Document vBNdBE65ar43rBoDdGypVvkwm

tft 7.341 AHCA COOe 114 CAST TEXAS BOX 2003 TYLER 75701 TUBERCULOSIS HOSPITAL .... . A UNIT OF THC TEXAS STATE DEPARTMENT of HEALTH February 3, 1967 r\V\3 Lee B. Grant, M. D. Medical Director Pittsburgh Plate Glass Company One Gateway Center Pittsburgh, Pennsylvania 15222 Dear Dr. Grant: Unclosed 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 (with the supervision of Dr. Cushing). It would probably be mid April or the first of May before we 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, II GAH:vp enc. George A. Hurst, M. D. Clinical Director THIS DOCUMENT WAS NOT A RECORD nr PPfi INDUSTRIES. INC. DID NOT COME FROM " ITS FILES AND CANNOT BE AUTHENTICATED BY PPG INDUSTRIES, INC. T 'f l-~ REQUEST FOR CRANT-IN-AID TO: Pittsburgh Plate Glass Company One Gateway Center Pittsburgh, Pennsylvania 15222 Attention: Lee B. Crant, M. D. TITLE: Clinical and Laboratory Evaluation of Workers Exposed to Asbestos fibers BUDGET REOUESTKD: $4200 PRINCIPAL INVESTIGATOR: George A. Hurst, M. D. Clinical Director East Texas Tuberculosis Hospital Box 2003 Tyler, Texas Fred H. Y. Liu, M. D. Box 2003 Tyler, Texas Ivan Cushing, M. D. Box 2003 Tyler, Texas CHECK TO BE MADE TO: East Texas Tuberculosis Hospital CHECK TO BE SENT TO: Sam Toppcrman, M. D. Superintendent East Texas Tuberculosis Hospital Box 2003 Tyler, Texas AIM OF PROPOSAL: I Tills project is designed to assess the extent and degree of pulmonary involvement in workers exposed to low concentrations of aniosite, an asbestos fiber. Observations will also be made concerning anv recog nizable relationship between the inhalation of asbestos fiber and pul monary tuberculosis. | BB 0008358 1 METHOD OP PROCEDURE: See attached protocol and forma liUDCET: See letter AGREEMENT: Pittsburgh Plate Glass Company agrees to pay $4200 to East Texas Tuberculosis Hospital for the conduct of this investi gation and stipulates, as donor, th.it 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. Coorge A. Hurst, M, D. Clinical Director Lee IJ. Crant, M. D. Medical Director Pittsburgh Plate Glass C Robert U. Skinner, M. D. Director, Tuberculosis Hospitals Albert C. Randall, M. D. Director, Tuberculosis Control Division James E. Peavy, M. D. Commissioner of Health C-6I Bb"o008359~T v uic4t O y f& c CO o 'U PROTOCOL DOCUMEN j u;M "TC` tijiq j'J 1 C. * nlo Ti Nor COME FROM PPG FILE CLINICAL AND LABORATORY EVALUATION OF WORKIRS EXPOSED TO ASBESTOS FIBERS BACKGROUND: Inhalation of dust containing asbestos fibers may cause a crippling form of pulmonary fibrosis 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 0.5 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 the 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 aud 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. Tills 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. (4,5) A brief physical will be done and findings recorded in the first part of Form It. 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 Neils Spirometer. The mean of 3 tracings will be utilized and volumes will be corrected to body temperature and pressure saturated (BTI'S). 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 Syncr. (6) The MUG will be performed utilizing the Stead Wells 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 breatli carbon mono xide diffusing capacity unit with a 13.5 liter respirometer. This method has been described by Motley. (d) i The single breath carbon monoxide diffusing capacity will be done with the above mentioned apparatus by the method of Consolazio, Johnson and Pccora. (9) Arterial pC>2, 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. 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 preemployment films. Pittsburgh-Corning Corporation, iOwentown, Texas / IJ1B 00 08360 l i a i f'i \ KKS BIBErOGRAFHY (1) Williams, R., and llugh-Jones, P.: The Significance of lung function changes in asboscosis. 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. G., and Anderson, D. 0.: The prevalence of chronic respiratory disease in a New Hampshire Town, Amer. Rev. Resp. Ois., 1962, 86, 165. (4) iliggens, I. T. T.: Respiratory symptoms bronchitis and ventilatory capacity in a random sample of an agricultural population, Brit. Med. J., 1957, 2, 1198. (5) Fletcher, C. M., Elmes, 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, Hrit. Med. J., 1959, 2, 257. (6) Kory, R. C., Callahan, It., 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, 11. 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). T BeToO08367*7 g,i:)7('o FORM r li QUESTIONNAIRE ON RESPIRATORY SYMPTOMS Nana.............. ............................... ...................................... Sax.......Race....................Dace of Birth Address............................ .................................................................................................................................... Dace of quaaclonnaire.............................................................. COUCH Do you usually have a cough?............................................................................ Yes/No Do you cough at all on getting up, or first thing In the morn ing.............................................................................................. In winter? Yes/No In summer? Yes/No Do you go on coughing during the day or at night: In winter? Yea/No In summer? Yes/No NOTE; THIS nnniIMFNT DID PHLEGM NOT COME FROM PPG FILES Do you usually bring up phlegm from your chest (not from the / back of your nose)?............................................................................................ Yes/No Do you bring up any phlegm at all on getting up, or first thing in the morning:.............................................................. In winter? Yes/No In summer? Yes/No Do you continue to bring up any phlegm during the day.......................................................................................... In winter? Yes/No In summer? Yes/No 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) don't know..................................................................................................... How long have you had this cough and/or phlegm..Leas than J years? ___________ 3 years or more?* Do you get boute of (lncreeeed) cough end phlegm last _____ ing for at least 3 weeks each winter?................... .................. Yea/No It yes:................................................................... Last 3 wintars only? Mors Chan 3 wlntera? ___________ 6<S-' I!)'.'?} 1 | BB 000B362 I Have you ever couched up blood? If yes: When was clils?(Years of occurrence)................................................... How much? (greatest amount).............................. Streaks More Yos/No 2 2 WHEEZING Does your chest ever sound wheezy or whistling? (If no: check: not even when you have e cold?) Yes/No If yes:................................................................................... Only with colds? Occasionally (apart from colds?) _____ Most days or nights? ______ TIGHTNESS Does your chest ever feel tight or your breethlng become difficult? Yes/No If Yes:............................................................................ Only with colds? BREATHLESSNESS Other occasions specify N0T; T.uir . Are you troubled by shortness of breath? (If No: check: Not even on hurrying on hill?) If disabled by a neurological or muscle-skeletal disease put "disabled" here... 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: Oo you have to stop for breath after walking about 100 yards (or after a few minutes) on thelevel?.................................................... Yes/No If Yea: Are you coo breathless to leave the house or breathless on undressing?............................................................................................................... Yes/No 2 z' 2: 2 2' 2 2 3E 39 40 41 COLDS If you get a cold, does It usually go to your chest?................................... NASAL CATARRH Apert from colds do you usually have a stuffy nose or catarrh at Che beck of your nose?.......................................................... In winter? In sumer?^ Yes/No Yea/No Yes/No c-c-l`r,v^ I BB 0B08363*7 42 43 44 Have you ever Couched up blond? Yes/No If yes: When was thlo?(Years of occurrence).......................................................... llow much? (greatest uwount).............. Streaks _______ V More _____ 2 2 WHEEZING Does your chest ever sound wheezy or whistling? (If no: check: not even when you have a cold?) Yes/No If yes:...................................................................................Only with colds? ___^_ Occasionally (apart fro* colds?) _______ Most days or nights? ____ TIGHTNESS Does your chest ever feel tight or your breathing become difficult? Yes/No If Yes:............................................................................ Only with colds? ___________ NOTEJfHWflOCtfSlENtmD BREATHLESSNESS NOT COME FROM PPG fljLESAre you troubled by shortness of breath? (If No: check: Not even on hurrying on level or walking up a alight hill?) If disabled by a neurulogical or muscle-skeletal disease put "disabled" here... 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 breach 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?,............................................... Yea/No If Yes: Are you coo breathless to leave the house or breathless on undressing?............................................................................................................... Yes/No 2 2 2 2 2 3 3 4 4 COLDS If you get a cold, does 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 4 4 4. | BB 0008364 | Does che weather affect your chest? Yes/No If yes: What sort of weather?..................................... Yes/No Damp-wet Yes/No Cold Yes/No Heat Yes/No Does any other sort of weather affect your chest? (Specify)................... Does this weather: make you wheeze?.............................. Yes/No increase cough or phlegm?.......... Yes/No make you more breathless?.......... Yes/No have any other effect on your chest (Specify).... CHEST ILLNESSES During the peat 3 years have you had a chesc Illness which has kept you off work. Indoors at home or in bed?........................................................................ Yes/No (If Nos check: Not even "flu"?) (If Yes: Give details of each illness. If doctor not seen put "none" In first column.) Doctor's Diagnosis Duration In Days Year Incr. cough Yes/No Incr. phi* Yes/No NOT GO IV1 FROM .PRG. fJixi. PAST ILLNESSES. If more chan three attacks put "recurrent" after age at first attack. Have you ever had; Pulmonary Tb. Pneumonia Each age of occurrence Yes/No...................... 56 Yes/No...................... 57 Bronchial Asthma................................Yes/No If Yes: Age started.^.......... Age stopped.............. Pleurisy Yes/No................... 58 Still present?....Yes/No Heart trouble.......................................Yea/No Bronchitis Sinusitis Yes/No....................... 59 Yes/No....................... 60 Details............................................................ I BB 0008365 | $ 6 6 G-C-Vsn'.\ SMOKING Do you smoke?............................................................................................................................................. Yea/No 64 If No: Have you avar smoked?.......................................................................................... Yes/No 65 If Yaa: Now Changes In Past 10 Years Cigarettes par week.............................................. .............................................................................................................. Os. tobacco/vaek (handrolled)..................... .............................................................................................. Os. tobacco/week (pipe)................................... ....................................................................... ...................... ............... Clgars/veek............................................................... ..................................... ........................................ ............................... Age started regular clgsratte smoking.. ..................... Age started regular plpe/clgar smokln Age stopped regular cigarette smoking.. ..................... Age stopped regular plpe/clgar saokln If smoking stopped or reduced give reason.............................................................. ............................... .. OCCUPATION How long have you been employed at Pittsburgh Corning! Do you work In a dusty atmosphere? Yes/No 66 67 nttvioua occupation Dates Agee Kesldence NOTE: Ink; NOT COME FftCi-.-: > ! | ", Materials Handled Actual Occupation (job) ` | I SB 0008366 I NOTE: THIS DOCUMENT DID NOT COME FROM PPGFILES 1 *. O Mil_________________ PHYSICAL FINDINGS 11T WT CHEST EXTREMETIES LABORATORY Ventilatory Studies Predicted FVC FORM II ACE__________________________RACE/SEX________________ DATE P ft DP LUNGS HEART Observed 1 Predicted KEV 0.5 sec 1.0 sec Observed Maximum breathing Capacity (MBC) X Total Predicted Observed Diffusion Studies Single breath CO method Predicted Observed Arterial Blood Cas Studies rust pll pCO, _ p07 0? sat Radiographs exercise Normal limits n Abnormal see below j BB 0003367 I