Richard S. Kronenberg

AIRFLOW OBSTRUCTION IN NONSMOKING, ASBESTOS-AND MIXED DUST-EXPOSED WORKERS

Obstructive changes in small airways have been described in patients exposed to asbestos and other mineral dusts. The physiologic significance of these small airways abnormalities and their relationship to dust burden and alveolitis remain unclear. We performed bronchoalveolar lavage (BAL) in 30 nonsmoking and 30 age-matched smoking subjects, all with mild asbestos and mixed dust exposure, to determine if parameters of lung dust burden correlated with spirometric evidence of airflow obstruction. Seventeen of 30 nonsmoking subjects and 24 of 30 smoking subjects met spirometric criteria for airflow obstruction. There were significantly more obstructed subjects in both dust exposed groups (P < 0.05) than in an age-matched nondust exposed group. There was, however, no significant difference in the number of obstructed subjects between the smoking and nonsmoking groups. There was no correlation in either group between airflow obstruction and total or differential cell counts, ferruginous bodies, total asbestos fibers, or the percent of free silica in the particulate fraction recovered by BAL. We conclude that evidence of small airways obstruction occurs commonly in occupationally dust exposed subjects and appears to be related to dust exposure per se and not to alveolar inflammation or fiber retention, important factors in the development of alveolitis and interstitial lung disease.

Chronic bronchitis. Choosing the optimal treatment.

Preview A number of therapies may be beneficial to patients with chronic bronchitis, but quitting smoking is the first and most important step. The authors of this article explain why smoking cessation is so essential for improvement of symptoms and preservation of pulmonary function. They also discuss current pharmacologic approaches to management of chronic bronchitis.

Asbestos-Related Disease in Employees of a Steel Mill and a Glass Bottle Manufacturing Plant

Asbestos is a well known health hazard. Initially, most cases of asbestos related disease were seen in miners, millers, and people employed in the manufacture of asbestos products (Becklake, 1976). In the late 1950s and early 1960s asbestos-related disease was reported in end-product users such as insulators, ship yard workers, and railroad workers (Doll, 1955; Selikoff et al., 1979). More recently, workers who did not directly use asbestos have been found to be at risk (Oliver et al., 1989). In most instances this &dquo;third wave&dquo; of asbestos disease has involved individuals who, while not directly using asbestos themselves, were in situations where their exposure to asbestos was fairly evident (Becklake, 1976; Rudd, 1989). The purpose of this report is to present preliminary observations on the prevalence of asbestos-related disease in workers at two industrial sites not generally associated with asbestos exposure:

Chronic bronchitis: Key points in evaluation

Preview Wheezing, difficulty in breathing, and coughing that produces thick sputum are all symptoms of chronic bronchitis. Differentiating this very common disorder from other pulmonary diseases with similar symptoms can be difficult. What factors contribute to the disorder? What should be the focus of clinical evaluation? In this article, Drs Kronenberg and Griffith answer these and other questions relating to evaluation of chronic bronchitis.