Source: Annual Congress 2002 - Asbestos and silica

Abstract

Subjects with asbestos-related pleural plaques being assessed for the purposes of possible compensation often complain of dyspnoea and attribute this to the presence of plaques even though it is generally accepted that plaques are not a cause of dyspnoea. Disability assessment bodies usually do not investigate such subjects further in order to assess the cause of the dyspnoea in detail. The aim of this study was to carefully evaluate a group of subjects with plaques who complained of dyspnoea on exertion in order to ascertain the cause of their symptom. 32 male subjects (mean age 65 years) with a history of asbestos exposure and with radiographic evidence of pleural plaques (but without evidence of diffuse pleural thickening or of asbestosis) were studied. Subjects with abnormal lung function tests at rest (spirometry, lung volumes and diffusion), ischaemic heart disease or with uncontrolled hypertension were excluded. 10 had well controlled hypertension and 6 were taking drugs for the relief of osteoarthritis. All had an incremental exercise test (Wasserman et al, Principles of Exercise testing, 2nd edition, 1994). In 15 subjects (47%) no abnormality was detected [11 (34%) had a normal response and 4 (13%) had findings due to reduced effort]. In 17 (53%) a physical abnormality was detected. 4 (13%) developed ECG changes of cardiac ischaemia and 2 (6%) had changes suggesting peripheral vascular disease. 8 (25%) ceased exercising due to musculo-skeletal discomfort in the lower limbs, and 3 (9%) had changes due to obesity. These findings indicate that a physical explanation for dyspnoea in subjects with discrete pleural plaques can often be found and that such symptoms should not be attributed to anxiety or to a desire for increased compensation without detailed investigation.

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D. H. Bryant (Darlinghurst, Australia). Breathlessness in subjects with asbestos-related pleural plaques. Eur Respir J 2002; 20: Suppl. 38, 841

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