Clinical features to stage alveolitis in asbestos workers

Abstract

To analyze the clinical features of asbestos-induced alveolitis and stage its activity, we evaluated 217 asbestos workers by the usual clinical, radiological, and functional parameters and computerized gallium 67(Ga) lung scan; we obtained bronchoalveolar lavage (BAL) in 33 and lung biopsy in 6. In addition, we scored the profusion of lung rales and correlated it with other parameters of severity of asbestosis. In the 55 workers without asbestosis and normal 67Ga scan, BAL analyses were comparable to those of controls. Of the 56 without asbestosis but increased 67Ga lung uptake, BAL analyses in 8 documented a predominantly macrophagic alveolitis (confirmed on lung biopsy in 3), with the highest levels of BAL fibronectin. In the 106 workers with asbestosis, 67Ga lung uptake was increased in 75; BAL in 17 demonstrated a macrophagic and neutrophilic alveolitis with elevated fibronectin levels. Lung biopsy in 3 of the latter workers documented peribronchiolar fibrosing alveolitis. Rale scores in all workers or in those without asbestosis did not correlate with 67Ga scores; they correlated fairly well with profusion of parenchymal opacities (Rs = 0.42) and rigidity of the lung pressure-volume curve (Rs = 0.39). Thus, 67Ga lung uptake is an early indicator of chronic macrophagic alveolitis in asbestos workers, which usually progresses to asbestosis. In the disease, profusion of lung rales constitutes a simple clinical mode of assessment of disease severity that correlates better with radiological and functional parameters than with parameters of alveolitis.

Tumour necrosis factor enhances the asbestos-induced production of reactive oxygen metabolites by human polymorphonuclear leucocytes (PMN)

“…The ceils of ihc bronchoalveolar comparlmcnt arc among the first to react to the insult of mineral dusls. PMN alveolilis is one ofthe earliest findings in interstitial lung disease of asbestosis and silicosis [26][27][28]. Locally the stimulation of PMN by TNF may contribute to ROM-induced damage.…”

Bacillus Calmette-Guérin (BCG) and immunoglobulins synergistically enhance mineral dust-induced production of reactive oxygen metabolites by human monocytes

“…In the study of Begin el at. [26], the level of IgG, IgA, and IgM correlated with the severity of the clinical findings. IgG and IgA act synergistically with various mineral fibres in the generation of ROM by human neutrophils and macrophages [10,14].…”

“…Raised concentrations of polyclonal immunoglobulin have been observed in bronchoalveolar lavage fluid of both silicaexposed [25] and asbestos-exposed workers [26]. In the study of Begin el at.…”

Lactate Dehydrogenase in Bronchoalveolar Lavage Fluid of Patients with Active Pulmonary Tuberculosis

“…Bronchoalveolar lavage fluid (BALF) LDH levels may increase following lung damage [7]. To our knowledge, BALF LDH concentrations have not been measured in cases with PTB.…”