (HRCT) early abnormalities of lung and pleural fibrosis in shipyard workers exposed to asbestos — S. Neri, P. Boraschi, et al. (1996)

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