Chest
Volume 115, Issue 6, June 1999, Pages 1720-1728
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Occupational and Environmental Lung Disease
Assessment of Hazardous Dust Exposure by BAL and Induced Sputum

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Objectives

BAL, an important tool in assessing occupational lung diseases, is unsuitable for screening programs, exposure evaluation, or monitoring hazardous dust because it is an invasive technique. The results of induced sputum (IS) analysis were compared with BAL and evaluated as a possible alternative.

Methods

We compared BAL with IS analysis of 5 workers exposed to asbestos and 14 exposed to silica and hard metals. Pulmonary function tests and BAL were performed by conventional methods. IS induction was performed after a 20-min inhalation of 3.5% saline solution with an ultrasonic nebulizer. Giemsa-stained cytopreparations were differentially counted. T-lymphocyte subsets were analyzed by flow-activated cell sorter, and messenger RNA (mRNA) was transcribed by reverse transcriptase-polymerase chain reaction. Mineralogic particles were analyzed by scanning electron microscopy and polarizing light microscopy and quantified by an analyzer.

Results

The percentage of neutrophils was significantly lower in BAL fluid than in IS specimens, whereas no differences were found in the percentage of lymphocytes and subsets profile. Asbestos fibers were found in BAL but not in IS samples from workers exposed to asbestos. Polarizing particles were found in both samples. Similar mineral elements were found in qualitative analysis by scanning electron microscopy. Quantitative studies showed similar size distribution with a small shift toward larger particles in sputum; mRNA showed the same cytokine profile.

Conclusions

A comparison of BAL and IS specimens in the evaluation of the study population yielded similar quantitative and qualitative results. Further research is needed to evaluate the hypothesis that IS, being a noninvasive technique, may be useful in monitoring exposed workers.

Section snippets

Study Population

All patients were hazardous dust workers and were followed up periodically according to the Israeli Safety and Health at Work Regulations. They were referred for evaluation because of symptoms or radiographic findings associated with pneumoconiosis.

Group 1 (Table 1) included five patients exposed to asbestos. Patients 1 and 2 worked in a large electric power plant and were retired at the time of study. They had worked there for 23 to 43 years before their referral for evaluation. Asbestos had

Results

The demographics, history of smoking, radiologic, histologic, and functional findings in the study population are shown in Table 1. Three of five asbestos workers and 12 of 14 silica and hard-metal workers had radiologic changes typical for pneumoconiosis. Values for the diffusing capacity of the lung for carbon monoxide were significantly reduced in group 2 compared with group 1 (72.1 ± 18.0% vs 104.4 ± 8.32%, respectively; p = 0.0014). None of the patients showed side effects from IS

Discussion

This study demonstrated that samples recovered by IS in workers exposed to hazardous dust show a quantitative and a qualitative pattern similar to those of samples recovered by BAL in terms of percentage and phenotype of lymphocytes, inflammatory markers, size distribution, and types of mineral particles.

BAL, which has been used in recent years for the diagnosis of interstitial lung diseases, is an invasive procedure that requires special expertise and willingness on the part of the subjects to

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