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Libby Amphibole Disease: Pulmonary Function and CT Abnormalities in Vermiculite Miners

Miller, Albert MD; Szeinuk, Jaime MD; Noonan, Curtis W. PhD; Henschke, Claudia I. PhD; Pfau, Jean PhD; Black, Brad MD; Yankelevitz, David F. MD; Liang, Mingzhu MD; Liu, Ying MD; Yip, Rowena MPH; McNew, Tracy MPA; Linker, Laura BS; Flores, Raja MD

Journal of Occupational and Environmental Medicine: February 2018 - Volume 60 - Issue 2 - p 167–173
doi: 10.1097/JOM.0000000000001178
Original Articles

Objective: This article describes radiologic and pulmonary function findings among miners exposed to Libby amphibole. Computed tomography (CT) permits the detection of the characteristic thin, lamellar pleural thickening (LPT).

Methods: Individuals who worked at the mine for a minimum of 6 months had chest CT and pulmonary function tests.

Results: Pleural thickening was noted in 223 (87%) of the 256 miners, parenchymal abnormalities in 49 (19%). LPT, found in 151 (68%), was associated with low values of forced vital capacity and diffusion capacity and significantly lower values in all pulmonary function tests when associated with parenchymal abnormalities.

Conclusion: Eighty-seven percent of miners exposed to Libby Amphibole had pleural abnormalities on CT. LPT alone, and more so with parenchymal abnormalities, resulted in decreased pulmonary function. The importance of this easily missed LPT is demonstrated by its high frequency and significant functional effects.

Mount Sinai Health System, Icahn School of Medicine, New York, New York (Drs Miller, Henschke, Yankelevitz, Liang, Liu, Ms Yip, Ms Linker, Dr Flores); Northwell Health, Department of Occupational Medicine, Epidemiology and Prevention, Great Neck, New York (Dr Szeinuk); University of Montana, Missoula, Montana (Dr Noonan); Montana State University, Bozeman, Montana (Dr Pfau); and Center for Asbestos Related Disease, Libby, Montana (Dr Black, Ms McNew).

Address correspondence to: Raja Flores, MD, Ames Professor of Cardiothoracic Surgery, Chairman, Department of Thoracic Surgery, Mount Sinai Health System, Icahn School of Medicine, One Gustave L. Levy Place, Box 1023, New York, NY 10029 (

This paper is dedicated to the memory of Dr Stephen M. Levin. His tireless work for the health and welfare of the Libby community shines as a beacon for those of us who have continued his efforts.

AM, JS, CWN, CIH, and JP significantly contributed to the drafting and writing of the manuscript.

BB, TM, LL, and RF further contributed to review and edited the final draft. All these authors have critically revised the manuscript for important intellectual content.

AM, JS, CWN, CIH, JP, BB, DFY, TM, LL, and RF significantly contributed to conception and/or design of the work, acquisition, analysis, and interpretation of data.

CWN, CIH, and RY performed the statistical and epidemiological analyses.

CIH, DFY, ML, YL, BB, and JS read and reviewed the CT scans.

LL is the overall administrator of the Grant.

RF is the PI of the Grant.

Grant Sponsor for this study was NIH/ATSDR/CDC; Grant No. TS000099-01 PI Raja Flores.

Dr Yankelevitz reports grants from FAMRI, outside the submitted work; and Dr David Yankelevitz is a named inventor on a number of patents and patent applications relating to the evaluation of diseases of the chest including measurement of nodules. Some of these, which are owned by Cornell Research Foundation (CRF), are nonexclusively licensed to General Electric. As an inventor of these patents, Dr Yankelevitz is entitled to a share of any compensation that CRF may receive from its commercialization of these patents.

Dr Henschke reports grants from FAMRI outside the submitted work and Dr Henschke is a named inventor on a number of patents and patent applications relating to the evaluation of pulmonary nodules on CT scans of the chest that are owned by CRF. Since April 2009, Dr Henschke does not accept any financial benefit from these patents, including royalties and any other proceeds related to the patents or patent applications owned by CRF. In addition, Dr Henschke is the President of the Early Diagnosis and Treatment Research Foundation; she receives no compensation for this service.

The remaining authors have no conflicts of interest to disclose.

Copyright © 2018 by the American College of Occupational and Environmental Medicine