Background: The clinical features of asbestos-related diffuse pleural thickening (DPT) remain unclear. Objectives: To clarify the association between radiological findings of DPT and respiratory function. Methods: Medical data from patients with asbestos-related DPT were collected, including their history of occupational or neighborhood asbestos exposure, initial symptoms, modified Medical Research Council dyspnea grade, smoking history, radiological findings, and respiratory function test results. Results: There were 106 DPT patients between 2005 and 2010 [i.e. 103 men (97.2%) and 3 women (2.8%)]. The median age at diagnosis was 69 years (range 46-88). Patient occupations related to asbestos exposure included: asbestos product manufacturing (n = 17); the shipbuilding industry (n = 14); the construction industry (n = 13); heat insulation work (n = 12); plumbing, asbestos spraying, and electrical work (n = 7 each), and transportation and demolition work (n = 4 each). The median duration of asbestos exposure was 25 years (range 2-54), and the median latency period before the onset of DPT was 46 years (range 25-66). Involvement of the costophrenic angle (CPA) was also negatively correlated with the percent vital capacity (%VC; r = -0.448, p < 0.01). Pleural thickness and the craniocaudal and horizontal extension of pleural thickening, as determined by chest computed tomography (CT), were also negatively correlated with %VC (r = -0.226, p < 0.05; r = -0.409, p < 0.01, and r = -0.408, p < 0.01, respectively). Conclusions: DPT develops after a long latency period following occupational asbestos exposure and causes marked respiratory dysfunction. The extension of DPT should be evaluated by chest CT, and chest X-ray would be important for the evaluation of the involvement of the CPA.

1.
American Thoracic Society: Diagnosis and initial management of nonmalignant diseases related to asbestos. Am J Respir Crit Care Med 2004;170:691-715.
2.
Epler GR, McLoud TC, Gaensler EA: Prevalence and incidence of benign asbestos pleural effusion in a working population. JAMA 1982;247:617-622.
3.
Hillerdal G: Non-malignant asbestos pleural disease. Thorax 1981;36:669-675.
4.
Yates DH, Browne K, Stidolph PN, Neville E: Asbestos-related bilateral diffuse pleural thickening: natural history of radiographic and lung function abnormalities. Am J Respir Crit Care Med 1996;153:301-306.
5.
Hillerdal G, Ozesmi M: Benign asbestos pleural effusion: 73 exudates in 60 patients. Eur J Respir Dis 1987;71:113-121.
6.
McLoud TC, Woods BO, Carrington CB, Epler GR, Gaensler EA: Diffuse pleural thickening in an asbestos-exposed population: prevalence and causes. Am J Roentgenol 1985;144:9-18.
7.
International Labour Office: Guidelines for the Use of the ILO International Classification of Radiographs of Pneumoconioses, rev ed. Geneva, International Labour Office, 2011, pp 6-8. http://www.ilo.org/safework/info/publications/WCMS_168260/lang-en/index.htm (accessed November 17, 2011).
8.
Lilis R, Lerman Y, Selikoff IJ: Symptomatic benign pleural effusions among asbestos insulation workers: residual radiographic abnormalities. Br J Ind Med 1988;45:443-449.
9.
de Klerk NH, Cookson WO, Musk AW, Armstrong BK, Glancy JJ: Natural history of pleural thickening after exposure to crocidolite. Br J Ind Med 1989;46:461-467.
10.
Jeebun V, Stenton SC: The presentation and natural history of asbestos-induced diffuse pleural thickening. Occup Med 2012;62:266-268.
11.
American Thoracic Society: Standardization of spirometry, 1994 update. Am J Respir Crit Care Med 1995;152:1107-1136.
12.
Kundel HL, Polansky M: Measurement of observer agreement. Radiology 2003;228:303-308.
13.
Gibbs AR, Pooley F: Mineral fiber analysis and asbestos-related diseases; in Craighead JE, Gibbs AR (eds): Asbestos and Its Diseases. New York, Oxford University Press, 2008, pp 296-316.
14.
Gibbs AR, Stephens M, Griffiths DM, Blight BJ, Pooley FD: Fibre distribution in the lungs and pleura of subjects with asbestos related diffuse pleural fibrosis. Br J Ind Med 1991;48:762-770.
15.
Kishimoto T, Gemba K, Fujimoto N, Aoe K, Kato K, Takeshima Y, Inai K: Clinical study on mesothelioma in Japan: relevance to occupational asbestos exposure. Am J Ind Med 2010;53:1081-1087.
16.
Kishimoto T, Gemba K, Fujimoto N, Onishi K, Usami I, Mizuhashi K, Kimura K: Clinical study of asbestos-related lung cancer in Japan with special reference to occupational history. Cancer Sci 2010;101:1194-1198.
17.
Gemba K, Fujimoto N, Kato K, Aoe K, Takeshima Y, Inai K, Kishimoto T: National survey of malignant mesothelioma and asbestos exposure in Japan. Cancer Sci 2012;103:483-490.
18.
Kee ST, Gamsu G, Blanc P: Causes of pulmonary impairment in asbestos-exposed individuals with diffuse pleural thickening. Am J Respir Crit Care Med 1996;154:789-793.
19.
Nemeth L, Tolnai K, Hovanyi E, Egervary M, Vincze E, Gyori S: Frequency, sensitivity and specificity of roentgenographic features of slight and moderate asbestos-related respiratory diseases. Rofo 1986;144:9-16.
20.
Matrat M, Pairon JC, Paolillo AG, Joly N, Iwatsubo Y, Orlowski E, Letourneux, M, Ameille J: Asbestos exposure and radiological abnormalities among maintenance and custodian workers in buildings with friable asbestos-containing materials. Int Arch Occup Environ Health 2004;77:307-312.
21.
Mastrangelo G, Ballarin MN, Bellini E, Bicciato F, Zannol F, Gioffre F, Zedde A, Tessadri G, Fedeli U, Valentini F, Scoizzato L, Marangi G, Lange JH: Asbestos exposure and benign asbestos diseases in 772 formerly exposed workers: dose-response relationships. Am J Ind Med 2009;52:596-602.
22.
Fletcher DE, Edge JR: The early radiological changes in pulmonary and pleural asbestosis. Clin Radiol 1970;21:355-365.
23.
Gevenois PA, de Maertelaer V, Madani A, Winant C, Sergent G, De Vuyst P: Asbestosis, pleural plaques and diffuse pleural thickening: three distinct benign responses to asbestos exposure. Eur Respir J 1998;11:1021-1027.
24.
Cotes JE, King B: Relationship of lung function to radiographic reading (ILO) in patients with asbestos related lung disease. Thorax 1988;43:777-783.
25.
Schwartz DA, Fuortes LJ, Galvin JR, Burmeister LF, Schmidt LE, Leistikow BN, LaMarte FP, Merchant JA: Asbestos-induced pleural fibrosis and impaired lung function. Am Rev Respir Dis 1990;141:321-326.
26.
Miller A, Bhuptani A, Sloane MF, Brown LK, Teirstein AS: Cardiorespiratory responses to incremental exercise in patients with asbestos-related pleural thickening and normal or slightly abnormal lung function. Chest 1993;103:1045-1050.
27.
Bourbeau J, Ernst P, Chrome J, Armstrong B, Becklake MR: The relationship between respiratory impairment and asbestos-related pleural abnormality in an active work force. Am Rev Respir Dis 1990;142:837-842.
28.
Kilburn KH, Warshaw RH: Abnormal lung function associated with asbestos disease of the pleura, the lung, and both: a comparative analysis. Thorax 1991;46:33-38.
29.
Begin R, Filion R, Ostiguy G: Emphysema in silica- and asbestos-exposed workers seeking compensation: a CT scan study. Chest 1995;108:647-655.
30.
Hendrick DJ: Occupational and chronic obstructive pulmonary disease (COPD). Thorax 1996;51:947-955.
31.
Finkelstein MM, Vingilis JJ: Radiographic abnormalities among asbestos-cement workers: an exposure-response study. Am Rev Respir Dis 1984;129:17-22.
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