Complications and residual pleural thickening after intrapleural instillation of streptokinase with pigtail catheter drainage of tuberculous pleural effusion

Background: Tuberculosis is the most common cause of exudative lymphocytic pleural effusion in India. Residual pleural thickening (RPT) is observed in about 50 percent of patients even after proper treatment with ATT. Pleural fluid drainage either with simple aspiration or with intercostal drainage and addition of corticosteroids along with antitubercular drugs have not shown to influence the incidence of RPT. The present study was undertaken to study the complications and residual effects of tubercular pleural effusion on the patients during the follow up period following intrapleural streptokinase instillation.Methods: Clinical profile, hospital course and outcome of tuberculous pleural effusion patients at the end of six months of anti-tubercular treatment of 50 patients from January 2009 to June 2010 were analyzed. These patients were randomly divided into two groups. One group (n=25) received intrapleural streptokinase via pigtail catheter and the other group (n=25) received intercostal drainage without intrapleural streptokinase instillation. All the patients received standard daily anti TB regimen of 2HERZ/4HR for a total duration of six months. All the patients were followed up for a total duration of 1 year for evidence of any residual pleural thickening.Results: Majority of the patients were above 40 years of age (60%). The male to female ratio was 2.3:1. The major symptoms of the patients were, fever in 44 patients (88%), cough in 42 patients (84%), breathlessness in 33 patients (66%), loss of appetite in 25 patients (50%) and chest pain in 25 patients (50%). Most of the patients had ADA levels between 40-70IU/L (48%) and only 6% had ADA levels below 40IU/L. The incidence of residual pleural thickening in the study group was less as compared to the control group (2.36�49mm vs 9.28�50mm) (p <0.0001).Conclusion: Intrapleural streptokinase instillation with pigtail catheter drainage less number of complications associated with study group and is successful with the decreased incidence of residual pleural thickening during the follow up period.

Serial pulmonary function test abnormality in tuberculous pleural effusion

Background: Pleural effusion is a common clinical problem that frequently causes dyspnoea and poor ventilatory function. In addition to fluid, pleural thickening, septations and calcifications can add to the functional deterioration of lungs. The drainage of pleural effusion is very effective in improving the functionality of lungs. Large volume pleural fluid tapping results in immediate hemodynamic improvement and relief from dyspnoea.Methods: The aim of the present study was to estimate the impact of tubercular pleural effusion on the ventilatory function of the lungs and to find out the correlation between the effect of pleural tapping and functional effect on the lungs. The study comprised of thirty tubercular pleural effusion cases. They were observed for six months by doing serial chest X-rays and pulmonary function test.Results: It was observed that tuberculous pleural effusion causes a restrictive abnormality and small airway obstruction. These abnormalities improve gradually over a period of six months when the patient is on anti-tubercular treatment. The role of any therapeutic intervention towards decreasing these lung function abnormalities will be subject of separate large-scale prospective study.Conclusions: Functional defects and residual pleural thickening has no correlation with the initial severity of pleural effusion.

Paquipleuritis y empiema loculado izquierdo secundario a neumonía adquirida en la comunidad en adolescente / Pachypleuritis and left loculated empyema secondary to community-acquired pneumonia in adolescents

La neumonía es una de las principales causas de mortalidad en las Américas, entre el 20 a 40% evolucionan a derrame pleural, sólo 0,6-2% evolucionan a empiema pleural. El empiema crónico se asocia a engrosamiento pleural, puede ser total o abarcar el parénquima pulmonar (paquipleuritis). Presentamos paciente adolescente, con neumonía al que se le realizó toracentesis con resultado de gram y cultivo positivo para Esta lococos sp, sin citoquímica, fue tratado como derrame pleural simple con diferentes antibióticos por 17 días sin mejoría. Posteriormente en hospital especializado, se realizó toracentesis guiada por ultrasonido que reportó masa heterogénea tabicada, se realizó decorticación de empiema loculado gigante izquierdo y liberación de atrapamiento pulmonar. Se dio alta médica con persistencia de paquipleuritis residual que resolvió espontáneamente a los seis meses. En la neumonía con derrame pleural es importante durante el tratamiento, correlacionar; clínica, citoquímica, pH, estudios de imagen y respuesta a los antibióticos.

Pneumonia is a leading cause of mortality in America, between 20-40% progresses to pleural e usion, only 0.6-2% evolve to pleural empyema. Chronic empyema associated with pleural thickening, can be total or cover the lung parenchyma (pleural thickening). Here we report a clinical case about an adolescent patient with pneumonia who had a thoracentesis with gram positive and positive culture for Staphylococcus sp, without cytochemical, it was treated as a simple pleural e usion with di erent antibiotics for 17 days without patient's improvement. Later on a specialized hospital, he had an ultrasound guided thoracentesis which reported that a partitioned heterogeneous mass was held. Decortication of giant loculated empyema and lung entrapment release was made. He was discharged with persistent residual pleural thickening which resolved spontaneously within six months. In pneumonia with pleural e usion, it is important during treatment to correlate clinical facts cytochemical, pH, imaging and response to antibiotics.

Lung Function Profiles among Individuals with Nonmalignant Asbestos-related Disorders

BACKGROUND: Inhalation of asbestos fibers can lead to adverse health effects on the lungs. This study describes lung function profiles among individuals with nonmalignant asbestos-related disorders (ARDs). METHODS: The study population was from the Workers' Compensation (Dust Diseases) Board of New South Wales, Sydney, Australia. Lung function measurements were conducted in males with asbestosis (n = 26), diffuse pleural thickening (DPT; n = 129), asbestosis and DPT (n = 14), pleural plaques only (n = 160) and also apparently healthy individuals with a history of asbestos exposure (n = 248). Standardized spirometric and single-breath diffusing capacity for carbon monoxide (DLCO) measurements were used. RESULTS: Mean age [standard deviation (SD)] was 66.7 (10.3) years for all participants. Current and ex-smokers among all participants comprised about 9.0% and 54.8%, respectively. Median pack-years (SD) of smoking for ex- and current-smokers were 22.7 (19.9). Overall 222 participants (38.6%) and 139 participants (24.2%) had forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) measurements < 80% predicted, and 217 participants (37.7%) had FEV1/FVC results < 70%. A total of 249 individuals (43.8%) had DLco values < 80% predicted and only 75 (13.2%) had DLco/VA results < 80% predicted. A total of 147 participants (25.6%) had peak expiratory flow (PEF) measurements < 80% predicted. The presence of ARDs lowered the lung function measurements compared to those of healthy individuals exposed to asbestos. CONCLUSION: Lung function measurement differs in individuals with different ARDs. Monitoring of lung function among asbestos-exposed populations is a simple means of facilitating earlier interventions.

The Relation of Residual Pleural Thickening with Matrix Metalloproteinases and Tissue Inhibitors of Metalloproteinases of Pleural Effusion in Patients with Tuberculous Pleuritis / 결핵및호흡기질환

BACKGROUND: Residual pleural thickening (RPT) is the most frequent complication of tuberculous pleurisy (TP), and this can happen despite of administering adequate anti-tuberculous (TB) therapy. Yet there was no definite relation between RPT and other variables. The aim of this study was to examine matrix metalloproteinases (MMPs) and the inhibitors of metalloproteinases (TIMPs) and to identify the factors that can predict the occurrence of RPT. METHODS: The patients with newly-detected pleural effusions were prospectively enrolled in this study from January 2004 to June 2005. The levels of MMP-1, -2, -8 and -9, and TIMP-1 and -2 were determined in the serum and pleural fluid by ELISA. The residual pleural thickness was measured at the completion of treatment and at the point of the final follow-up with the chest X-ray films. RESULTS: The study included 39 patients with pleural fluid (PF). Twenty-three had tuberculous effusion, 7 had parapneumonic effusion, 7 had malignant effusion and 2 had transudates. For the 17 patients who completed the anti-TB treatment among the 23 patients with TP, 7 (41%) had RPT and 10 (59%) did not. The level of PF TIMP-1 in the patients with RPT (41,405.9+/-9,737.3 ng/mL) was significantly higher than that of those patients without RPT (29,134.9+/-8,801.8) at the completion of treatment (p=0.032). In 13 patients who were followed-up until a mean of 8+/-5 months after treatment, 2 (15%) had RPT and 11 (85%) did not. The level of PF TIMP-2 in the patients with RPT (34.4+/-6.5 ng/mL) was lower than that of those patients without RPT (44.4+/-15.5) at the point of the final follow-up (p=0.038). CONCLUSION: The residual pleural thickening in TP might be related to the TIMP-1 and TIMP-2 levels in the pleural fluid.

Characteristics, causes and sequel of pleural thickening in pleural effusion in children

145 children with pleural effusion were investigated at HCM Pediatric Hospital from Jan 1999 to May 2002. Results found that 53,1% of cases occurred in under five years old children, among them 62,8% were admitted in Hospital > 7 days after onset of the disease with the symptoms of fever, tachypnoe, dyspnoe, cough, lung pain. The effusion was commonly occurred in the right side . Pleural effusion S. Aureus was usually occurred 54% off cases were pleural thickening and adhesive. The mortality acconnted for 2,8% with the cause of sepsis and respiratory distress.

Pleural Fluid Analysis in Tuberculous Pleurisy Progressing into Severe Pleural Thickening Underwent Pleural Decortication / 결핵

BACKGROUND: Although most patients with tuberculous pleurisy respond well to anti-tuberculous drugs, some are known to progress into severe pleural thickening which needs decortication despite adequate anti-tuberculous treatment. Therefore, the purpose of this study was to identify factors associated with the development of severe pleural thickening in patients who finally underwent pleural decortication in tuberculous pleurisy. PATIENTS AND METHODS: From retrospective medical records review, 121 patients initially diagnosed as tuberculous pleurisy without initial pleural fluid loculation were enrolled between January 1998 and December 2002. They were separated into two groups: 85 patients in group 1 who improved by anti-tuberculous drugs only, and 36 patients in group 2 who had progressed into pleural adhesion and finally underwent pleural decortication despite adequate (more than 6 months) anti-tuberculous treatment. RESULTS: Males were more common in group 2 (M/F=31/5) than in group 1 (M/F=53/32) (p=0.010). Group 2 patients tended to have lower pleural fluid glucose level (58+/-4 mg/dL) than group 1 (89+/-3 mg/dL) (p=0.001) and higher pleural fluid adenosine deaminase level (86+/-5 IU/L) than group 1 (76+/-3 IU/L), (p=0.038). There were no significant differences in age, symptom duration, pleural fluid amount, or pleural fluid LDH level between groups 1 and 2. CONCLUSIONS: There was a relative risk of tuberculous pleurisy progression into severe pleural thickening which needed decortication in the case of male patients, low pleural fluid glucose or high adenosine deaminase level. But further, large-scale, prospective studies should be investigated.

Imaging study of non-bronchial systemic collateral supply in hemoptysis / 介入放射学杂志

Objective To investigate the significance of non-bronchial systemic collaterals (NBSCs) in supplying bronchial hemoptysic lesions,and to study the morphological features of bronchial artery (BA) when NBSCs become the predominant supplying vessels. Methods Multi-slice helical CT angiographic findings in 124 patients with bronchial hemoptysis were retrospectively analyzed. 3D reconstruction of thoracic systemic arteries,including BAs and NBSCs,was performed at the console work station with the help of real-time thin-slice enhanced helical CT scanning. The number of NBSCs and BAs was calculated,and the internal diameter of the arteries and the thickness of pleura in the vicinity of the pulmonary lesion were measured. According to the presence or absence of NBSCs,the patients were divided into NBSCs group and non-NBSCs group. The relevant data was statistically analyzed. Results NBSCs group included 36 cases,the mean internal diameter of BA was (1.850 ? 0.631)mm and the pleura adjacent to the pulmonary lesion was obviously thickened in 22 cases (61%) with a thickness of 2.7-16.0 mm [mean(7.71 ? 4.12) mm]. In the non-NBSCs group (n = 88),the mean internal diameter of BA was (2.200 ? 0.528) mm and the pleura adjacent to the pulmonary lesion was obviously thickened in 7 cases (8%) with a thickness of 1.1-2.4 mm [mean(1.7 ?0.53) mm]. The differences in both internal diameter of BA and the thickness of lesion's adjacent pleura between two groups were statistically significant (P

Factors Associated with Residual Pleural Thickening After Chemotherapy in Tyberculous Pleurisy / 결핵

BACKGROUND: Residual pleural thickening is frequently seen following treatment for tuberculous pleurisy, and pleural decortication is performend occasionally in patients with severe residual pleural thickening. However, predictive factors for the development of residual pleural thickening are uncertain at the initial diagnosis of the tuberculous pleurisy. Therefore, the purpose of this study was to identify the associated factors for residual pleural thickening at initial diagnosis. METHODS: We separated 63 patients diagnosed as tuberculous pleurisy into two groups; group 1 consisted of patients without residual pleural thickening and group 2 comprised patients with residual pleural thickening at the end of tuberculous pleurisy treatment. We analyzed the clinical characteristics, radiological findings, pleural biopsy and characteristics of pleural fluid between group 1 and group 2. RESULTS: The study population and clinical symptoms of the two groups were not significantly different and the duration of symptoms before treatment and the peripheral WBC were similar between the two groups. The presence of pulmonary tuberculosis, pleural fluid loculation or the amount of pleural effusion sid not differ significantly between the thwo groups. The incidence of positive AFB staining(group 1 : 8%, group 2 : 38%) and granuloma(group 1 : 30%, group 2 : 62%) on pleural biopsy specimens was significantly higher in group 2 than in group 1. Pleural fluid WBC and differential count, adenosine deaminase level, pH, preotein level or glucose level did not differ between the two groups. However, group 2 had higher LDH levels (1370±208mg/dl) than group 1 (860±71mg/dl, p<0.05). CONCLUSION: In tuberculous pleurisy, patients with residual pleural thickening following treatment demonstrated a higher incidence of posivive AFB staining and granuloma on the pleural biopsy specimens or higher LDH level in the pleural fluid than patients wihtout residual pleural thickening From these results, we speculate that the amonut of tuberculous bacilli and granuloma are probably correlated with residual pleural thickening in the tuberculous pleurisy.

The Effect of the Extents of Pleural Thickening in Tuberculous Pleurisy on the Impairment of Pulmonary Function / 결핵

BACKGROUND: Tuberculous pleurisy treatment improve symptoms such as fever, chest pain, cough, and prevents the progression to active pulmonary tuberculosis and the development of residual pleural thickening that decrease diaphragm and rib cage movement. This study investigated how the degree of residual pleural thidkening affects the pulmonary function. METHODS: Fifty seven patients who were initially diagnosed as having tuberculous pleurisy, were treated with anti-tuberculous medication for 6 months and had residual pleural thickening between May 1998 and January 2000 at the Eulji university hospital were reviewed. A chest X-ray and pulmonary function test(PFT, Sensormedics 2200) were perfored. The predicted value (%) of the forced vital capacity(FVC), forced inspiratory vital capacity(FIVC) and total lung capacity(TLC) were measured. The residual pleural thickening was defined the average of the summation in the lateral chest at the level of the imaginary line intersecting from the cardiophrenic angle to the diaphragmatic dome and the lowest part of the costophrenic angle between them. The results were sorted into three grades according to pleural thickness; <2mm(grade I), 2~10mm(grade II), 10mm(grade III). RESULTS: 1. FVC(% pred) and FIVC(% pred) were statistically different between grade I and III, and II and III. However, there was no difference between the TLC(% pred) between each of the groups. 2. The pleural thickness that cause restrictive dysfunction(FVC<80%) and a statisticall difference, is 3 mm. CONCLUSION: The larger the extent of the residual pleural thickness after antituberculous medication, the greater the reduction in the FVC, FIVC, TLC. A pleural thickness of 3 mm is recommended as a guideline for diagnosing a restrictive pulmonary dysfunction.

TNF-alpha, TGF-beta, and fibrinolytic parameters in tuberculous and malignant pleural effusions / 결핵

BACKGROUND: Residual pleural thickening(RPT) develops in about 50% of tuberculous pleurisy(PLTB). Some reports have suggested that elevated TNF-α and impaired fibrinolysis could be the cause of RPT, but until now, the mechanism and predictors of RPT have not been well known. TGF-β has been known to promote fibrogenesis and is increased in tuberculous pleural fluid(PF). PLTB and malignant pleurisy(PLMAL) manifest lymphocyte-dominant exudative pleural effusion, and it has clinical implications in the differentiation of the two diseases, based on the findings of pleural effusion. We performed this study to compare pleural fluid TNF-α, TGF-β, and fibrinolytic parameters between PLTB and PLMAL, and to find the predictors of RPT in PLTB. METHODS: Thirty-five PLTB and 14 PLMAL patients who were admitted to the Asan Medical Center from February 1997 to August 1999 were enrolled. All PLTB patients were prescribed a primary, short-course, anti-tuberculosis regimen. TNF-α, tissue plasminogen activator (tPA), plasminogen activator inhibitor 1 (PAI-1), plasminogen, α2-antiplasmin, and D-dimer were measured in both PF and PB, TGF-β was measured only in PF. Clinical characteristics, TNF-α, TGF-β, and fibrinolytic parameters were compared between patients with RPT less than 2 mm and patients with more than 2 mm of the thirty patients who completed the anti-tuberculosis treatment. RESULTS: The levels of TNF-α, tPA, PAI-1, plasminogen, α2-antiplasmin, and D-dimer in PF were higher than those in peripheral blood (PB) in PLTB, whereas only plasminogen, α2-antiplasmin, and D-dimer were higher in PF than in PB in PLMAL. Pleural fluid TNF-α, TGF-β, PAI-1, plasminogen, α2-antiplasmin were increased in PLTB compared with PLMAL, but these factors did not show any further advantages over ADA in differentiation between PLTB and PLMAL. TNF-α, TGF-β, and fibrinolytic parameters did not show any differences between patients with RPT less than 2 mm and patients with RPT more than 2 mm. CONCLUSION: Our data suggest that TNF-α, TGF-β, and fibrinolytic parameters may play some role for the development of RPT in PLTB, but they failed to predict the occurrence of RPT in PLTB. Also these parameters did not seem to have any advantages over ADA in differentiating between two diseases.

Factors Associated with the Development of Pleural Thickening in Tuberculous Pleurisy / 결핵

BACKGROUND: A sizable percentage of tuberculous pleurisy patients are known to have residual pleural thickening(RPT) despite adequate anti-tuberculous chemotherapy. But, the predictive factors related to the development of RPT is not well known. Therefore, we studied to determine which factors are related to the development of RPT after completion of therapy. METHODS: By retrospective review of medical records, fifty-eight patients initially diagnosed as having tuberculous pleurisy between March 1995 and January 1998 were separated into two groups: 27 patients in group 1 had RPT on simple chest radiography, while 31 patients in group 2 had no RPT after 6 month of anti-tuberculous chemotherapy. The clinical characteristics, radiologic findings and pleural fluid findings of the two group were compared at the time of diagnosis and during the course of therapy. RESULTS: 1) 47% of patients had RPT after 6 month of chemotherapy, and RPT was more common in man than in women(54% vs 29%,p=0.092). 2) In group 2 patients, complete resorption of pleural lesion occurred rather late stage of therapy(1-2 month : 26%, 3-4 month :29%, 5-6 month : 45%). 3) Group 1 patients had increased percentage of loculated pleural lesion(26% vs 19%) and increased white blood cell and lymphocyte count, lactate dehydrogenase level in pleural fluid (3527+/-5652 vs 2467+/-2201/ml, 2066+/-2022 vs 1698+/-1835/ml and 1636+/-1143 vs 1441+/-923IU/ml, respectively) than group 2 at the time of diagnosis, but statistically insignificant. 4) Duration of symptom prior to treatment, size of pleural effusion, presence of parenchymal lung lesion, level of total protein, glucose and adenosine deaminase(ADA) activity in pleural fluid were similar in both group. CONCLUSION: 53% of tuberculous pleurisy patients showed slow but complete resorption of pleural lesion after 6 month of chemotherapy. But, no clinical, radiological and pleural fluid findings are predictive for the development of RPT.

Sclerosing mesenteritis associated with skin panniculitis and pleural thickening / 대한내과학회지

Sclerosinng mesenteritis is a rare disease that occurs most often among middle aged man. Fewer than 200 cases have been reported in the literature. It is a benign mesenteric lesion characterized by fat necrosis, fibrosis and chronic inflammation. The pathogenesis of this disease is unclear through an autoimmune origin has been proposed. The disease is generally localized and self- limiting. Fatal case is rare but has been reported. In patients with biopsy proven sclerosing mesenteritis having a relentless downhill course, treatment with prednisolone and oral cyclophosphamide in isolated case report has lead to evident clinical and radiological responses. This is a report of a case of sclerosing mesenteritis, who presented to us with history of colicky abdominal pain and weight loss. She was treated with prednisone and intravenous cyclophosphamide pulse therapy and resulted in radiological and clinical improvement. Interestingly this case has associated with skin panniculitis and pleural thickening. The skin panniculitis also showed good response to prednisolone. Our case is the first in which sclerosing mesenteritis was associated with pleural thickening.

The Effects of Urokinase Instillation Therapy via Percutaneous Transthoracic Catheter Drainage in Loculated Tuberculous Pleural Effusion: A randomized prospective study / 결핵

BACKGROUND: Tuberculous pleural effusion responds well to the anti-tuberculosis agents in general, so no further aggressive therapeutic managements to drain the tuberculous effusion is necessary except in case of diagnostic thoracentesis. But in clinical practice, we often see some patients who later decortication need due to dyspnea caused by pleural thickening despite the completion of anti-tuberculosis therapy in the patients with tuberculous effusion. Especially, the patients with loculated tuberculous effusion might have increased chance of pleural thickening after treatment. The purpose of this study was that intrapleural urokinase instillation could reduce the pleural thickining in the treatment of loculated tuberculous pleural effusion. METHODS: Thirty-seven patients initially diagnosed as having loculated tuberculous pleural effusion were randomly assigned to receive either the combined treatment of urokinase instillation and anti-tuberculosis agents(UK group) and anti-tuberculosis agents(Non-UK group) alone. The 16 patients in UK group received a single radiographically guided pig-tail catheter ranging in size from 10 to 12 French. 100,000 units of urokinase was dissolved in 150 ml of normal saline and instilled into the pleural cavity via pig-tail catheter every day, also this group was treated with anti-tuberculosis agents. While the 21 patients in Non-UK group were teated with anti-tuberculosis agents only except diagnostic thoracentesis. Then we evaluated the residual pleural thickening after treatment for their loculated tuberculous pleural effusion between the two groups. Also the duration of symptoms and the pleural fluid biochemistry like WBC counts, pH, lactic dehydrogenase (LDH), glucose, proteins, and adenosine deaminase (ADA) were compared. RESULTS: 1) The residual pleural thickening (RPT) (5.08 +/- 6.77 mm) of UK group was significantly lower than that (20.32 +/- 26.37 mm) of Non-UK group (Por=10 mm(5.23 +/- 3.89 wks) was significantly longer than the patients with RPT or=10 mm and the patients with RPT <10 mm. CONCLUSION: The treatment of loculated tuberculous pleural effusion with the urokinase instillation via percutaneous transthoraic catheter was effective to reduce the pleural thickening.

The Effect of Pleural Thickening on the Impairment of Pulmonary Function in Asbestos Exposed Workers / 결핵

BACKGROUND: Pleural abnormality is the the most common respiratory change caused by asbestos dust inhalation and also develp other asbestos related disease after cessation of asbestos exposure. So we conducted epidemiologic study to investigate if the pleural abnormality is associated with pulmonary function change and what factors are influenced on pulmonary function impairement. METHODS: Two hundred and twenty two asbestos workers from 9 industries using asbestos in Korea were selected to measure the concentration of sectional asbestos fiber. Questionnaire, chest X-ray, PFT were also performed. All the data were analyzed by student t-test and chi-square test using SAS. Regressional analysis was performed to evaluate importent factors, for example smoking, exposure concentration, period and the existence of pleural thickening, affecting to the change of pulmonary function. RESULTS: 1) All nine industries except two, airborn asbestos fiber concentration was less than an average permissible concentration. PFT was performed on 222 workers and the percentage of male was 88.3%, their mean age was 41+/-9 years old, and the duration of asbestos exposure was 10.6+/-7.8 yrs. 2) The chest X-ray showed normal(89.19%), pulmonary Tb(inactive)(2.7%), pleral thickening (7.66%), suspected reticulonodular shadow(0.9%). 3) The mean values of height, smoking status, concentration of asbestos fiberwere not different between the subjects with pleural thickening and others, but age, cumulative pack-years, the dura-tion of asbestos exposure were higher in subjects with pleural thickening. 4) All the PFT indices were lower in the subjects with pleural thickening than in the subjects without pleural thickening. 5) Simple regression analysis showed there was a significant correlation between FEF75 which is sensitive in small airway obstruction and cumulative smoking pack-years, the duration of asbestos exposure and the concentration of asbestos fiber. 6) Multiple regression analysis showed all the pulmonary function indices were decreased as the increase of cumulative smoking pack-years and especially in the indices those are sensitive in small airway obstruction. Pleural thickening was associated with reduction in FVC,FEV1, PEFR and FEF25. CONCLUSION: The more concentration of asbestos fiber and the more duration of asbestos exposure, the greater reduction in FEF50,FEF75. Therefore PFT was important in the evaluation of early detection for small airway obstuction. Furthermore pleural thickening without asbesto-related parenchymal lung disease is associated with reduction in pulmonary function.