Document j0bY7bG209dNd0N6bBv5w302

ST TEXAS TUBERCULOSIS HOSPITAL ?'sv} , toox tylbu. nm m unit Vor' TW* TEXAS STATE DEPARTMENT * HEALTH February 3, 1967 Lee fi# Grant,.H. D. Medical Director Pittsburgh Plate Class Company One Gateway Center Pittsburgh, Pennsylvania 15222 Dear Dr. Crant: 4 Enclosed you will find a request, for Orant*In-Aid, Protocol and related information'on the proposed asbestos!*' survey. The budget figure was computed la the following manner: supplies and telephone - 5210, radiographs and pulmonary function tests on 52 workers $1060, professional services; physicians, technicians and secretarial assistance^ $2250, administrative overhead - $700 making a total of $6200. Ali of us involved in this project arc 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 vere inserted at the suggestion of our Central Office in Austin in order to obviate any possible objection from legislators. After ve receive your approval of this project, we will proceed to get a ' Collins single breath carbon monoxide diffusion apparatus and perfect our technique (with the supervision-of Or. Cushing). It would probably be aid April or the first of Hay before ve are ready to begin the project and w would hope to finish it as soon as possible. Any suggestions or comments that you might have would "be appreciated. Sincerely yours GAB:yp enc.' George A. Hurst, H. D Clinical Director WV-11154 REQUEST FOR CRANT-IK-AlD TOi ** Pittsburgh Plate Class Coopany One Gateway Center y Pittsburgh, Pennsylvania 15222 Attention: Lee B. Crane, K. D. * TITLE: Clinical and Laboratory ^Valuation of torbars Exposed to Asbestos fibers * BUDGET REQUESTS: $4200 % ` PRINCIPAL INVESTIGATOR: Ccorge A. ifurst, ff, E.. Clinical Director East Texas Tuberculosis Hospital Bex 2003 Tyler, Texas Fred H. Y. Liu, 21. D. Box 2003 Tyler, Texas Ivan Cushing, K. D. - Box 2002 Tyler, Texas , CHECK TO BE HADE TO: 4 *^ MUM*' .... ' East Texas Tuberculosis Hospital CHICK TO BE snrr TO: . Saa Toppemsn, M. D. Super!atendent East Texas Tuberculosis Hospital Box 2001 Tyler, Texas AIM 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 Bade concerning anv recog nizable relationship between the inhalation of asbestos fiber and pul monary tuberculosis* KETUOD or PROCEDURE; >* ' BUOCtrf; See letter see attached protocol and terms ACREUTESTs ^_ ' * ** Pittsburgh fiate Class Company agrees to pay <4200 to Cast Texas Tuberculosis Hospital for the conduct of this investi gation ana 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 vbich he deseng necessary in connection with the research program at the East Texas Tuberculosis Hospital* 0>4^<W kO. George A, Hurst, \u D. * Clinical Director (Sera Topptfrjnan, M. Superintendent Lee B. Grant, M. D. Wadical Director Pittsburgh Plate Glass Co Robert fi. Skinner, 51. D. Director, Tuberculosis Hospitals Albert C. Randall, IU D. Director, Tuberculosis Control Division Jsraes E. Pcavy, H. D. Commissioner of Health T7 PROTOCOL ( . CLINICAL AND LABORATORY EVALUATION OF WORKERS * . EXPOSED TO ASBESTOS FIBERS BACKGROUND: Inhalation of dust containing* asbestos fibers may cause a crippling fora of pulmonary fibrosis which usually 4ocs not appear until many years after initial exposure. (1) Amosite is mined in South Africa. These fibers, with a seen diameter of 0.5'micron, are larger than Canadian asbestos fibers and tend to settle out oore rapidly Iron the atmosphere* The diagnosis can be suspected when'history of exposure is associated with one or sore of the following: a) abnormal pulmonary function studies, specifically reduction in pulmonary diffusing capacity. (1,2) Tills is the hallmark of esbestosis and often precedes definite changes In the radiograph or discernible physical signs, b) radiographic changes consisting of fine diffuse nottling In both bases, e) phy sical signs such as crepitant rales, clubbing and labored breathing. The last 2 signs occur late in the disease. Although the relationship of asbestos!* and tuber culosis has not been emphasised, this project will investigate any potential co existence of thc6et 2 conditions. METHODS OF PROCEDURE: Approximately 32 workers exposed to amosite fibers in a pipe Insulation manufacturing fins* will be studied at the East Texas Tuberculosis hospital, Each employee will be administered a questionnaire on respiratory symptoms (Form 1) by one of the investigators. This questionnaire was used by Ferris and Anderson in a / survey of chronic respiratory disease in a New Hampshire town. (3) It is similar to I questionnaires used extensively in Great Britain. (4,5) A brief physical will he done ; and findings recorded in the first part of. Fora XX.. f 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 j forced expiratory volume (FEV) will be calculated from spirograms obtained with the I Stead Dells Spirometer. The mean of 3 tracings will be utilised and volumes will J be corrected to body temperature and pressure saturated (BTFS). Nomogram for pre dicting TVC 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 utilising the Stead Veils Spirometer. The mean of 3 tests which should chock 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 tlilting Chs -Callias hei ivst reel duel-volume -spperat-us -and ~*S.**M .hasAAcb Mrixm -mono xide diffusing capacity unit with a 13.5 liter respirometcr. This method has been described by Motley. {*) The single breath carbon monoxide diffusing capacity will be done with the above mentioned apparatus by the method of Consolatio, Johnson and Pecora. (9) Arterial pOg, pH and pCOg, before and after exercise will be done only in these eases which show low diffusing capacity. Radiometer A.ME equipment with e Clarke electrode will be employed in the above named determinations. Ahtero posterior and lateral radiographs of the chest will be taken and read by 2 of the investigators independently. Comparison will be made with earlier preemployment films. * Pittsburah-Cornins Corporation, Owentown, Texas ViaS' 1) BIBLIOGRAPHY (1)* Williams,.*., and Hugh-Jones, P. j the Significance of lung /unction change* in asbesteals, Thorax, 1960, 15, 109. (2) Thomson, H, L. and McGrath, M. V., Saither, 17. J., Shepherd, J.M.: Some anomalies in the measurement of pulmonary diffusion in asbestos!* and chronic . Bronchitis with emphysema, Clio. Sci., 1961, 21, 1. . 0) Terris, 8. C., and Anderson, 0. 0.: The prevalence of chronic respiratory disease in a New Hampshire Town, Amer. Rev, Reap. Dis., 1962, 86, 165. {*> Higsens, 1. 7. T.; Respiratory symptom bronchitis and veacllscory capacity in a random sample of an agricultural population, firit. Med. J., 1957, 2, 1198. (5) Fletcher, C. K., Else*, P. C., Foirbairn, A. 5., end Wood, C. >1.: 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, s The veterans adaini,stration-srmy cooperative study of pulmonary function 2. Clinical spirometry in -- normal men, Amer. J. Med., 1961, 30, 2*3.' (7) Motley, H. L.: Clinical pulmonary physiology II. Detection of early lung function changes in industrial exposure, Indust. Med., 1953, 22, 267. (6) 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 Puls. Us., 1957, 76, 601. (9) Consoles!, C. F., Johnson, R. E., Peeora, L. J.: Physiological measurements of metabolic functions in man, 1963, 239. (HcCraw Hill Book Company). / TQM 2 * QUESTIONNAIRE- ON MSPXIATORY SWTTOMS yf.*........... -.......................................................,....St,.......... .bet.................. fliu of Sirth< Address............. ............. ................. ...................................... .. otu of ^uesUeanaire.................... / / COUGH Do you usually have a cough?......... Do you cough at al) cut getting up, or first thing in the sort- ig......... ................................................ .. Xn susffler? So you go os coughing during the day ox at nights I winter? In susner? Yes/Ko Yes/No Yes/No Yes/No Yes/No PHLEGM go you usually bring up phlegm from you; chest (not from the back of ywt wsi)T............................ or first thing In winter? In susuner? Do you continue to bring up any phlegm during thet In winter? In siacaer? Vhat color is this phlegms (a) always dear white, gray, or bivefclvft? tCbeeWbJ before roeecfilog) <b) occasionally yellow or green, at least in part*?....... <c) usually yellow or gsaer?............................... <d) don't know........................ .. How long have you had this cough and/or phlegm..Lett than 3 years? 3 years or mere? Be you get bouts of (increased) eeugh and phlegm last*ng for at least 3 weeks each winter?................. if .......................................................................Lest 3 winters only? Kora than 3 winters? Yes/Ho Yes/Ko Yes/Ko Yes/No Yes/Ho Tes/Ko 4 t V .1 * A " Nave you ever counted up blood?.., *****%% - ?' jf yes* When was thio?(Years of occurrence). I 3 Bow such? (greatest mount)......... Streaks Haze Yc*/Ne WJEEZ1KC . ' Does your chest ever sound vhecty r whistling? t / 'i (If eat cheek! see even when you have * cold?) Yes/No 3f ........................ ....................................................... ...Only with colds? -- <. Occasionally (apart frea colds?) _ sicmzss . ' Most days or sights? i Doe* your chest ever feel tight or your breathing becoe* difficult? Tts/No It Yes ......... ................... .....Only with colds? _ j Other cessions specify ____ BREATHLESSNESS i Are you troubled by shortness C breath?................. ..................... .. Ye*/ (If Mo: check: Met even on hurrying on level or walking up a slight hill?) .1 If disabled by a neurological or eu*cle-*kcl*t*l disease put . "disabled'' hare... H Yes: Do you have to walk slower than people of your age on the level because of breathlessness?......... ............................. .. If Yes! 0 you ever have to step for breath when walking at your Yes/Ho OVu .pace fin ............. ..................... ............. ~?s'7$o If Yes: Do you have to stop for breath ifter walking about iOD yards (or after few nlmttes) oc the level?......... . Yes/No If Ye*t Arc you too brsachless to leave the house or breathless on Yes/No *. COLDS If you get a cold, docs it usually go to your chest?......... .. NASAL CATARRH Apart free colds do you usually have a etuffy nose or catarrh at the back of your oose?................. la sunder? Yes/No Yes/No Yes/Ho 4; 4: