Emphysema findings associated with heavy asbestos-exposure in high resolution computed tomography of finnish construction workers.
Asbestos fibers are known to cause lung fibrosis, but their role in emphysema is unclear. We wanted to evaluate the relationship between asbestos exposure and emphysema by using high-resolution computed tomography (HRCT). Conventional and high resolution CT was performed on 600 smoking construction workers with an asbestos-related occupational disease. Emphysema subtypes (centrilobular, paraseptal, panlobular emphysema and bullae) were separately scored on a semiquantitative scale from 0 to 5, which scores were added up to yield the total emphysema score. Occupation, exposure duration, age, pack years and asbestosis diagnosis were analyzed in general linear models for possible associations with emphysema. The inter- (quadratic weighted kappa, kappa(qw)=0.46-0.72) and intraobserver (kappa(qw)=0.78-0.94) agreements for the subtype-scores and the reliability of the total score (Cronbach's alpha=0.87) were good. Insulators had a significantly higher paraseptal, panlobular and total score than the other occupational groups when adjusted for age and smoking. An asbestosis diagnosis was also a significant independent predictor of a higher total score. Emphysema was more common when workers had asbestosis or were heavily exposed to asbestos (insulators), but due to confounding factors the causative role of asbestos in emphysema needs further study.
Huuskonen
Olli
O
Finnish Institute of Occupational Health, Helsinki, Finland.
Kivisaari
Leena
L
Zitting
Anders
A
Kaleva
Simo
S
Vehmas
Tapio
T
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005387:Finland / Q000453:epidemiology; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008875:Middle Aged; D009784:Occupational Diseases / Q000453:epidemiology*; D016273:Occupational Exposure; D011656:Pulmonary Emphysema / Q000145:classification / Q000000981:diagnostic imaging / Q000453:epidemiology*; D012907:Smoking / Q000453:epidemiology; D014057:Tomography, X-Ray Computed / Q000379:methods