Pulmonary abnormalities as a result of exposure to Libby amphibole during childhood and adolescence—The Pre‐Adult Latency Study (PALS)

Szeinuk, Jaime; Noonan, Curtis W.; Henschke, Claudia I.; Pfau, Jean C.; Black, Brad; Miller, Albert; Yankelevitz, David F.; Liang, Mingzhu; Liu, Ying; Yip, Rowena; Linker, Laura; McNew, Tracy; Flores, Raja M.

doi:10.1002/ajim.22674

Cited by 22 publications

(24 citation statements)

References 55 publications

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“…Symptoms included severe (prolonged) fatigue, Raynaud's phenomenon, rashes, swollen painful joints, and musculoskeletal pain. Although many of the patients also suffer from pulmonary abnormalities indicative of ARD, it is generally not interstitial disease (Antao et al 2012;Peipins, et al 2003), but rather a thin lamellar pleural thickening (Black, et al 2014;Szeinuk, et al 2017). The purpose of this case series was to describe a small sample of people who presented with asbestos-related diseases and autoimmune disease.…”

Section: Discussionmentioning

confidence: 99%

“…Various investigators reported that this uncertainty is based upon the possibility that not all forms of asbestos drive an autoimmune response, and that autoimmune responses are seen more often with amphibole, rather than chrysotile, exposures (Ferro, et al 2013;Pfau, et al 2015;Pfau 2017). Historically, chrysotile exposures have been prevalent due to extensive commercial use, but reductions in asbestos mining and product manufacturing are revealing that environmental asbestos exposures are abundant, often contain amphibole fibers, and exert adverse health impacts even at low levels of exposure (Baumann et al 2013;Wolfe, et al 2017;Bayram and Bakan 2014, Buck, et al 2013, Lockey, et al 2015, Andujar et al, 2016Lemen, 2016;Szeinuk, et al 2017). Therefore, the current study regarding LAA suggests that more research is needed regarding specific mineral fibers that may be triggers for SAID.…”

Section: Introductionmentioning

confidence: 93%

“…He was asymptomatic at the time and diagnosed with smooth, lamellar pleural thickening identified on CT scan. The radiographic description of this type of pleural disease has been described elsewhere (Black, et al 2014;Szeinuk, et al 2017). His initial pulmonary functions were within the normal range in 2015 with FVC recorded as 103% and DLCO 106%.…”

Section: Case # 1 -Urticarial Vasculitismentioning

confidence: 99%

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Case series: rheumatological manifestations attributed to exposure to Libby Asbestiform Amphiboles

Diegel

Black

Pfau

et al. 2018

Journal of Toxicology and Environmental Health, Part A

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An increased risk for Systemic Autoimmune Diseases (SAID) has been reported in Libby, Montana, where extensive exposures to fibrous amphiboles occurred due to mining and use of asbestos-laden vermiculite. In addition, positive antinuclear autoantibody tests are associated with exposure to Libby Asbestiform Amphiboles (LAA) in both humans and mice. Among 6603 subjects who underwent health screening at the Center for Asbestos Related Diseases (CARD, Libby MT), 13.8% were diagnosed with an autoimmune disease, with prevalence values for the most common SAID being significantly higher than expected in the United States. Among the CARD screening population, serological and clinical profiles are diverse, representing symptoms and autoantibodies reflective of systemic lupus erythematosus (SLE), scleroderma, rheumatoid arthritis and other rheumatic syndromes including Undifferentiated Connective Tissue Disease (UCTD). Based upon screening of medical records by physicians with rheumatology expertise, the evolving nature of rheumatological disease in these patients is often atypical, with mixed diagnostic criteria and with a 1:1 male-to-female ratio. Through the Libby Epidemiology Research Program, cases were identified that illustrate clinical autoimmune outcomes with LAA exposure. Our goal was to better characterize SAID in Libby, MT in order to improve recognition of autoimmune outcomes associated with this exposure. In view of recent discoveries of widespread exposure to fibrous minerals in several areas of the U.S. and globally, it is critical to evaluate rheumatologic manifestations in other cohorts so that screening, surveillance and diagnostic procedures are able to detect and recognize potential autoimmune outcomes of asbestos exposure.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 93%

Section: Case # 1 -Urticarial Vasculitismentioning

confidence: 99%

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Case series: rheumatological manifestations attributed to exposure to Libby Asbestiform Amphiboles

Diegel

Black

Pfau

et al. 2018

Journal of Toxicology and Environmental Health, Part A

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“…Mediastinal calcified circumscribed thickening was also present. No lamellar pleural thickening was observed . One underwent surgical pleural biopsy due to suspicion of malignant mesothelioma (Figure ).…”

Section: Resultsmentioning

confidence: 99%

High frequency and severity of pleural changes in former workers exposed to anthophyllite associated with other contaminating amphibole asbestos in Brazil

Macedo

Cerqueira

Algranti

et al. 2019

American J Industrial Med

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Objective To evaluate the frequency and severity of pleuropulmonary alterations in anthophyllite‐exposed former workers in Itapira, São Paulo, Brazil. The amphibole anthophyllite, a magnesium‐iron silicate, had its mining, marketing, and use forbidden in Brazil in 1995. Methods Former workers were followed from 1999 to 2011. All completed chest X‐ray interpreted using the International Labour Office (ILO) classification. High‐resolution computed tomography was used at the final evaluation. Spirometry assessed forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), and FEV1/FVC throughout the follow‐up period. Samples from the mined ore were analyzed by X‐ray diffraction (XRD) and scanning electron microscopy coupled to energy dispersive spectroscopy (SEM‐EDS). Results XRD and SEM‐EDS confirmed the presence in ore of anthophyllite at a concentration of 75%, in addition to tremolite and other amphiboles in lower concentrations. Twenty‐eight subjects were evaluated. Median time of exposure was 3 years (minimum = 1; maximum = 18; interquartile interval = 1‐4). Twenty cases of pleural abnormalities were diagnosed in 26 evaluated (77%). The average latency time was 25.6 ± 7.4 years. Two individuals (7.7%) showed progressive worsening of diffuse pleural thickening (DPT) and exhibited an annual FVC decrease of 85 mL and 150 mL, respectively. Conclusion This small sample showed a very high index of nonmalignant pleural abnormalities in anthophyllite‐exposed workers compared with workers exposed to other kinds of fibers. Rapidly progressive DPT, defined by the severity of pleural compromise, was possibly secondary to the presence of other amphibole types in the inhaled dust. No significant loss of FVC was found in the studied group as a whole. No cases of asbestosis, lung carcinoma, and mesothelioma were diagnosed in this cohort.

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“…For example, the mine waste material was used on the school running track, the community baseball field and in many residential gardens as a soil amendment (6). Screening studies have identified associations between nonoccupational, environmental exposures to these materials and occurrence of pleural abnormalities (27,28). Despite the small size of the community, elevated SMRs for respiratory cancers have been observed (29), and 11 mesothelioma case reports among non-occupationally exposed residents were described (30).…”

Section: Environmental Exposure From Industrial Operationsmentioning

confidence: 99%

Environmental asbestos exposure and risk of mesothelioma

Noonan¹

2017

Ann. Transl. Med.

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107

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Mesothelioma is commonly considered an occupational disease occurring as a result of asbestos exposure in the workplace. Several avenues for environmental asbestos exposures have been described and may be associated with asbestos related disease, including mesothelioma. Worker take-home asbestos, or para-occupational exposure, has been well documented and is the most commonly reported pathway for asbestos exposure among mesothelioma cases that do not have history of occupational asbestos exposure. Observational studies have evaluated several communities with elevated mesothelioma incidence and environmental exposures attributed to local asbestos-related industries. Potential, but uncertain, mesothelioma risk also may be associated with general population asbestos exposure through contact with asbestos-containing commercial products, particularly housing materials that can be easily disturbed through normal activity. Finally, studies have described elevated mesothelioma incidence in several areas where populations are exposed to naturally occurring asbestos materials. These various environmental asbestos exposure pathways are poorly understood, and further studies should be pursued to evaluate their respective importance for population mesothelioma risk.

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Pulmonary abnormalities as a result of exposure to Libby amphibole during childhood and adolescence—The Pre‐Adult Latency Study (PALS)

Abstract: Cumulative environmental exposure was associated with risk of pleural thickening. Among this cohort, quantitative measures of pleural thickening were associated with decreased PFT. Am. J. Ind. Med. 60:20-34, 2017. © 2016 Wiley Periodicals, Inc.

Cited by 22 publications

References 55 publications

Case series: rheumatological manifestations attributed to exposure to Libby Asbestiform Amphiboles

Case series: rheumatological manifestations attributed to exposure to Libby Asbestiform Amphiboles

High frequency and severity of pleural changes in former workers exposed to anthophyllite associated with other contaminating amphibole asbestos in Brazil

Environmental asbestos exposure and risk of mesothelioma

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