Document V3pQRzjZrmVYyzmJ09r4zNXRq

EAST TEXAS' TUBERCULOSIS HOSPITAL i.-** BOX 200) TYLBR 7J70J ' A UNIT OP TM( TEXAS STATE DEPARTMENT ot DEALT February 3, 1967 i Lee B. Crane,.M. D. Medical Director Pittsburgh Plate Glass Company One Gateway Center Pittsburgh, Pennsylvania 15222 Dear Dr. Crane: ` Enclosed you will find a request.for Grant-In-Aid, Protocol and related information on the proposed asbestosis survey. \ The budget figure was computed in the following manner: supplies and telephone - $210, radiographs and pulmonary function tests on 52'workers $1040, professional services; physicians, technicians and secretarial assistance - $2250, administrative overhead - $700 making a total of $4200. All of us involved in this project are already salaried employees. We propose, therefore, to use the majority of this money to purchase equipment for our Pulmonary Function Laboratory. The references to tuberculosis were inserted at the suggestion of our Central Office in Austin in order to obviate any possible objection from legislators. . After we receive your approval of this project, we will proceed to get a ' Collins single breath carbon monoxide diffusion apparatus and perfect our technique (v/ith the supervision of Dr. Cushing). It would probably be mid April or the first of May before ve are ready to begin the project and we would hope to finish it as soon as possible. Any suggestions or comments that you might have would be appreciated. ' Sincerely yours, ; .. .-w ^ - CAH:vp enc. George A. Hurst, M. D. Clinical Director /. t/; v' J ' ' | '' . : , ;; , : ' REQUEST FOR CRANT-IN-AID TO: ' '* Pittsburgh Plate Glass Company J One Gateway Center Pittsburgh, Pennsylvania 15222 Attention: Lee B. Grant, M. D. ' `. TITLE: Clinical and Laboratory ^valuation of Workers Exposed to Asbestos fibers . . BUDGET REQUESTED: $4200 . PRINCIPAL INVESTIGATOR: George A. Hurst, M. D. ' Clinical Director East Texas Tuberculosis Hospital Box 2003 Tyler, Texas . Fred H. Y. Liu, II. D. Box 2003 Tyler, Texas ` . Ivan Cushing, M. D. - Box 2003 Tyler, Texas '' . CHECK TO BE MADE TO: . East Texas Tuberculosis Uospital * CHECK TO BE SENT TO: Sam Topperman, M. D. Superintendent East Texas Tuberculosis Hospital Box 2003 Tyler, Texas . ' * AIK OF PROPOSAL: This project is designed to assess the extent and degree of pulmonary involvement in workers exposed to low concentrations of amosite, an asbestos fiber. Observations will also be made concerning anv recog nizable relationship between the inhalation of asbestos fiber and pul monary tuberculosis. t 1 'A METHOD OF PROCEDURE: See attached protocol and forms ' BUDCET: See letter AGREEMENT: . * * Pittsburgh Plate Glass Company agrees to pay $4200 to East Texas Tuberculosis Hospital for the conduct of this investi gation anu stipulates, as donor, that these grant funds are to be used solely at the discretion of the Superintendent of the East Texas Tuberculosis Hospital in the support of any expense which he deems necessary in connection with the research program at the East Texas Tuberculosis Hospital. George A. Hurst, M. D. Clinical Director Lee B. Crant, M. D. Medical Director Pittsburgh Plate Glas Robert U. Skinner, !I. D. Director, Tuberculosis Hospitals Albert C. Randall, ;t. D. Director, Tuberculosis Control Division James E. Pcavy, M. D. Commissioner of Health i i PROTOCOL . CLINICAL AND LABORATORY EVALUATION OF WORKERS EXPOSED TO ASBESTOS FIBERS BACKGROUND: Inhalation of dust containing asbestos fibers may causa, a crippling form of pulmonary flbrosls which usually does not appear until many years after initial exposure. (1) Amosite is mined in South Africa. These fibers, with a mean diameter of 0.S'micron, arc larger than Canadian asbestos fibers and tend to settle out more rapidly from the atmosphere. The diagnosis can be suspected when'history of exposure is associated with one or more of th^ following: a) abnormal pulmonary function studies, specifically reduction in pulmonary diffusing capacity. (1,2) This is the hallmark, of asbestosis and often precedes definite changes in the radiograph or discernible physical signs, b) radiographic changes consisting of fine diffuse mottling in both bases, c) phy sical signs such as crepitant rales, clubbing and labored breathing. The last 2 signs occur late in the disease. Although the relationship of asbestosis and tuber culosis has not been emphasized, this project will investigate any potential co existence of these 2 conditions. METHODS OF PROCEDURE: Approximately 52 workers exposed to amosite fibers in a pipe insulation manufacturing firm* will be studied at the East Texas Tuberculosis Hospital. Each employee will be administered a questionnaire on respiratory symptoms (Form I) by one of the investigators. This questionnaire was used by Ferris and Anderson in a V survey of chronic respiratory disease in a New Hampshire town. (3) It is similar to questionnaires used extensively in Great Britain. (A,5) A brief physical will he done $ and findings recorded in the first part of. Form II. . C'YT'ot The following laboratory tests will be done and recorded in the appropriate place on Form II. The forced vital capacity (FVC) and the 0.5 second and 1 second forced expiratory volume (FEV) will be calculated from spirograms obtained with the Stead Wells Spirometer. The mean of 3 tracings will be utilized and volumes will be corrected to body temperature and pressure saturated (BTPS). Nomogram for pre dicting FVC and FEV will be taken from the Veterans Administration-Army Cooperative Study of Pulmonary Function by Kory, Callahan, Boren and Syner. (6) * The MBC will be performed utilizing the Stead Kells Spirometer. The mean of 3 tests which should check within 5 liters will be recorded. The prediction formula will be calculated according to the method of Motley. (7) The residual volume will be determined by the helium closed circuit method utilizing the Collins helium residual volume apparatus and single breath carbon mono xide diffusing capacity unit with a 13.5 liter rcspirometcr. This method has been described by Motley, (d) The single breath carbon monoxide diffusing capacity will be done with the above mentioned apparatus by the method of Consolazio, Johnson and Pecora.T. (9) ' Arterial p02, pH and pC02 before and after exercise will be done only in those cases which show low diffusing capacity. Radiometer AME equipment with a Clarke electrode will be employed in the above named determinations. t Antero posterior and lateral radiographs of the chest will be taken and read by 2 of the investigators independently. Comparison will be made with earlier pre employment films. - ' Pittsburgh-Coming Corporation, Owentown, Texas i > . bibliography (1) Williams, R., and Hugh-Jones, P.: The Significance of lung function changes in asbestoslSf Thorax, 1960, 15, 109. (2) Thomson, M. L. and McGrath, M. W., Smither, W. J., Shepherd, J.M.: Some anomalies in the measurement of pulmonary diffusion in asbestosis and chronic bronchitis with emphysema, Clin. Sci., 1961, 21, 1. . (3) Ferris, B. C., and Anderson, D. 0.: The prevalence of chronic respiratory disease in a Hew Hampshire Town, Amer*. Rev. Resp. Lis., 1962, 36, 165. (4) Higgens, I. T. T.: Respiratory symptoms bronchitis and ventilatory capacity in a random sample of an agricultural population, firit. Med. J., 1957, 2, 1198. (5) Fletcher, C. M,, Elraes, P. C., Fairbairn, A. S,, and Wood, C. H.: The signi ficance of respiratory symptoms and the diagnosis of chronic bronchitis in a working population, Brit. Med. J., 1959, 2, 257, (6) Kory, R. C.,, Callahan, R., Boren, H. G., Syner, J. C.: The veterans admini stration-army cooperative study of pulmonary function I. Clinical spirometry in normal men, Amer. J. Med., 1961, 30, 243. (7) Motley, H. L.: Clinical pulmonary physiology II. Detection of early lung function changes In industrial exposure, Indust. Med., 1953, 22, 267. (8) Motley, H. L.: Comparison of a simple helium closed circuit method with the oxygen open circuit method for measuring residual air, Amer. Rev. Tuberc. and Pulm. Dis., 1957, 76, 601. (9) Consolazio, C. F., Johnson, R. E., Pecora, L. J.: Physiological measurements of metabolic functions in man, 1963, 239. (McCraw Hill Book. Company). i i . rORM I QUESTIONNAIRE ON RESPIRATORY SYMPTOMS Name.........................................................................................Sex................Race.................... Dace .of Birth Address................................ ................................................. ...................................................................... Date of questionnaire............................... ............................ .. COUGH Do you usually have a cough?...................................................................................... Do you cough at all on getting up, or first thing in the roorr.-* * ing..................................................................... .................. .. In winter? In summer? Do you go on coughing during the day or at night: In winter? . In sunnier? Yes/No Yes/No Yes/No Yes/No Yes/No PHLECK Do you usually bring up phlegm from your chest (not from the ' back of your nose)?............................................. ................................ ................ Do you bring up any phlegm at all on getting up, or first thing in the morning:................................................................... Inwinter? . In summer? Do you continue to bring up any phlegm during the day.................................................................................................. Inwinter? * In summer? What color Is this phlegm: (a) always clear white, gray, or blackish? (Check (b) before recording) (b) occasionally yellow or green, at least in parts?............... . (c) usually yellow or green?.................... .................................................. (d) don11 know................................................................... ............. ...................... How long have you had this cough and/or phlegm. .Less than 3 years? . . a years or more<^ . Do you get bouts of (increased) cough and phlegm last- ing for at least 3 weeks each winter?........................... .. If yea:....'................................................Last 3 winters only? . More than 3 winters? Yes/No Yes/No Yes/No Yes/No Yes/No Tes/No 3 4 5 6 7 8 9 10 11 12 13 14 15 lb 17 i 16 19. m- Have you ever coughed up blood?............................. Yes/No If yea: When was clils?(Ycars of occurrence)............ .................. ........................... Uow much? (greatest amount)................... ' More WHEEZING Does your chest ever sound wheezy or whistling? .. (If nos check: not even when you have a cold?) Yes/No If yes:.......................'...................................................Only with colds? . Occasionally (apart froo colds7) _____ ; TIGHTNESS '' ' Most days or nights? Does your chest ever feel tight or your breaching become difficult? If Yes:........................................................... ............ Only with colds? Yes/No _________ Other occasions specify BREATHLESSNESS Are you troubled by shortness of breath?.................................... .................... (If No: check: Not even on hurrying on level or walking up a slight hill?) If disabled by a neurological or muscle-skeletal disease put. "disabled" here... Yes/No If Yes: Do you have to walk slower than people of your age on the level because of breathlessness?......................................... ...................... Yes/No If Yes: Do you ever have to stop for breath when walking at your own pace on the level?................. ............. ................................... .................. Yes/No If Yes: Do you have to stop for breath after walking about 100 yards (or after a few minutes) on the level?.................................................. Yes/No If Yes: Are you too breathless to leave the house or breachleas on undressing?................................................ v**/y-. COLDS . If you get a cold, docs it usually go to your chest?.................................. NASAL CATARRH Apart from colds do you usually have a stuffy nose or catarrh at the back of your nose?... ,.In winter? ' In summer? Yes/No Yes/No Yes/No 2C 21 22 23 24 25 26 27 28 29 37 38 39 40 ui 43 44 . KAMI ACERACE/SEXPATE ' PHYSICAL riNDfSC? HI VT P CHESy FORM II R LUNCS BP * ' HEART EXTREMITIES . LABORATORY , Ventilatory Studies Predicted FVC Observed 1 Predicted PEV 0.5 see 1.0 sec Observed Maximus Breaching Capacity (MBC) I Total _ Predicted Observed Diffusion Studies Single Breach CO method Arterial Blood Cos StudLes rest oil r>COi oOi 0-> sat Radiographs: Normal Predicted Observed exercise Abnormal bclv- Does the weather effect your chest?.............. Yea/No If yes: What sort of weather?...................... Yes/No - Damp-wet ,. Yea/No Cold Yea/No - Heat Does any ocher sort of weather affect your chest? (Specify)................... Does this weather: make you wheeze?...................... ' Increase cough or phlegm?.......... m^ke you more breathless?.......... Yea/No Yes/No Yes/No Yes/No have any ocher effect on your chest (Specify).... CHEST ILLNESSES -' During Che past 3 years have you had a chest illness which has kept you off work, indoors at home or in bed?................................................. ....................... Yes/No (If No: check; Not even "flu"?) (If Yes: Clve details of each illness. If doctor not seen put "none" . in first column.) *5 46 47 48 49 50 51 52 53 54 55 Doctor's Diagnosis Duration in Days - Year ' Incr. cough Yes/No Incr. phlegm Yes/No PAST ILLNESSES. If more chan three attacks put "recurrent" after age at first attack. Have you ever had: ' Each age of occurrence Pulmonary Tb. Yea/No..........56 Bronchial Asthma.................. Yes/ Pneumonia . Yea/No..........57 If Yes: Age started....... . Age stopped....... Still present?....Yea/No Pleurisy Yes/No...................... 58 Heart trouble. ................. Yes/No Bronchitis Yes/No......... .. 59 Details.......................................................... Sinusitis Yes/No...................... 60 l l 62 63 'Do you saoke?.............. ................................ .................... ............. ................................................... Ye/Ko If No; Have you ever Booked?.................. .......................... Yes/Ho ' 6t5 If Yea: Cigarettes per veek............... ........................... . Now Changes in Past 10 Years .......... ........................... ........................................................... .. Oz. tobacco/veek (bankrolled)............ ........ Or. tobacco/week (pipe)............ ....................... .......... ..................... ........................................................... .......... ................................................................................... Cigars/veek................................................................ ....................................................... .. ....................................................... Age started regular cigarette Booking.'. ...................... Age started regular pipe/ctger snoki Age stopped regular cigarette smoking.. .......... Age stopped regular pipe/cigar snoki If sacking stopped or reduced give resoon...................................................................................................................... OCCUPATION . Bov long hove you been employed at Pittsburgh Corning? Do you work in a duaty atmosphere? Yes/No 66 6? mvious OCCUPATION Dates Age* Kcsldence Materials Handled Actual Occupation dob) 1l