Document RJK1M59LQXrz5b3YVze0VLLwv
FILE NAME Brakes BRK
DATE 2012
DOC BRK222
DOCUMENT DESCRIPTION Journal Article - Asbestos Diseases in Automobile Mechanics
Ann Occup Hyg Vol No 1 pp 55-60 2012 'The Author 2011 Published by Oxford University Press
on behalf of the British Occupational Hygiene Society doi 10 mer066
Asbestos Diseases in Automobile Mechanics
JACQUES AMEILLE,,NICOLE ROSENBERGMIREILLE MATRAT ALEXIS DESCATHA,,DOMINIQUE MOMPOINT LOUNIS HAMZI CATHERINE ATASSI MANUELA VASILE ROBERT GARNIERand
CLAUDE PAIRON
HP Unit^'de pathologie professionnelle H^pitalRaymond Poincar^'92380 Garches France
2AP Consultation de pathologie professionnelle Hopital Fernand Widal 75010 Paris France
Centre Hospitalier Intercommunal Unit^'de pathologie professionnelle 94000 Cr^'teilFrance INSERM Unit^'955 94000 Cr^'teilFrance HP Service de radiologie Hopital Raymond
Downlade Poincar^'92380 Garches France HP Service de radiologie Hopital Fernand Widal 75010
Paris France Service de radiologie Centre Hospitalier Intercommunal 94000 Cr^'teilFrance
Received 24 March 2011 in final form 23 June 2011 published online 28 September 2011
from
htp:/anhyg.oxfrdjounals.org/
htp:/anhyg.oxfordjournals.org/
Purpose Automobile mechanics have been exposed to asbestos in the past mainly due to the
htp:/anhyg.oxfrdjounals.org/ presence of chrysotile asbestos in brakes and clutches Despite the large number of automobile
mechanics little is known about the malignant respiratory diseases observed in this popu-
lation The aim of this retrospective multicenter study was to analyse the frequency of pleural
htp:/anyg.oxfrdjuls and parenchymal abnormalities on resolution computed tomography HRCT in a popula-
tion of automobile mechanics
Methods The study population consisted of 103 automobile mechanics with no other source of occupational exposure to asbestos referred to three occupational health departments in the Paris area for systematic screening of asbestos diseases All subjects were examined by
HRCT and all images were reviewed separately by two independent readers who in the case of
by
guest disagreement discussed until they reached agreement Multiple logistic regression models
were constructed to investigate factors associated with pleural plaques
Results Pleural plaques were observed in five cases 4.9 and interstitial abnormalities
on
consistent with asbestosis were observed in one case After adjustment for age smoking status
February and a history of asbestos respiratory diseases multiple logistic regression models
a showed significant association between the duration of exposure to asbestos and pleural pla-
ques
18
2014 Conclusions The asbestos exposure experienced by automobile mechanics may lead to pleu-
ral plaques The low prevalence of malignant asbestos diseases using a very sen-
sitive diagnostic tool is in favor of a low cumulative exposure to asbestos in this population of
workers
Keywords asbestos automobile mechanics brakes resolution computed tomography pleural plaques
INTRODUCTION
The presence in the past of chrysotile asbestos in automobile brakes or clutches has given rise to con-
cerns about increased risks of asbestos
* Author to whom correspondence should be addressed Tel +33147107754 fax +33147107768
mail jacques.ameille@rpc.aphp.fr jacques.ameille@rpc.aphp.fr
diseases among automobile mechanics Lemnen 2004 Paustenbach et al 2004 Welch 2007
A large number of automobile mechanics have been potentially exposed to asbestos According to the data of the 1999 census the estimated population of automobile mechanics aged 16-60 years in France was 242 360 Imbernon et al 2005
Partly due to the different methodologies employed available data concerning atmospheric measurements
55
56
J. Ameille et al
of asbestos fibers during brake or clutch repair show disagreement Rohl et al 1976 Rodelsperger Rodelsperger et al 1986 Plato et al 1993 Paustentach et , 2003 Finley et al 2007 Blake ct al 2008 Cohen and Van Ordea 2008 Bang et al 2008 contributing to
uncertainties about the level of risk of asbestos
Soci^'t^'fran^aise de ra^decine du travail Soci^'t^' de pneumologie de langue fran^aise 1999 Subjects with sources of occupational exposure to asbestos
other than their work as automobile mechanics were
excluded from the analysis
diseases in automobile mechanics
Cases of malignant pleural mesothelioma have
METHODS
been reported in automobile mechanics Pur et al 1985 Rodelsperger et al 1986 Butor et al 2003 However published analysis of the epidemiological literature that examined the risk of pleural mesothelioma Wong 2001 Goodman et al
For each subject information was collected on gender age previous chest diseases and smoking status Subjects were classified into three categories according to tobacco consumption smokers smokers
and smokers smokers were defined as those
3004 or lung cancer Goodman et al 2004 did not
who had quit smoking for at least 1 year
show any elevated relative risks
For each subject the year of starting work as an
Very few data concerning malignant asbestos- automobile mechanic was recorded together with
related diseases or impairment of lung function in au-
tomobile mechanics have been published Boillat and
Downlade Loh 1973 Marcus al 1987 Dahlqvist et al 1992
from Plato et al 1995 Only one study using size
the type of work light vehicles trucks mixed activity duration of exposure and the time interval be-
tween start of asbestos exposure and the HRCT
latency For calculation of the duration of exposure
chest radiographs investigated the prevalence of pleu- to asbestos only work prior to 1997 year in which
htp:/anhyg.oxfrdjounals.org/
ral plaques Marcus et al 1987 To our knowledge
asbestos was banned in France was taken into
htp:/anhyg.oxfrdjournals.org/
no study using chest computed tomography CT scan
account Information on the use of compressed air
for the detection of asbestos diseases in auto-
during brake cleaning was also collected
mobile mechanics has been published
The aim of the present retrospective multicenter study resolution computed tomography
htp:/anyg.oxfrdjuls was to analyze the frequency ofpleural and parenchy-
mal abnormalities on chest resolution computed tomography HRCT in a population of automobile mechanics referred by occupational physicians to occu-
Spiral HRCT acquisition parameters were defined in accordance with the French Thoracic Imaging Society guidelines full inspiration slice thickness of 1.5-5 mm pitch of 1.5-2.0 120 KV 60-150 mAs
pational health departments in the Paris area for sys-
All CT scans were performed without intravenous
by
tematic screening of asbestos diseases
guest contrast agent Localized acquisition in the prone position was on required in the case of suspected gravitational lung
STUDY POPULATION AND METHODS
abnormalities
All images were reviewed separately by two inde-
February
pendent readers in each occupational health depart-
18
2014 Study population The eligible population consisted of all automobile
ment a radiologist and an occupational diseases specialist who if they disagreed discussed further
mechanics referred to occupational health depart- until they reached agreement concerning the pres-
ments in university hospitals of Garches Cr^'teil ence of pleural or parenchymal abnormalities consis-
and Fernand Widal between 1 January 2002
tent with an asbestos disease
and 30 June 2009 for HRCT detection of asbestos
A structured form elaborated from a previous
lated diseases These subjects were systematically re-
study Ameille et al 2007 was filled out describ-
ferred by occupational physicians because of known ing the features of pulmonary abnormalities consis-
exposure to asbestos As social welfare benefits such
tent with asbestosis thickened interstitial short
as early retirement allowance or pension are provided lines septal lines septal lines combing
in France for workers with asbestos diseases curvilinear subpleural lines ground glass opacities
including pleural plaques when confirmed by chest and pleural abnormalities
CT scan examinations a consensus conference held
When associated with rounded atelectasis or
in Paris in January 1999 recommended the use of chest CT scan after a sufficient latency period for
the surveillance
of workers occupationally exposed to asbestos
parenchymal bands pleural thickenings were considered to correspond to diffuse pleural thickening fibrosis of visceral pleura Gevenois et al 1998 Beigelman et al 2007
Asbestos diseases in automobile mechanics
57
Pleural plaques were considered to be present in
Table 1. Characteristics of the study population n == 103
the case of circumscribed quadrangular pleural elevations with sharp borders and tissue density sometimes calcified or in the case of multiple bilateral less typical images with a typical topography Beigelman et al 2007
Pleural abnormalities not meeting the criteria for pleural plaques or diffuse pleural thickening were considered to be nonspecific pleural thickening
Gender male
Age years
50
50-59
60
Tobacco consumption
smokers
n
103
22 62 18
% 100
22.3 60.2 17.5
Mean SD 54.4 7.2
ANW
31.7
Statistical analysis
smokers
ANW
40.6
Values for continuous variables were expressed as the mean standard deviation SD Bivariate analysis was performed to study factors associated with
Smokers
Latency years
20
ANW
27.7
36.8 7.0
102
1.0
pleural plaques using Fisher's exact test for qualita-
20-30
102
9.7
tive variables or Wilcoxon's test for continuous var-
30
102
89.3
iables A value 0.05 was considered statistically
Duration of exposure
22.3 8.1
Downlade significant Multiple logistic regression models were years
constructed including age previous respiratory dis-
20
2822
30.1
from eases smoking status latency and duration of expo-
20-30
2822
48.5
sure to asbestos Due to the strong collinearity
30
2822
21.4
http
between latency and duration of exposure separate
Brake repair of trucks
2822
41.8
/anhyg.oxfordjournals
models were constructed A value 0.05 was con- Use of compressed air % 83.5 /anhyg.oxfordjournals
sidered statistically significant
Time interval between start of asbestos exposure and HRCT
/anhyg.oxfrdjuals Statistical analysis was performed using SAS soft-
ware version 9.1 SAS Institute Inc Cary NC USA Informed consent was obtained from all subjects
The study was approved by the French national com-
Duration of asbestos exposure before 1997 Interstitial abnormalities consistent with asbestosis
mittee for data protection Commission Nationale de
org were observed in one subject This subject had worked
l'Informatique et des Libert^'sCNIL
for 24 years as an automobile mechanic ensuring
by
Independent ethics committee approval was not
brake repairs on trucks for > h a week Interstitial
guest necessary as chest CT scans are recommended in
abnormalities consisted of bilateral honeycombing
France for screening purposes in asbestos
on
workers Socie tedFranc^aisede Me^'decinedu Tra
ground opacities and septal lines in the post-
inferior zones of the lungs Five automobile
vail 1999
February mechanics had pleural plaques four had diffuse pleural
thickening and nine had nonspecific pleural thicken-
18
RESULTS
2014 ing No case of lung cancer or pleural mesothelioma
was detected Pleural plaques were diagnosed in each
During the study period 242 automobile mechanics were referred to the occupational health depart-
occupational health department participating in the study one in two departments two in one department
ments participating in the study Eighty automobile mechanics with other possible sources
of asbestos exposure and 50 automobile mechanics
with no available HRCT were excluded The study population therefore consisted of 103 subjects
General characteristics of the study population are
The five subjects with pleural plaques had no previous chest diseases likely to explain pleural thickening
Characteristics of the subjects according to HRCT abnormalities are presented in Table 2. Subjects with nonspecific pleural thickening had similar asbestos exposure to that of the subjects without HRCT ab-
given in Table 1. All subjects were male with a mean age of 54.4 7.2 years 69 68 were smokers or smokers Mean latency was 36.8 7.0 years range
normalities in terms of latency or duration of exposure Subjects with pleural plaques and subjects with diffuse pleural thickening had longer latency and du-
19-57 years Mean duration of asbestos exposure was 22.6 8.1 years range 4-45 years Most of the study population 83.5 used compressed air for brake cleaning
ration of asbestos exposure than subjects without HRCT abnormalities Table 2
In comparison with subjects without pleural plaques subjects with pleural plaques had significantly
58
J. Ameille et al
Table 2. Characteristics of the subjects according to HRCT abnormalities
No abnormalities n = 84
Nonspecific
pleural thickening
n
Age m in years SD
Latency m in years SD
Duration of exposure m
in years SD
Brake repair of trucks n %
Use of compressed air n % Previous respiratory diseases n %
53.9 7.4 36.2 7.1 21.8 8.0
34 405 405 68 81.0 10 119 119
54.1 40 36.0 4.8 23.1 5.8
5 556 556 8 88.9 3 33.3
Pleural plaques
5
59.0 6.9 42.2 5.6 31.0 3.9
3 60.0 5 100 1 20.0
Diffuse
pleural
thickening
4
59 7.1 42.5 5.9 27.8 12.9
00 4 100 1 25.0
Asbestosis =
63 47 24
1 100 1 100
0
m mean
Interstitial abnormalities consistent with asbestosis
Time interval between start of asbestos exposure and HRCT
Duration of asbestos exposure before 1997
Downlade Table 4 Pleural plaques study of determinants by
multivariate logistic regression analysis
Table 3. Characteristics of the subjects according to the presence of pleural plaques
d
aOR
P
from
95 CI
Pleural plaques
pa Model 1
http
Age m SD
Latency m SD
Duration of exposure m SD Brake repair of trucks
yes
5
59.0 6.9 42.2 5.6 31.0 3.9
3 60.0
no
= 98
54.2 71 36.6 7.0 22.2 8.0
0.12 0.047 0.01
40 40.6
Age years Previous respiratory diseases yes versus no
Smokers or smokers
yes versus no
Latency years
Model 2
/anhyg.oxfrdjournals 1.0 0.8-1.2
1.2 0.1-13.7
Z
Z
2.0 0.2-20.7
Z
1.1 0.9-1.4
Z
/anhyg.oxfrdjuls
org %
Use of compressed air
5 100.0
81 81.8
Age years
1.0 0.9-1.2
NS
%
Previous respiratory diseases
1.1 01-17.8 01-17.8
NS
by
guest yes versus no
m mean
Wilcoxon test
Smokers or smokers
3.7 0.3-46.3
NS
on
yes versus no
Time interval between start of asbestos exposure and
exposure HRCT
Duration of
years
1.2 1.0-1.4
0.048
February18 Duration of asbestos exposure before 1997
longer latency and duration of asbestos exposure
Adjusted odds ratio
"
significant
Non significant
Time interval between start of exposure ans HRCT
Duration of exposure before 1997
2014 Table )
After adjustment for age smoking status and his-
tory of previous unrelated respiratory dis-
eases multiple logistic regression models showed jects with pleural plaques had no known history of
a statistically significant association between the du- chest disease likely to explain pleural abnormalities
ration of asbestos exposure and the presence of pleu-
The prevalence of pleural plaques in this study is
ral plaques Table 4
similar to that observed in the only previous pub-
lished study that investigated the frequency of pleu-
DISCUSSION
In this population of automobile mechanics re-
ral plaques in car mechanics Marcus et al 1987 In that study based on chest radiographs pleural plaques defined by pleural thickening at least mm
ferred for systematic detection of asbestos
thick on the chest wall or mm thick on the dia-
diseases by HRCT only one case of interstitial ab-
phragm were observed in 41 of 925 car mechanics
normalities consistent with asbestosis five cases of
4.4 However our results must be compared cau-
pleural plaques 4.9 and four cases 3.9 of diffuse pleural thickening were observed The five sub-
tiously with those reported by Marcus of ) 1987
due to the selection factors and the use of different
Asbestos diseases in automobile mechanics
59
tools for the radiological detection of asbestos-
Many measurements in car repair workshops have
related abnormalities
shown that occupational exposure of car mechanics
The prevalence of pleural plaques observed in this to asbestos is generally fairly low Rob et al 1976 re-
study was similar to that observed on HRCT examina-
ported airborne chrysotile concentrations of up to
tions in subjects exposed to indoor asbestos pollution
30 f ml However these were peak exposure
De Raeve et al 2001 or in urban transportation concentrations measured during brake cleaning with
workers with low cumulative exposure to asbestos
the use of compressed air According to Pausteubact
Ameille et al 2007
et 2003 analysis of the available published data in-
The main limitations of this study are the rela-
dicates that 90 of 8 h weighted average TWA
tively small number of subjects the absence of an unexposed control group and the lack of objective
concentrations experienced by mechanics servicing brakes in the 1970s was 0.1 f ml mean 0.04 f
assessment of the level of occupational exposure to
ml In Sweden Plato et al 1995 using a model
asbestos The representativity of the study sample based on data from the international literature and
is also questionable However inclusion criteria quantitative asbestos measurements performed in
had nothing to do with symptoms or abnormalities
1976-1978 in Swedish car repair workshops esti-
on chest radiographs
mated the mean cumulative exposure to be 2.6 f
Downlade One of the strengths of this study is the use of HRCT
for detection of asbestos diseases HRCT has
been shown to be much more sensitive and specific than
ml ^ years in a group of 103 car and bus mechanics with 15 years of asbestos exposure Car me-
chanics had a TWA exposure range of 0.11-0.41 f
chest radiographs for the detection of early pleural and ml mean 0.21 f ml in 1965 and 0.003 0.08f
from
parenchymal changes Aterie et al 1988 1988b mlin mlin 1985 mean 0.021 f mlflIn Germany based
htp:/anhyg.oxfrdjournals.org/
on dust measurements in 76 service stations and the
1994 Geveuwis et al 1994 Another strength is the standardized reading w h
occupational histories of 210 vehicle mechanics with an average duration of employment of 21 -10 years
htp:/anyg.oxfrdjunals.og/
systematic double interpretation followed by con-
a mean cumulative exposure to asbestos was esti-
sensus reading in the case of disagreement
mated to be 0.54 1.1 f ml ^ years for car mechan-
htp:/anyg.oxfrdjulsg/ Furthermore only automobile mechanics with no
other known occupational exposure to asbestos and with a sufficiently long latency 20 years in 99 of cases 30 years in 89 of cases to allow eval-
ics Rodelsperger et al 1986 Finley et al 2007 recently developed estimates of cumulative chrysotile exposures experienced by automobile mechanics working with brakes and manual clutches They re-
uation of asbestos diseases especially pleu- ported that the 95th percentile and 99th percentile cu-
by
guest ral plaques were included in the study Schwartz
mulative exposures for vehicles mechanics in the
1991 Paris et al 2009
1970s were 2.0 and 5.7 f ml years respectively on
In the absence of a control group demonstration
Another explanation for the low prevalence of as-
of a significant relationship between pleural plaques and duration of exposure used as a surrogate
related diseases in automobile mechanics might be that decomposition of asbestos occurs during nor-
February
of cumulative exposure to asbestos is an argument
mal use of brakes due to thermal decomposition into
18
2014 in favor of the causal role of asbestos Paris et al
2009
forsterite a fibrous material Lemen 2004
The low prevalence of pleural plaques and interstitial abnormalities in this study is an indirect argu-
CONCLUSION
ment in favor of low cumulative exposure to asbestos for most automobile mechanics These data
are consistent with the analysis of epidemiologic studies that investigated the incidence of lung cancer and pleural mesothelioma in automobile me-
chanics and failed to demonstrate increased meta-
relative risks Wong 2001 Goodinan et al 2004
The asbestos exposure experienced by French car mechanics may lead to pleural plaques The low prevalence of malignant asbestos diseases despite the use of HRCT which is a very sensitive diagnostic tool is in favor of low cumulative exposure to asbestos in the study population
Our data are also consistent with the results of
a recently published population control study Rolland et al 2010 that reported a slight but not significant increased risk of pleural mesothelioma in male car mechanics odds ratio = 1.50 95 confidence interval 0.76-2.95
FUNDING
The Caisse nationale d'assurance maladie des travailleurs salari^'sD^'partementdes risques professionnels Caisse r^'gionaled'assurance maladie d'Ile de France
60 J. Ameille et al
Acknowledgements authors declare that they have no
conflict of interest
among automobile mechanics Rev Epidemiol Sant^'Pub 53 491-500
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