Comments on the Creswell et.al. paper - Too Soon to Breathe Easy

The paper by Creswell et al has an important message for occupational medicine practioners about the ongoing occurrence of asbestos-related lung disease.1 This paper examined hospital discharge data through 2023 for nonmalignant respiratory disease but the message is also relevant for asbestos-related malignancies, for example, lung cancer and mesothelioma.2 Healthcare practioners need to continue to include asbestos-related conditions in their differential diagnosis despite the decreased use of asbestos and stricter workplace controls. There are two findings in the Creswell paper that need further explanation. The authors are concerned that the fact that the overwhelming percentage of asbestos-related diagnoses in Wisconsin were among non-Hispanic White might represent “underreporting or misclassification of race and ethnicity.” There is no reason to suggest that a limitation in their data is a cause for the White male predominance in their results given the long history of discrimination in union locals, particularly construction skill trade unions, which worked directly with asbestos, as well as industrial unions to exclude Black workers despite national union leadership policy against discrimination.3 The results that reports of nonmalignant asbestos related lung disease in Wisconsin occur predominately among White men are similar to results of hospital discharge data from New Jersey4 and national Medicare data.5 Unlike previous studies that used administrative data bases to examine nonmalignant asbestos-related respiratory disease,5 the authors included the International Classification of Diseases, Tenth Revision (ICD-10) code specific for pleural scarring. In their analysis the ICD code for asbestosis, which should be the code for the parenchymal condition, was lumped together with the ICD code for pleural changes. Providing the data separately by parenchymal and pleural codes, which is available since 2015, might provide additional information to clinicians about possible differences in trends and which changes are more common. The continuing diagnosis of asbestos-related conditions has practical importance including identification of a high-risk group to target smoking cessation and periodic computed tomography scans for lung cancer screening.6 Kenneth D. Rosenman, MDMichigan State UniversityCollege of Human MedicineEast Lansing, MI