Asbestosis (Asbestoses)

Asbestosis - Fibrous pleural plaque (7468458430)[1]

Asbestosis is a pneumoconiosis caused by inhaled asbestos fibers. It is marked by pulmonary fibrosis.[1]

The disease is related to the following process: Poison.

Presentation

The presentation of patients after asbestos exposure is not immediate. The symptoms often do not appear for several decades after exposure. This latency may be shortened if the intensity of exposure to asbestosis is high [7][8].
The most common presenting feature of asbestosis is dyspnea on exertion, which once started is progressive in nature. Other may also complain of a dry non-productive cough. Presence of a productive cough indicates a concomitant respiratory tract infection. Vague chest pain or discomfort is also a common complaint in patients with advanced disease.
Physical exam may reveal rales which are primarily heard at the lung bases and in the lower posterior area beneath the scapula.
Clubbing of the digits may be seen in 50% of patients but has no correlation to the severity of the disease.
With advanced disease, there will be decreased expansion of the chest that clinically correlates with restrictive ventilatory impairment and reduced vital capacity. Patients with Cor pulmonale may have varying degrees of cyanosis, hepatojugular reflux, jugular venous distension and pedal edema. Most patients with end stage lung disease appear cachectic, out of breath and moribund.

cardiovascular
Chest Pain
  • Usually asympto-matic; if severe, chest pain, dyspnea, and cough.[atsdr.cdc.gov]
  • pain where as only 1(one) with parenchymal disease reported chest pain.[ehjournal.biomedcentral.com]
  • Other symptoms of advanced asbestosis include chest pain, hoarseness, and restless sleep.[encyclopedia.com]
  • Asbestosis symptoms include a tight chest, a crackling sound in the lungs, persistent cough, chest pain, and more.[webmd.com]
  • Main symptoms that may be present in an asbestosis sufferer are - Chest pain Clubbing of the fingers Cough Nail abnormalities Shortness of breath Tightness in the chest Asbestosis treatment There is no current cure for asbestosis, although stopping exposure[pneumoconiosis.org.uk]
Cyanosis
  • The skin may appear bluish gray (cyanosis), and signs of right-sided heart failure (prominence of the veins in the neck and swelling of the feet and ankles) may be noted.[mdguidelines.com]
  • Clinical features may include: Progressive shortness of breath Cough Inspiratory crackles Cyanosis Clubbing Complications of asbestos exposure Lung cancer can result from asbestos exposure and is the most common malignancy associated with it.[lecturio.com]
  • Other indications of asbestosis include abnormal lung sounds on examination, changes in the ends of the fingers and toes (" clubbing "), a blue tinge to the fingers or lips ("cyanosis"), and failure of the right side of the heart ("cor pulmonale").[medicinenet.com]
  • Physical findings of crackles, clubbing, or cyanosis are associated with increased risk for asbestos-related mortality [ 16 , 17 ].[ehjournal.biomedcentral.com]
Lip Cyanosis
  • Other indications of asbestosis include abnormal lung sounds on examination, changes in the ends of the fingers and toes (" clubbing "), a blue tinge to the fingers or lips ("cyanosis"), and failure of the right side of the heart ("cor pulmonale").[medicinenet.com]
  • more...
  • respiratoric
    Cough
    • Recurrent respiratory infections and coughing up blood are common.[encyclopedia.com]
    • Persistent, dry cough - This troublesome cough, which often makes it difficult to sleep and eat, may be accompanied by chest pain.[slideshare.net]
    • Medications can thin lung secretions to make coughing easier and relieve chest pain.[asbestos.com]
    • Whether caused by smoking or asbestos exposure, the basic lung cancer symptoms are the same: Chest pain Cough Coughing up blood Frequent bronchitis or pneumonia Persistent chest, shoulder, or back pain that worsens with deep breathing Fatigue Hoarseness[asbestos.net]
    Pleural Effusion
    • Non-malignant asbestos pleural effusions.[atsdr.cdc.gov]
    • Pleural Effusion Asbestos exposure also can cause pleural effusion, which is the buildup of fluid between the parietal and visceral layers of the pleura.[pleuralmesothelioma.com]
    • There are four types of pleural disease: pneumothorax (collapsed lung), pleural effusions, pleurisy, and pleural mesothelioma.[asbestos.net]
    • Benign asbestos-related pleural effusion Pleural effusions can occur within 10-20 years of asbestos exposure but may appear much later [ 2 ] .[patient.info]
    • effusions, usually no symptoms Asbestos fiber detection: H&E, Prussian blue, incineration and EM Gross images Images hosted on other servers: Pleural plaque Microscopic (histologic) description Early: interstitial pneumonia with desquamative features[pathologyoutlines.com]
    Dry Cough
    • Persons with advanced cases of the disease have a dry cough.[britannica.com]
    • Initially, the person has no symptoms and later, dry cough and progressive shortness of breath occur.[health-tutor.com]
    • Persistent, dry cough - This troublesome cough, which often makes it difficult to sleep and eat, may be accompanied by chest pain.[slideshare.net]
    • Likewise, patients with these diseases will experience many of the same symptoms, such as: Wheezing or dry cough Shortness of breath Pain in the abdomen or chest Difficulty breathing (or respiratory complications) Anemia Muscle weakness Fever Shortness[maacenter.org]
    • Some of the Asbestosis symptoms are: Shortness of breath Persistent dry cough Appetite loss with unintended weight loss Clubbing of the extremities Chest pain Diagnosis of Asbestosis Asbestosis is a difficult disease to diagnose since the signs and symptoms[epainassist.com]
    Rales
    • Asbestosis is diagnosed by a signature sound in the lungs, known as basal crackles or rales, and by X-ray images that show specific irregularities.[angeloslaw.com]
    • When listening to the chest with a stethoscope, the provider may hear crackling sounds called rales.[medlineplus.gov]
    • Also known as "rales", they are usually detected near the end of a full inspiration.[ccohs.ca]
    • Inspiratory basilar rales, restrictive impairment, small airway obstruction, and gas exchange disturbances in pulmonary function are considered valuable information for clinical diagnosis, for occupational health practice, and for attribution purposes[sjweh.fi]
    Dyspnea
    • If severe, can cause dyspnea.[atsdr.cdc.gov]
    • Shortness of breath (dyspnea) - This is often the first symptom to appear and, as mentioned before, it may be ten or more years before shortness of breath is evident.[slideshare.net]
    • Patients may complain of fatigue and increased shortness of breath with activity (dyspnea on exertion).[mdguidelines.com]
    • Symptoms of asbestosis include dyspnea, and cough.[sjweh.fi]
    Pulmonary Disorder
    • Clubbing of fingers (advanced stages) - This increased curvature of the nails and thickening of the digits is often indicative of a serious pulmonary disorder such as asbestosis. 11. honeycombed 12.[slideshare.net]
    • The first modern evidence of fibrotic pulmonary disorder in an asbestos worker was discovered in an autopsy performed by Dr Montague-Murray in England in 1899, and reported on in 1907.[asbestosassociation.com.au]
    • Retrieved 2009-12-20 . a b c d e f g "Asbestosis - Pulmonary Disorders" .[en.wikipedia.org]
    Clubbed Finger
    • Patients with mesothelioma may develop clubbed fingers, but it is more rare.[mesotheliomaguide.com]
    • Clubbed fingers and toes: When the lungs deliver insufficient oxygen to the blood, a symptom called “clubbing” may arise.[asbestos.com]
    • People with mesothelioma may also develop clubbed fingers, but this is much rarer.[mesotheliomatreatmentcenters.org]
    Chronic Cough
    • Asbestosis victims may have an extremely difficult time breathing and chronic cough.[mesotheliomacenter.org]
    • Symptoms of lung cancer include chronic cough, weight loss, shortness of breath, fever, and chest pain.[ccohs.ca]
    Exertional Dyspnea
    • It produces a restrictive pattern of disease and progressive exertional dyspnea.[atsdr.cdc.gov]
  • more...
  • Entire body system
    Fatigue
    • Tiredness and fatigue: The scarring and inflammation of lungs can also reduce the ability to exchange oxygen and carbon dioxide, which can lead to a reduction in lung function and subsequently cause fatigue.[robertsjackson.co.uk]
    • Because the body relies on oxygen for energy, chronic breathing difficulties lead to fatigue and weight loss.[asbestos.com]
    • Other symptoms include: a persistent cough wheezing fatigue or extreme tiredness pain in your chest or shoulder in more advanced cases, clubbed (swollen) fingertips Diagnosis If you have any of the symptoms mentioned above, you should discuss this with[blf.org.uk]
    • By LISA FOGARTY Photo Credit Patient Voices: Hepatitis Fatigue, liver disease and the stigma of a contagious disease: six men and women speak about living with hepatitis.[nytimes.com]
    • Whether caused by smoking or asbestos exposure, the basic lung cancer symptoms are the same: Chest pain Cough Coughing up blood Frequent bronchitis or pneumonia Persistent chest, shoulder, or back pain that worsens with deep breathing Fatigue Hoarseness[asbestos.net]
  • more...
  • Workup

    The diagnosis of asbestosis is based on the following:

    • One must obtain a thorough history and take into account the dose and duration of exposure to asbestos. It is important to known the type of work one was performing and if any body protection was used (garments, gloves or masks).
    • Always ask for an old chest x-ray to determine if the disease was present earlier and it has progressed, as compared to the present chest x-ray.
    • Determine degree of dyspnea - whether it is at rest, exercise or during sleep
    • Any prior treatment for heart failure as some patients may have developed right heart failure
    • Laboratory blood tests are not specific for diagnosis of asbestosis exposure but a blood gas is needed to determine hypoxia and hypercarbia.
    • Gallium citrate scan is not recommended as it is not specific for asbestosis.
    • Even though some healthcare workers make the diagnosis of asbestosis based on the history and physical, errors in diagnosis can occur because there are many other interstitial lung diseases that can present with similar features of asbestosis. When using the history to make the diagnosis, it is important to keep in mind that there is a long latent period between exposure and development of symptoms. Many cases of medical malpractice have resulted when the diagnosis of asbestosis is missed because of reliance on just the history and physical exam.

    Radiography

    • Chest x-ray will show diffuse reticulonodular infiltrates in the middle and lower lung segments. Honeycombing may be seen in advanced disease. Typically there will be thickening of the lower and middle pleural wall. Sometimes a large calcified pleural plaque on the diaphragmatic pleura may be seen.
    • CT scan is always done in a patient with asbestosis. The Ct scan can determine the size and location of any pleural lesion, presence of effusion, invasion of the chest wall or other structures, or atelectasis. CT scan is also excellent at defining the fibrosis. Even in people with normal chest xrays, the CT scan will reveal presence of abnormalities

    Pulmonary Function Test
    Pulmonary function tests are performed in patients with asbestosis but are not specific. The CO diffusing capacity is decreased and may be the earliest abnormality seen. As the disease advances, the patient will develop reduction in total lung capacity and vital capacity. However, these features are nonspecific and can be seen in many other restrictive lung disorders.


    Oximetry
    Pulse oximetry will usually reveal hypoxia which may be exacerbated in the presence of right heart failure and cor pulmonale. In the clinic, the pulse oximetry can be performed at rest and during exercise and can quickly reveal the severity of hypoxemia


    Bronchoalveolar Lavage and Bronchoscopy
    The role of bronchoscopy and bronchoalveolar lavage in making the diagnosis of asbestosis is limited. It is only helpful when trying to make a diagnosis of an infection or determining the cause of a sudden wheeze in an elderly individual. During bronchoscopy, the airways can be lavaged and the fluid is collected to assess the number of asbestos fibers. If there is more than one asbestos body/ml of lavage from the airways, then the probability of high exposure to asbestos is likely. Bronchoscopy should not be used to perform a lung biopsy as the tissue yield is inadequate and false negatives are high.

    Lung biopsy
    Lung biopsy is necessary to make the diagnosis of asbestosis and rule out other disorders. In addition, the lung biopsy may reveal the absence or presence of a malignancy. The biopsy specimen is usually viewed under light and electron microscopy and reveal presence of fibrosis and asbestosis bodies. A grading system has been developed to assess the severity of asbestosis related fibrosis. It is important to note that presence of asbestosis bodies alone is not diagnostic for the disorder because sometimes the pathologist may observe these bodies in individuals who have had no exposure or have had only a transient exposure to asbestos


    Biopsy of the pleura
    Pleural thickening can occur with asbestosis and it is difficult to know if this is a benign or malignant lesion. Hence a biopsy is required. This is usually done in the operating room via an open procedure because the yield from a needle biopsy is not sufficient to make the diagnosis of a malignancy. Even though pleural plaques can occur with several other medical disorders, the presence of plaques and dyspnea should be a good indicator of prior exposure to asbestos.

    Pathology

    Other Pathologies
  • more...
  • Biopsy
  • more...
  • Laboratory

    Serum
  • more...
  • Pleura
    Pleural Effusion
    • Non-malignant asbestos pleural effusions.[atsdr.cdc.gov]
    • Pleural Effusion Asbestos exposure also can cause pleural effusion, which is the buildup of fluid between the parietal and visceral layers of the pleura.[pleuralmesothelioma.com]
    • There are four types of pleural disease: pneumothorax (collapsed lung), pleural effusions, pleurisy, and pleural mesothelioma.[asbestos.net]
    • Benign asbestos-related pleural effusion Pleural effusions can occur within 10-20 years of asbestos exposure but may appear much later [ 2 ] .[patient.info]
    • effusions, usually no symptoms Asbestos fiber detection: H&E, Prussian blue, incineration and EM Gross images Images hosted on other servers: Pleural plaque Microscopic (histologic) description Early: interstitial pneumonia with desquamative features[pathologyoutlines.com]
  • more...
  • Imaging

    X-ray
    X-Ray Abnormal
    • X-ray abnormalities include thickening of the lining of the lungs and tiny lines marking the lower portions of the lungs.[medicinenet.com]
  • more...
  • ECG

    Axis
  • more...
  • P Wave
  • more...
  • Test Results

    Pulmonary Function Test
    Restrictive Pulmonary Function
    • Diffuse pleural thickening can be associated with mild (or, rarely, moderate to severe) restrictive pulmonary function deficits such as decreased ventilatory capacity.[atsdr.cdc.gov]
    • Diffuse pleural thickening can be associated with mild, or rarely moderate or severe, restrictive pulmonary function defects.[sjweh.fi]
    Decreased Lung Compliance
    • This fibrosis can lead to Reduced lung volumes, Decreased lung compliance, Impaired gas exchange, Restrictive pattern of impairment, Obstructive features due to small airways disease, and Progressive exertional dyspnea with an insidious onset.[atsdr.cdc.gov]
  • more...
  • Treatment

    • Once the diagnosis of asbestosis has been made, the goal of the treatment is to prevent any further exposure and manage the symptoms. The patient should be strongly advised to discontinue smoking [9].
    • The severity of the lung disease and functional impairment should be studied and treatment individualized. Then a follow up plan must be developed to monitor the patient. This may involve regular pulmonary function tests, arterial blood gases, and obtain serial chest x-ray or CT scans. The patient’s oxygen status must be assessed at rest and with exercise to determine if hypoxemia occurs at rest or with exercise.
    • Supplemental oxygen may be required while ambulation or at night time.
    • If the patient has an upper respiratory tract infection or pneumonia, appropriate antibiotic treatment is needed.
    • All patients with asbestosis should be immunized against pneumococcal pneumonia and influenza.
    • Many patients with end stage lung disease are cachectic, immobile and bedridden. These patients may require appropriate palliative care. Relief from shortness of breath must be provided. During the terminal phase of the disease, comfort and supportive care is needed.
    • Once asbestosis has developed, there is no effective medication. Even though both corticosteroids and a variety of immunosuppressive agents have been tried, the course of the disorder is not altered.
    • For patients who develop wheezing, bronchodilators are useful.
    • Patients who have developed lung cancer or a mesothelioma need to be referred to a thoracic surgeon. Most patients are either not candidates for surgery or the cancer is too far advanced

    Prognosis

    The prognosis for most individuals after prolonged exposure to asbestos has to be guarded. The symptoms of asbestosis are not immediate and often present after several decades. However, once the symptoms start, they are progressive and can be debilitating. The majority of patients will develop lung related complications such as:

    Risk factors for chronic respiratory insufficiency include:


    • Duration and intensity of asbestosis exposure
    • Degree of shortness of breath
    • Continued use of tobacco
    • Combined pulmonary and pleural involvement
    • Chest X-ray and CT scan imaging showing honeycombing
    • Bronchoalveolar lavage with high number of inflammatory cells


    Malignancy
    Prolonged exposure to asbestos is known to cause lung cancer and mesotheliomas of the upper respiratory tract (pharynx, larynx), esophagus, kidney and biliary tract. The combination of tobacco and asbestos has a synergistic effect on the development of lung cancer. Individuals who smoke and have asbestosis exposure are at a very high risk for development of lung cancer than people who do not smoke [6].


    Asbestosis, when it coexists with other lung disorders like COPD, emphysema, bronchitis, bronchiectasis or idiopathic fibrosis, can severely worsen the symptoms and worsen the quality of life. Most of these patients develop severe dyspnea and have no exercise tolerance. Asbestosis also worsens the symptoms of asthma and over time, even bronchodilators do not have an effective response.
    Many studies have shown that asbestosis has a high morbidity and mortality rate. The disorder leads to premature termination of employment and numerous visits to the hospital.

    Complications

    Pulmonary Hypertension
    • This is called pulmonary hypertension, which is a different condition from the more commonly occurring “high blood pressure” or systemic hypertension.[asbestos.com]
    • Heart problems - pulmonary hypertension caused by asbestosis can lead to the enlargement of the heart's right ventricle and, eventually, its failure.[pleuralmesothelioma.com]
    • Pulmonary hypertension can lead to enlargement and failure of your heart’s right ventricle (cor pulmonale).[wardblacklaw.com]
    • hypertension, progressive pulmonary insufficiency and possibly colon cancer .[mdguidelines.com]
    • Providing oxygen therapy can also help prevent pulmonary hypertension and cor pulmonale.[lecturio.com]
    Pleurisy
    • Pleurisy Pleurisy, also known as pleuritis, is inflammation of the pleura.[pleuralmesothelioma.com]
    • There are four types of pleural disease: pneumothorax (collapsed lung), pleural effusions, pleurisy, and pleural mesothelioma.[asbestos.net]
    • The pleura (membrane covering the chest cavity) may get irritated causing pleurisy with chest pain that worsens during inspiration .[health-tutor.com]
    • Other potential complications include heart failure, collapsed (deflated) lung, and pleurisy (inflammation of the membrane that protects the lung).[encyclopedia.com]
    Hypoxia
    • This is effective in correcting underlying Hypoxia and shortness of breath.[hxbenefit.com]
    Cor Pulmonale
    • Causes of death include 7 : respiratory failure cor pulmonale asbestos related malignancy bronchogenic carcinoma mesothelioma Consider other causes of pulmonary fibrosis: in the absence of pleural plaques or diffuse pleural thickening the differentiation[radiopaedia.org]
    • Progression of asbestosis may lead to fine bilateral inspiratory crackles, finger clubbing and cor pulmonale.[patient.info]
    • Oxygen therapy may help minimize symptoms and/or accompanying heart failure (cor pulmonale).[mdguidelines.com]
    • Providing oxygen therapy can also help prevent pulmonary hypertension and cor pulmonale.[lecturio.com]
    • Pulmonary hypertension can lead to enlargement and failure of your heart’s right ventricle (cor pulmonale).[wardblacklaw.com]
    Pneumothorax
    • There are four types of pleural disease: pneumothorax (collapsed lung), pleural effusions, pleurisy, and pleural mesothelioma.[asbestos.net]
    • […] and mixed mineral dusts; Exudative pleural effusions such as Empyema, Tuberculous effusions, Hemothorax, Post-cardiac surgery, Chronic hemodialysis; and Other medical conditions such as Legionella pneumonia, Histoplasmosis, End-stage renal disease, Pneumothorax[atsdr.cdc.gov]
    Silicosis
    • Silicosis Definition of silicosis Silicosis refers to pulmonary fibrosis caused by inhalation of silica particles following occupational exposure.[lecturio.com]
    • Silicosis and asbestosis are chronic lung diseases.[health-tutor.com]
    • […] similar to other fibrosing lung diseases such as UIP Begins around respiratory bronchioles and alveolar ducts, extends distally; eventually causes honeycomb lungs Begins in lower lobes and subpleurally (in contrast to coal workers' pneumoconiosisP and silicosis[pathologyoutlines.com]
    • Asbestosis shares some similarities with silicosis (miner's lung), in that they are both pneumoconioses (chronic, incurable lung diseases) resulting from the inhalation of an irritant.[mesotheliomacenter.org]
    • Like silicosis, asbestosis is a serious condition which is incurable and can result in death at an early age.[agius.com]
    Anthracosis
    • When a diagnosis of Asbestosis is being given it needs to be distinguished between other types of Pneumoconiosis such as: Anthracosis (miners lung) from exposure to coal dust; Silicosis exposure to silica and sometimes known as Potters rot or Grinders[nationalasbestos.co.uk]
    Pneumoconiosis
    • […] to asbestos and other mineral fibers J62 Pneumoconiosis due to dust containing silica J62.0 Pneumoconiosis due to talc dust J62.8 Pneumoconiosis due to other dust containing silica J63 Pneumoconiosis due to other inorganic dusts J63.0 Aluminosis (of[icd10data.com]
    • Minimal pneumoconiosis found in ponies in coal mines.[medical-dictionary.thefreedictionary.com]
    • Advertisement Lung - nontumor Pneumoconiosis Asbestosis Author : Elliot Weisenberg, M.D.[pathologyoutlines.com]
    • […] plural asbestoses play \ -ˌsēz \ : a pneumoconiosis due to asbestos particles that is marked by thickening and scarring of lung tissue First Known Use of asbestosis 1927 Medical Dictionary plural asbestoses play \ -ˌsēz \ : a pneumoconiosis due to asbestos[merriam-webster.com]
    • It is possible however to have a diagnosis of more than one of the above Pneumoconiosis.[nationalasbestos.co.uk]
    Bronchogenic Carcinoma
    • Cessation of smoking is also mandatory as the two are independent and synergistic risk factors for bronchogenic carcinoma 5 .[radiopaedia.org]
    • carcinoma. as·bes·to·sis ( as'bes-tō'sis ), Pneumoconiosis resulting from inhalation of asbestos fibers suspended in ambient air; sometimes complicated by pleural mesothelioma or bronchogenic carcinoma; ferruginous bodies are the histologic hallmark[medical-dictionary.thefreedictionary.com]
    • Asbestos exposure increases the risk of bronchogenic carcinoma 5-fold.[gpnotebook.co.uk]
    • Asbestos inhalation is also associated with a form of lung cancer (bronchogenic carcinoma) in people who smoke .[my.clevelandclinic.org]
    • A few decades later studies established asbestosis as a predisposing factor for bronchogenic carcinoma and malignant mesothelioma.[medindia.net]
    Silicotuberculosis
    • […] tuberculosis 2016 2017 2018 Non-Billable/Non-Specific Code A15 ( ICD-10-CM Diagnosis Code J65 Pneumoconiosis associated with tuberculosis 2016 2017 2018 Billable/Specific Code Applicable To Any condition in J60 - J64 with tuberculosis, any type in A15 Silicotuberculosis[icd10data.com]
    Pericardial Mesothelioma
    • Asbestosis may also cause Pleural Mesothelioma which is Mesothelioma in the lining of lungs, Pericardial Mesothelioma affecting the heart lining and Peritoneal Mesothelioma affecting the abdomen.[hxbenefit.com]
    Malignant Pleural Mesothelioma
    • Malignant pleural mesothelioma is a rare tumor arising from the pleural mesothelium.[atsdr.cdc.gov]
    • Asbestos Victims Support Groups Forum UK Malignant pleural mesothelioma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up ; European Society for Medical Oncology (2015) Tomioka K, Natori Y, Kumagai S, et al ; An updated historical[patient.info]
    • pleural mesothelioma : a necropsy-based study.[em-consulte.com]

    Etiology

    Asbestos exposure in most countries occurs during manufacture of the following products:

    • Making asbestos paper for insulation and filters
    • Incorporation of asbestos cement in shingles, sheets, pipes and clapboards
    • Use in motor vehicles brake lining and clutch facings
    • Preparing dry wall products containing asbestos
    • Making of vinyl asbestos floor tiles
    • Manufacture of textile products such as felt, cord, rope and yarn
    • Manufacture of spray products for thermal, acoustic and fireproofing

    Occupations with high risk of asbestosis include the following:


    • Boilermakers
    • Car mechanics who work on brake linings and clutches
    • Insulation workers
    • Janitors
    • Pipefitters
    • Plumbers
    • Roofers
    • Steamfitters
    • Welders


    When there is uncontrolled removal of asbestos from the environment studies show that even within a few months, individuals can have very high levels of asbestos fibers in the airways.

    Causes

    Hypoxia
    • This is effective in correcting underlying Hypoxia and shortness of breath.[hxbenefit.com]

    Epidemiology

    Asbestos exposure was significant nearly half a century ago. Almost every country was using asbestos related products and hence many people were exposed to it. By the 1980s, there was awareness of the dangers of asbestos, and thus, the use of asbestos products declined gradually in most western countries. At present, there are no solid data on the number of people somehow exposed to asbestosis. In the USA, experts indicate that there may be less than a few hundred cases of patients presenting with asbestos related lung disease. Strict governmental regulation of use of asbestos products in the home and better means of protecting the worker has significantly reduced the risk of asbestosis development. However, individuals who have been exposed to asbestos in previous decades continue to be at risk for the pneumoconiosis and other related disorders.
    In most western countries, the use of asbestosis is strictly regulated. However in developing countries there is evidence that the use of asbestos is not regulated and in fact asbestos related health disease is rapidly increasing. The reason why asbestos continues to be used in developing countries is because it is cheap, readily available and has exceptional insulating properties.

    Sex distribution
    Age distribution

    Pathophysiology

    The incidence of asbestosis is variable and greatly dependent on the cumulative dose of inhaled fibers over many years. Those individuals who have high and prolonged exposure tend to have a higher incidence of asbestosis. Every single type of asbestos fiber studied so far has been shown to induce fibrosis of the lung. Inhalation of the crocidolite fibers are also known to cause malignant lesions of the lung and pleura. Fibers which are less than 3 microns tend to induce fibrosis as they are able to penetrate the cell lining. Thicker fibers are incompletely phagocytised and remain in the lung where they continue to generate an inflammatory reaction. Besides influx of inflammatory cells, there is generation of oxygen free radicals which damage the lung enzymes, proteins and endothelial cell lining [5].
    The ability of asbestosis fibers to induce inflammation depends on individual susceptibility, immunological factors and respiratory clearance. Overall, people who tend to smoke have poor airway clearance and are more likely to see progression of disease with asbestosis. Asbestos leads to development of intense fibrosis of the lung, which is most common at the bases. In addition, the ongoing inflammation initiates pleural thickening and plaques.
    There is also evidence that some people who are exposed to asbestos fibers of the amphibole type may develop an autoimmune reaction, with generation of autoantibodies. Further research shows that asbestos related lung disease is slightly more common in people who have positive serology for antinuclear antibodies. These patients were also more prone to developing more intense fibrosis of the lung and large pleural plaques, then individuals who were seronegative for anti nuclear antibodies.

    Prevention

    To prevent asbestosis, one needs to restrict the use of asbestos in the home and workplace. Anyone exposed to asbestos must discontinue all further exposure by either changing the job or home. This is to prevent further exposure and decrease the risk of developing asbestos related lung disease. Unfortunately, once asbestos exposure has occurred, the disease continues even though the exposure had discontinued. Smoking cessation is highly recommended.

    Summary

    Asbestos are naturally occurring fibers that are extremely heat resistant and have superb insulating properties. For decades, these two properties of asbestos have led to its widespread use in the home and industry. Microscopically, asbestos fibers vary from 1-12 microns in size and may be curved (serpentine asbestos) or straight (amphibole). Over the years several subtypes of amphibole fibers have been recognized, namely actinolite, anthophyllite, crocidolite, amosite and tremolite. Of these, chrysotile is by far the most common type of asbestos fiber produced and used in the manufacturing industry. Asbestos was widely used in the industry until reports started to appear in the late 60s that people who were exposed to it were developing severe restrictive lung disease, lung cancer and mesotheliomas. It was not until a decade later that it was finally concluded that asbestos exposure was not benign and hence, its use started to decline in most western countries. In the manufacturing industry, strict guidelines were introduced to limit the levels of asbestos in the environment. Further workers were asked to wear proper garments and masks when working with asbestos related product. The use of asbestos as insulation in the home continued until the late 80s but sporadic reports exist that asbestos can be found in dry wall made in china [2][3][4].

    Patient Information

    Asbestos was a common product once used in the home and manufacturing industry to make a variety of products. However, because of the risk of developing severe lung disease and cancer, the use of asbestos has declined in most western countries. Today, people who work in the manufacturing industry are at the highest risk, but because of awareness and use of appropriate garments and masks, there has been a significant decrease in asbestos associated lung disease. When uncontrolled asbestos exposure occurs, the inhaled fibers can cause severe lung fibrosis and increase the risk of lung and pleural cancer. The patients usually present several decades after the initial exposure. Treatment is immediate cessation of exposure. Besides oxygen, there is no definitive therapy for asbestosis. Patients need to be monitored for life as some may develop right heart failure, severe lung fibrosis and even cancer.

    Self-assessment

    Ask Question


    5000 Characters left Format the text using: # Heading, **bold**, _italic_. HTML code is not allowed.

    References

    1. Cullinan P, Reid P Pneumoconiosis. Prim Care Respir J. 2013 Jun;22(2):249-52.
    2.Gulati M, Redlich CA. Asbestosis and environmental causes of usual interstitial pneumonia. Curr Opin Pulm Med. 2015 Mar;21(2):193-200.
    3.Norbet C, Joseph A, Rossi SS, Bhalla S, Gutierrez FR. Asbestos-Related Lung Disease: A Pictorial Review. Curr Probl Diagn Radiol. 2014 Oct 30. pii: S0363-0188(14)00117-0.
    4.Bernstein DM. The health risk of chrysotile asbestos. Curr Opin Pulm Med. 2014 Jul;20(4):366-70.
    5.Liu G, Cheresh P, Kamp DW. Molecular basis of asbestos-induced lung disease. Annu Rev Pathol. 2013 Jan 24;8:161-87.
    6.Campbell K, Brosseau S, Reviron-Rabec L, Bergot E, Lechapt E, Levallet G, Zalcman G. Malignant pleural mesothelioma: 2013 state of the art]. Bull Cancer. 2013 Dec;100(12):1283-93.
    7. Dang GT, Barros N, Higgins SA, Langley RL, Lipton D. Descriptive review of asbestosis and silicosis hospitalization trends in North Carolina, 2002-2011. N C Med J. 2013 Sep-Oct;74(5):368-75.
    8. Donaldson K, Poland CA, Murphy FA, MacFarlane M, Chernova T, Schinwald A. Pulmonary toxicity of carbon nanotubes and asbestos - similarities and differences. Adv Drug Deliv Rev. 2013 Dec;65(15):2078-86.
    9. Prazakova S, Thomas PS, Sandrini A, Yates DH. Asbestos and the lung in the 21st century: an update. Clin Respir J. 2014 Jan;8(1):1-10.

    • A Case of Pulmonary Asbestosis - KT Woodsides - Journal of Occupational and Environmental , 1967 - journals.lww.com
    • Asbestos pleurisy - HB Eisenstadt - CHEST Journal, 1964 - journal.publications.chestnet.org
    • Analysis of the differential diagnosis and assessment of pleuritic chest pain in young adults - WT Branch, BJ McNeil - The American journal of medicine, 1983 - Elsevier
    • Asbestos pleural effusion. - EA Gaensler, AI Kaplan - Annals of internal medicine, 1971 - ncbi.nlm.nih.gov
    • A new look at pattern recognition of diffuse pulmonary disease - B Felson - American Journal of Roentgenology, 1979 - Am Roentgen Ray Soc
    • Asbestos exposure, pleural mesothelioma, and serum osteopontin levels - HI Pass, D Lott, F Lonardo, M Harbut - England Journal of , 2005 - Mass Medical Soc
    • Asbestos-associated diseases in a cohort of cigarette-filter workers - JA Talcott, WA Thurber, AF Kantor - England Journal of , 1989 - Mass Medical Soc
    • Chronic pulmonary hypertension‐the monocrotaline model and involvement of the hemostatic system - AE Schultze, RA Roth - and Environmental Health, Part B Critical , 1998 - Taylor & Francis
    • Acute pleurisy in asbestos exposed persons - GK Sluis-Cremer, I Webster - Environmental research, 1972 - Elsevier
    • Assessment of progression of asbestosis in the sheep model by bronchoalveolar lavage and pulmonary function tests. - R Begin, M Rola-Pleszczynski, S Masse, D Nadeau - Thorax, 1983 - thorax.bmj.com
    • A follow-up study of workers from an asbestos factory - PC Elwood, AL Cochrane - British journal of industrial medicine, 1964 - oem.bmj.com
    • Carbon nanotubes introduced into the abdominal cavity of mice show asbestos-like pathogenicity in a pilot study - CA Poland, R Duffin, I Kinloch, A Maynard - Nature , 2008 - nature.com
    • An overview of how asbestos exposure affects the lung - GP Currie, SJ Watt, NA Maskell - BMJ, 2009 - bmj.com
    • Asbestos, asbestosis, pleural plaques and lung cancer - G Hillerdal, DW Henderson - Scandinavian journal of work, environment & , 1997 - JSTOR
    • Case of tuberculous pleurisy with eosinophilic pleural effusion and hematological eosinophilia]. - E Kato, N Yamada, T Sugiura - Kekkaku:[Tuberculosis], 2007 - ncbi.nlm.nih.gov
    • Accelerated loss of lung function and alveolitis in a longitudinal study of non‐smoking individuals with occupational exposure to asbestos - WN Rom - American journal of industrial medicine, 1992 - Wiley Online Library
    • Occupational and paraoccupational history.......................................... 8 3.2 Apply four specific criteria to make the diagnosis of asbestosis.................. 9 3.3 Use - JS Webber - CME - piermedicine.acponline.org
    • [Clinical aspects and prevention of pneumoconiosis caused by inorganic dusts (author's transl)] - WT Ulmer - Praxis und Klinik der Pneumologie, 1979 - ukpmc.ac.uk
    • 24 years of pneumoconiosis mortality surveillance in Australia - DR Smith, PA Leggat - Journal of occupational health, 2006 - J-STAGE
    • [Interrelationships between lipids and scleroproteins in asbestosis and anthracosis] - GV Belobragina, LN El'nichnykh - Gigiena truda i professional'nye , 1978 - ukpmc.ac.uk
    • OBSERVATIONS OF THE DUST CONTENT AND COMPOSITION IN LUNGS WITH ASBESTOSIS, MADE DURING WORK ON COAL MINERS PNEUMOCONIOSIS* - G Nagelschmidt - Annals of the New York Academy of , 2006 - Wiley Online Library
    • Asbestos exposure and neoplasia - IJ Selikoff, J Churg, EC Hammond - Jama, 1964 - faculty.smu.edu
    • A study of the histological cell types of lung cancer in workers suffering from asbestosis in the United Kingdom - F Whitwell, ML Newhouse, DR Bennett - British journal of industrial , 1974 - oem.bmj.com
    • Dust levels and dust-induced diseases in the main dust-producing industries - M Dobreva, T Burilkov, S Ivanova, L Mikhaĭlova - Problemi na , 1990 - ukpmc.ac.uk
    • Black spots concentrate oncogenic asbestos fibers in the parietal pleura. Thoracoscopic and mineralogic study. - C Boutin, P Dumortier, F Rey, JR Viallat - American journal of , 1996 - Am Thoracic Soc
    • [ill] current Cardiac Constriction [ill] ter Pericardiectomy - RA Pick, BC Joswig, CM Bloor - Archives of internal medicine, 1984 - Am Med Assoc
    • Abnormal pulmonary function associated with diaphragmatic pleural plaques due to exposure to asbestos. - KH Kilburn, RH Warshaw - British journal of industrial medicine, 1990 - oem.bmj.com
    • Asbestosis & Asbestos-Related Pleural Disease - ME Hanley, CH Welsh - Current Diagnosis & Treatment in , 2003 - accessmedicine.com
    • A case of pulmonary asbestosis presenting with temporal arteritis involving multiple medium-sized vessels - S Hirata, N Hattori, N Ishikawa, K Fujitaka - Modern , 2008 - Springer
    • Benign asbestos pleural effusion: diagnosis and course. - BW Robinson, AW Musk - Thorax, 1981 - thorax.bmj.com
    • Anesthesiafor congenital heartsurgery Classification, diagnosis and management of drug-induced respiratory disease - JA DINARDO - Drug-Induced and Iatrogenic Lung Disease~ autofilled - books.google.com
    • Asbestosis associated with bronchogenic carcinoma - R STOLL, R BASS, AA ANGRIST - Archives of Internal Medicine, 1951 - Am Med Assoc
    • A diagnostic approach to asbestosis, utilizing clinical criteria, high resolution computed tomography, and gallium scanning - VE Klaas - American journal of industrial medicine, 1993 - Wiley Online Library
    • A case of asbestosis - YS Lee, TW Jang, HD Yu, MH Jung, YH Lee - Korean Journal of , 1999 - KoreaMed
    • Absence of synergism between exposure to asbestos and cigarette smoking in asbestosis. - JM Samet, GR Epler, EA Gaensler - The American review of , 1979 - ncbi.nlm.nih.gov
    • Abnormal spontaneous rosette formation and rosette inhibition in lung carcinoma - RL Gross, A Latty, EA Williams - New England Journal , 1975 - Mass Medical Soc
    • Cement, asbestos, and cement-asbestos pneumoconioses. - G Scansetti, GC Coscia, W Pisani - of environmental health, 1975 - ncbi.nlm.nih.gov
    • Asbestosis: assessment by bronchoalveolar lavage and measurement of pulmonary epithelial permeability. - AR Gellert, JA Langford, RJ Winter, S Uthayakumar - Thorax, 1985 - thorax.bmj.com
    • A rare case of classic biphasic pulmonary blastoma - SM Schulze, S Sbayi, JT Costic - The American , 2005 - ingentaconnect.com
    • Diffuse interstitial pulmonary disease from the perspective of the clinician. - RA DeRemee - Chest, 1987 - chestjournal.chestpubs.org
    • Asbestos fibers in laryngeal tissues - A Hirsch, MD Bignon - Med Sci, 1977 - journal.publications.chestnet.org
    • Centrilobular opacities in the lung on high-resolution CT: diagnostic considerations and pathologic correlation. - JF Gruden, WR Webb - American Journal of , 1994 - Am Roentgen Ray Soc
    • Asbestos induced diffuse pleural fibrosis: pathology and mineralogy. - M Stephens, AR Gibbs, FD Pooley, JC Wagner - Thorax, 1987 - thorax.bmj.com
    • Asbestos bodies in carcinoma of colon in an insulation worker with asbestosis - A Ehrlich, AN Rohl, EC Holstein - JAMA: the journal of the American , 1985 - Am Med Assoc
    • Acute pneumonitis with bilateral pleural effusion after talc pleurodesis. - A Bouchama, J Chastre, A Gaudichet - CHEST , 1984 - journal.publications.chestnet.org
    • Abnormal lung function associated with asbestos disease of the pleura, the lung, and both: a comparative analysis. - KH Kilburn, RH Warshaw - Thorax, 1991 - thorax.bmj.com
    • Cardiac Complications of Progressive Generalized Vaccinia Report of a Case - MC McNalley, Y Qamar - CHEST Journal, 1966 - journal.publications.chestnet.org
    • A case of pneumoconiosis - HE Seiler - British Medical Journal, 1928 - bmj.com
    • 46 Chest Examination - PG TUTEUR - Clinical methods: the history, physical, and , 1990 - ncbi.nlm.nih.gov
    • Asbestos, asbestosis and mesothelioma of the pleura. - WJ Smither - Proceedings of the Royal Society of Medicine, 1966 - ncbi.nlm.nih.gov
    • Absence of synergism between exposure to asbestos and cigarette smoking in asbestosis. - JM Samet, GR Epler, EA Gaensler - The American review of , 1979 - ncbi.nlm.nih.gov
    • Asbestos-induced pleural fibrosis and impaired lung function - DA Schwartz, LJ Fuortes, JR Galvin - American Journal of , 1990 - Am Thoracic Soc
    • Asbestos exposure, pleural mesothelioma, and serum osteopontin levels - HI Pass, D Lott, F Lonardo, M Harbut - England Journal of , 2005 - Mass Medical Soc
    • ASBESTOSIS AMONG HOUSEHOLD CONTACTS OF ASBESTOS FACTORY WORKERS* - HA Anderson, R Lilis, SM Daum - Annals of the New York , 1979 - Wiley Online Library
    • A case of primary malignant pericardial mesothelioma - DD Lagrotteria, B Tsang, LJ Elavathil, CW Tomlinson - Can J Cardiol, 2005 - ukpmc.ac.uk
    • Asbestos exposure, pleural mesothelioma, and serum osteopontin levels - HI Pass, D Lott, F Lonardo, M Harbut - England Journal of , 2005 - Mass Medical Soc
    • Chest radiography in desquamative interstitial pneumonitis: a review of 37 patients - DS Feigin, PJ Friedman - American Journal of , 1980 - Am Roentgen Ray Soc

    Media References

    1. Asbestosis - Fibrous pleural plaque (7468458430), CC BY-SA 2.0

    Languages

    Self-assessment
    Symptoma
      • Hi, this is Symptoma.