Thin-section CT abnormalities and pulmonary gas exchange impairment in workers exposed to asbestos.
OBJECTIVE
To evaluate the relationship between abnormalities at thin-section computed tomography (CT) and indexes of pulmonary gas exchange impairment at rest and during moderate exercise in workers exposed to asbestos.


METHODS
Eighty-two workers with long-term exposure to asbestos and abnormal thin-section CT findings underwent respiratory physiologic measurements at rest (lung diffusing capacity, Dlco) and during exercise (oxygen uptake-corrected alveolar-arterial pressure difference for oxygen, DeltaP[A-a]O(2)/VO(2)). CT results were compared with physiologic measurements of impairment in gas exchange (Dlco < 70% predicted value and/or DeltaP[A-a]O(2)/VO(2) > 20 mm Hg. L. min(-1)). The CT findings were divided into five categories by using a previously described method. Odds ratios and 95% CIs for gas exchange defects were calculated for patients grouped according to CT findings. Logistic regression analysis was performed with gas exchange as the dependent response and CT abnormalities as independent variables.


RESULTS
A significant association was found between extent of disease at CT and impairment of gas exchange (P <.01). Probability of functional impairment was increased with multifocal (class II) and diffuse (class III) CT abnormalities, particularly when several lesion types were found concomitantly. Logistic regression analysis demonstrated significant association of parenchymal bands (odds ratio, 6.20; 95% CI: 1.99, 19.22) and subpleural nodules (odds ratio, 3.83; 95% CI: 1.23, 11.89) with functional impairment. Presence and number of pleural plaques did not improve model accuracy for gas exchange impairment prediction (P >.05).


CONCLUSIONS
Thin-section CT grading of interstitial lung disease is useful in assessing the likelihood of pulmonary gas exchange impairment at rest (Dlco) and during exercise (DeltaP[A-a]O(2)/VO(2)) in workers with long-term asbestos exposure.
Sette
Andrea
A
Pulmonary Function and Clinical Exercise Physiology Unit, Div of Respiratory Diseases, Federal Univ of São Paulo, Rua Professor Francisco de Castro 54, Vila Clementino, CEP 04020-050 São Paulo, Brazil.
Neder
J Alberto
JA
Nery
Luiz E
LE
Kavakama
Jorge
J
Rodrigues
Reinaldo T
RT
Terra-Filho
Mario
M
Guimarães
Sandra
S
Bagatin
Ericson
E
Müller
Nestor
N
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001195:Asbestosis / Q000000981:diagnostic imaging* / Q000503:physiopathology; D005080:Exercise Test; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging*; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D011653:Pulmonary Diffusing Capacity; D011659:Pulmonary Gas Exchange; D013902:Radiography, Thoracic; D013147:Spirometry; D014057:Tomography, X-Ray Computed
D010100:Oxygen