ORIGINAL ARTICLE Mireille Matrat Æ Jean-Claude Pairon Ann-Gae¨ lle Paolillo Æ Nathalie Joly Æ Yuriko Iwatsubo Ewa Orlowski Æ Marc Letourneux Æ Jacques Ameille Asbestos exposure and radiological abnormalities among maintenance and custodian workers in buildings with friable asbestos-containing materials Received: 22 September 2003 / Accepted: 15 March 2004 / Published online: 27 May 2004 Ó Springer-Verlag 2004 Abstract Objectives: Few studies have been carried out to evaluate the respiratory effects of asbestos exposure of custodian and maintenance workers. Methods: By a multicentre cross-sectional study, 277 custodian and maintenance employees working in buildings with fria- ble asbestos-containing materials and 87 unexposed subjects were studied for radiological abnormalities by use of the International Labour Office (ILO) classifica- tion of radiographs of pneumoconiosis, in relation to parameters of asbestos exposure. Results: The cumula- tive asbestos exposure index was generally low (fewer than 5 fibres/ml · years in 82.3% of exposed workers). On multivariate analysis, pleural thickening was signif- icantly related to latency since onset of exposure to asbestos in exposed workers, after adjustment for age, body mass index and tobacco smoking. Conclusions: Asbestos exposure of custodian and maintenance employees in buildings with friable asbestos-containing materials might be associated with an excess of pleural thickening on chest X-rays. Keywords Occupational exposure Æ Chest X-ray Æ Pleural thickening Æ Pneumoconiosis Introduction Friable asbestos-containing materials (ACMs) were used extensively in the 1960s and 1970s in public, residential, and commercial buildings, and were sprayed onto structural beams to prevent building collapse in the event of fire, or on other surface materials such as acoustic insulation and thermal insulation applied around steam pipes and boilers. The US Environmental Protection Agency has estimated that approximately 733,000 (20%) of all government, residential and private non-residential buildings in the USA contained some type of friable ACMs (US Environmental Protection Agency 1984). In France, the proportion of buildings containing friable ACMs might be around 5% (personal communication). Custodian and maintenance workers might disturb or damage ACMs in the course or their work and might thereby experience peak exposure episodes. With appropriate working methods, the level of asbestos exposure of maintenance and custodian workers rarely exceeds the permissible exposure limit (Price et al. 1992; Corn et al. 1994; Mlynarek et al. 1996). Unfortunately, these appropriate working methods have only been used more recently, and it has been shown that without adequate controls, exposures can exceed 10 fibres/ml (f/ ml) during some types of removal and repair work (Health Effects Institute-Asbestos Research 1991). However, such episodes are poorly characterized, and few studies have been devoted to the investigation of ACM-related health effects among custodian and maintenance workers in buildings with friable ACMs. High prevalences of pleural and/or parenchymal radio- logical abnormalities have been reported in school cus- todians and maintenance workers (Oliver et al. 1991; M. Matrat Æ J.-C. Pairon Æ A.-G. Paolillo Æ N. Joly Institut Interuniversitaire de Me´decine du Travail de Paris-Ile de France, Paris, France M. Matrat Æ J.-C. Pairon Service de Pneumologie et de Pathologie Professionnelle, Centre Hospitalier Intercommunal, Cre´teil, France M. Matrat Æ J.-C. Pairon Æ Y. Iwatsubo Æ E. Orlowski INSERM E03.37, Faculte´ de Me´decine de Cre´teil, Cre´teil, France A.-G. Paolillo Æ N. Joly Æ J. Ameille (&) Unite´ de Pathologie Professionnelle et de Sante´ au Travail, Hoˆpital Raymond Poincare´, 104 boulevard Raymond Poincare´, 92380 Garches, France E-mail: jacques.ameille@rpc.ap-hop-paris.fr Tel.: +33-1-47107754 Fax: +33-1-47107768 M. Letourneux Service de Pathologie Professionnelle, CHU Coˆte de Nacre, Caen, France Int Arch Occup Environ Health (2004) 77: 307–312 DOI 10.1007/s00420-004-0520-7