pneumoconiosis medical panel

One hundred and fifty five male cases of asbestosis certified by the London Pneumoconiosis Medical Panel during 1968-74 were followed up during 1978-9, 4-11 (mean 7-5) years after certification. Fifty nine patients had died, 23 (39%) from lung cancer, 6 (10%) from mesothelioma, and 11 (19%) from other respiratory causes. The number of observed deaths was 2 25 times greater than expected and 7-4 times greater than expected for lung cancer. Adenocarcinoma was the commonest histological type but other cell types were also increased. Finger clubbing (p < 001) and percentage of predicted FEV1 (p < 001) were of value in predicting death, but increasing profusion of small opacities greater than 1/0 (ILO/U-C international classification of radiographs of pneumoconiosis, 1971), duration of exposure to asbestos, time from first exposure to asbestos, and percentage of predicted vital capacity and transfer factor did not predict death. Patients certified as having asbestosis frequently ask about the implications of such certification for them in terms of survival, the development of cancer, and progression of the asbestosis. This paper attempts to provide such information for survival and for lung cancer. McVittie' followed up 247 workers certified during 1955-63 and recorded 59 deaths. Twenty one (36%) were due to lung cancer, 17 (29%) were due to asbestosis and three (5%) were due to mesothelioma. Berry2 carried out a mortality study of workers certified by the London, Swansea, and Cardiff Panels from 1952 to 1976 and some of these cases are included in this study. Of 283 male deaths, 102 (36%) were due to lung cancer, 57 (20%) to asbestosis, and 25 (9%) to mesothelioma. He found the main factor influencing mortality was the clinical state of the men at the time of certification as reflected in the percentage disability awarded, but he did not relate mortality to clinical, radiographic, or physiological variables. In this study we have attempted to examine in greater detail the factors that predict mortality. Patients and methods From 1968 onwards claimants coming before the London Pneumoconiosis Medical Panel seeking penAddress for reprint requests: Dr I I Coutts, Royal Cornwall Hospital (Treliske), Truro, Cornwall TRI 3LJ. Accepted 7 October 1986 sions for asbestosis have had respiratory function tests carried out at the Brompton Hospital. At this visit a clinical questionnaire including a history of asbestos exposure was completed, physical examination was performed, and a serum sample was collected. Most of these claimants were seen by MTW. From 1968 to the end of 1974 155 men were seen in whom the panel independently made the diagnosis of asbestosis. The guidelines used for the diagnosis of asbestosis3 at this time state that, given exposure to asbestos, two of the features breathlessness, finger clubbing, basal rales, radiological changes, and reduced gas transfer would be strongly suggestive of asbestosis. Fifty nine deaths had occurred by the end of August 1979. The mortality data have been examined and an attempt has been made to identify the clinical features which on initial examination predict death. FEV1, forced vital capacity (FVC), and vital capacity (VC) were recorded with a low inertia spirometer and single breath transfer factor (TLCO) was measured with a Resparameter Mark 3. The tests were carried out with the subjects seated and wearing a nose clip and the results have been expressed as percentages of the predicted normal values on the basis of the data of Cotes.4 Chest radiographs were available for all cases and were independently categorised according to the 1971 ILO/U-C classification of radiographs of pneumoconiosis' by three experienced readers. Inter111 group.bmj.com on January 6, 2018 Published by http://thorax.bmj.com/ Downloaded from