title: Reduced lung function in smokers in a lung cancer screening cohort with asbestos exposure and pleural plaques.
abstract: BACKGROUND
  While low dose computed tomography (LDCT) screening for lung cancer is recommended for high-risk smokers, ages 55-74 years, information about asbestos exposure may not be routinely elicited. Asbestos exposure is associated with declining respiratory function over time; however, the effect of a history of asbestos exposure in LDCT screening cohorts is limited. We report the relationship between asbestos exposure and pulmonary function in a cohort of heavy smokers with a history of occupational asbestos exposure, hypothesizing that these subjects will have additional decreased pulmonary function. We also examined relationships between spirometric measurements and the presence of isolated pleural plaques.
  
  
  METHODS
  A cross-sectional study was performed using data from the NYU Lung Cancer Biomarker Center cohort to compare study subjects with a history asbestos exposure primarily in the period since 1970 when tighter federal standards were in place (n = 359) to those without asbestos exposure (n = 1038) with respect to pulmonary function, LDCT lung imaging findings, and clinical symptoms. We further classified individuals with asbestos exposure by length of exposure time to examine the effect of duration of exposure on pulmonary function. Lastly, for asbestos-exposed participants, we examined the association of spirometric measurements with the presence of absence of isolated pleural plaques.
  
  
  RESULTS
  Individuals with asbestos exposure had decreased FVC % predicted compared to those with no asbestos exposure (76% vs. 85% predicted, P < 0.01) and FEV1 % predicted (64% vs. 67% predicted, P < 0.01). Since there was no change in FEV1 /FVC ratio, the findings are consistent with restrictive impairment. Those with ≥20 years of exposure had a lower mean FVC % predicted compared to those with less than 20 years of exposure (74% vs. 78% predicted, P = 0.017). Individuals with asbestos exposure were more likely to have pleural plaques (P < 0.001) on CT. Those with isolated pleural plaques had lower mean % predicted FEV1 (P = 0.005) and FVC (P = 0.001) compared to those without pleural plaques.
  
  
  CONCLUSIONS
  Occupational asbestos exposure in a cohort of heavy smokers was associated with a significant restrictive decline in pulmonary function, with longer duration of exposure associated with greater decline. The presence of isolated pleural plaques was also associated with reduced lung function.
authors.affiliation: Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, New York University School of Medicine, New York, New York.
authors.forename: Sarah
authors.initials: S
authors.lastname: Lopatin
authors.affiliation: Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, New York University School of Medicine, New York, New York.
authors.forename: Jun-Chieh
authors.initials: JC
authors.lastname: Tsay
authors.affiliation: Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, New York University School of Medicine, New York, New York.
authors.forename: Doreen
authors.initials: D
authors.lastname: Addrizzo-Harris
authors.affiliation: Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, New York University School of Medicine, New York, New York.
authors.forename: John S
authors.initials: JS
authors.lastname: Munger
authors.affiliation: Division of Thoracic Surgery, Department of Cardiothoracic Surgery, New York University School of Medicine, New York, New York.
authors.forename: Harvey
authors.initials: H
authors.lastname: Pass
authors.affiliation: Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, New York University School of Medicine, New York, New York.
authors.forename: William N
authors.initials: WN
authors.lastname: Rom
mesh_terms: D000368:Aged; D001194:Asbestos; D015331:Cohort Studies; D055088:Early Detection of Cancer; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D016015:Logistic Models; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016273:Occupational Exposure / Q000706:statistics & numerical data*; D010995:Pleural Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology*; D011656:Pulmonary Emphysema / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000503:physiopathology; D012907:Smoking / Q000503:physiopathology*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D014797:Vital Capacity
chemical_list: D001194:Asbestos