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Asbestosis



This disease is caused by inhaling asbestos fibers.

Asbestos is a silicate mineral, its fibers are durable, chemically inert and heat-resistant. So due to this reasons asbestos can be an excellent building material. It was widely used in fireproofing, insulation and other materials until 1960s.

So asbestos has excellent physical properties except one: inhaling asbestos fibers are extremely dangerous for health. During renovation or demolition Asbestos Containing Materials (ACM) are disturbed so it can be very dangerous for those who work around ACM. The asbestos fibers penetrate into the lungs, causing scar tissue by making tiny cuts in the alveoli (air sacs), thus decreasing the amount of oxygen that the lungs can process. The more the person is exposed to Asbestos Containing Materials (ACM) the more level of damage to the lungs and the more the risk of developing. Asbestos-related lung diseases include mesothelioma, asbestosis and lung cancer.

The main cause of asbestosis is, as it can be seen out of its name, inhalation of asbestos dust. It is necessary to notice that asbestosis is not a cancer. The process of asbestosis development is not yet fully known, but most likely that asbestos fibers in the lungs cause inflammation and irritation. There are various complex ways in body to neutralize these foreign fibers and most of these processes lead to further cell damage and inflammation. Eventually scar tissue appears around the small airways and alveoli in the interstitial spaces and this scarring in its turn hinders carbon dioxide and oxygen from traveling between the blood cells and the alveoli. Effectiveness of breathing drops greatly.

Usually asbestosis can be detected only by x-ray because it often exists without any symptoms. Shortness of breath and coughing are the most common symptoms of asbestosis. As time goes by symptoms can worsen. Even after exposure to asbestos has stopped it can continue to progress. There are rare evidences that it also can be lethal.

X-rays and CT scans can be used to detect scarring and thickening. Breathing or pulmonary function test (PFT) can also help to detect asbestosis.

Asbestosis can be diagnosed only when there is a positive results from a clinical exam, CT scans, chest x-rays, and/or a pulmonary function test (PFT.) and there was a history of asbestos exposure. It is also easy to detect asbestosis through a biopsy.

Asbestosis is usually widespread (diffuse) and can be found in the lower fields of the lungs in both lungs.

The heavier and longer was the exposure to asbestos the more serious asbestosis can develop. But it only means that everyone who gets asbestosis was exposed to large quantities of asbestos fibers and it does not mean that everyone who was heavily exposed to asbestos gets asbestosis. The development of asbestosis does not depend on the specific type of asbestos fiber to which the worker was exposed.

By now there is no effective treatment for asbestosis. There is also a very high risk of development of mesothelioma in people with asbestosis.

Symptoms

It is very difficult to diagnose asbestosis because the effects of long-term exposure to asbestos typically show up only in 20 to 30 years after the first exposure. The damage and scarring caused by the asbestos fibers lead to stiffness and only after this signs and symptoms begin to develop in your lung tissue. The result is that your lungs can't contract and expand normally. This is one of the forms of pulmonary fibrosis.

Some of the signs and symptoms of asbestosis include:

  • Shortness of breath, initially only with exertion, but eventually even while resting
  • Decreased tolerance for physical activity
  • Coughing
  • Chest pain
  • Finger clubbing in some cases

The symptoms of asbestosis are similar to asthma, but the way of its development is not not same. It is also a very insidious disease, which symptoms appear in months and years.

Anatomy

Asbestosis can develop like mild coarsening of the lung parenchyma or honeycombing. Under microscopic, one can see complete distortion of lung architecture by thick fibrosis and cystic spaces or mild increase in interstitial collagen depending on the stage. Discrete areas of fibrosis in the walls of proximal respiratory bronchioles are the earliest histologic findings of asbestosis. As time goes by more distal bronchiolar and alveolar interstitium and greater portions of the lung are become involved.

Diffuse interstitial fibrosis and asbestos bodies can be detected during the microscopic diagnosis of asbestosis. Inhaled asbestos exists in lungs either as coated with a protein-iron matrix and uncoated fibers or asbestos bodies, which are fibers that have been phagocytized. Asbestos bodies are readily detected with conventional light microscopy instead of uncoated fibers that are visible only under electron microscopy. Usually it is necessary to detect more than one asbestos body to diagnos asbestosis.

However, the total asbestos burden in the lung is not only asbestos bodies. Besides a patient with heavy exposure sometimes don't have any detectable asbestos bodies. So we can say that the presence of asbestos bodies is quite a considerable marker. But their absence shouldn't mean that there is no asbestosis. It is very difficult to distinguish the lung fibrosis seen in asbestosis from that of other interstitial diseases. The only way to do it is to find the presence of asbestos bodies. Another distinction of lymphadenopathy is that progressive massive fibrosis trend not to occur.

Treatment

There are several goals of treatment. The first one is to help patients breathe more easily. Also very important to control complications associated with advanced disease and to prevent colds and other respiratory infections. The way to loosen bronchial secretions is to use ultrasonic, cool-mist humidifiers or controlled coughing. Regular exercise can also help to improve lung capacity. Patients are encouraged to resume their regular activities as soon as they can. However sometimes temporary bed rest may be recommended.

To combat infection antibiotics should be prescribed. Also bronchodilators that are swallowed or inhaled can be prescribed to relax and widen breathing passages and aspirin or acetominophen (Tylenol) to relieve minor discomfort.

Sometimes it is useful to prescribe diuretics (drugs that increase urine production and excretion) or digitalis glycoside (Digitalis purpurea).

Anyone who develops symptoms of asbestosis should see a family physician or lung disease specialist. A doctor should be notified if someone who has been diagnosed with asbestosis:

  • coughs up blood
  • continues to lose weight
  • is short of breath
  • has chest pain
  • develops a sudden fever of 101F (38.3C) or higher
  • develops unfamiliar, unexplained symptoms

Prognosis

It is possible to control the symptoms of asbestosis but it can't be cured. By now it is difficult to say why the health of some patients remain the same and the condition of others deteriorates. The possible reason is the difference in exposure of asbestos. People who smoke more than one pack of cigarettes each day, are in the high risk group for developing lung cancer. This patients must be advised to give up smoking.

Prevention

It is obligatory to have regular x rays to determine whether lungs of workers in asbestosis-related industries are healthy. It is necessary to eliminate asbestos exposure if a shadow was detected in X-Ray even if there are no symptoms of the condition.

A protective mask or a hood with a clean-air supply should be also used. Workers in asbestosis-related industries must obey all recommended procedures that help to control asbestos dust. Here are recommendations for those who are at risk of developing asbestosis:

- to maintain cardiopulmonary fitness by regularly exercises

- quit smoke

- be vaccinated against influenza and pneumonia

- avoid the possibility of contacting with respiratory infections

Mortality

It is very difficult to calculate the death rate from asbestosis because it is confounded by deaths from lung cancer and mesothelioma or any-asbestos diseases. The asbestosis mortality rate is increasing each year. For examples in the USA it was 0.49 per million persons in 1970 and increased to 3.06 in 1990. The peak of mortality from asbestosis occurred in mid-1990s and then started to decline because of decreasing asbestos use and stricter work regulations since the 1970s. According to recent reports clinical asbestosis is decreasing in frequency and severity but the asbestos-related lung cancer deaths remains on the same level.

The US National Center for Health Statistics reports the number of asbestosis deaths from 1968-1992 in US residents aged 15 years and older as follows:

  • From 1968-1978 - 1359 total deaths
  • From 1979-1990 - 6856 total deaths
  • In 1991 - 946 total deaths
  • In 1992 - 959 total deaths
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