• Clinical science

Asbestosis

Summary

Asbestosis is a type of pneumoconiosis caused by the inhalation of asbestos fibers and occurs primarily as a result of occupational exposure. After a long latency period, this condition manifests with nonspecific symptoms, e.g., coughing and dyspnea, which are caused by fibrotic changes in the lungs. The diagnosis is established based on a history of occupational exposure (such as working with textiles, cement, ship-building, insulation) and characteristic changes on chest x-ray (reticular opacities and pleural plaques). Currently, there is no curative treatment for asbestosis. Management consists of measures that provide symptomatic relief like oxygen therapy, prompt antimicrobial treatment of respiratory infections, cessation of exposure, and immunization against influenza and pneumococcal pneumonia. Long-term exposure to asbestos can lead to complications like fibrosis, respiratory failure, and malignancy (especially bronchogenic carcinoma, and mesothelioma). Pleural effusion may be the first sign of a malignant mesothelioma. A combination of chemotherapy, surgery, and/or radiation therapy is used to manage malignant mesothelioma. The prognosis of patients with malignant mesothelioma is poor, with the mean survival time being ∼ 1 year.

Etiology

  • Type of pneumoconiosis caused by inhalation of asbestos fibers
  • Risk factors
    • Occupations involving the manufacture or demolition of ships, plumbing, roofing, insulation, heat-resistant clothing, and brake lining
    • Smoking

References: [1][2]

Pathophysiology

A high cumulative dose of asbestos is associated with a higher incidence of asbestosis. In smokers, the disease progresses more rapidly because mucociliary clearance is impaired.

References: [1]

Clinical features

References: [1][3]

Diagnostics

Although asbestos is commonly found in roofing materials, it predominantly affects the lower lobes of the lungs.

References:[5][1][3]

Treatment

References: [3]

Complications

Mesothelioma

Other

The most common malignancy associated with asbestosis is bronchogenic carcinoma, not mesothelioma!

References:[9][10]

We list the most important complications. The selection is not exhaustive.

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  • 3. Kasper DL, Fauci AS, Hauser S, Longo D, Jameson LJ, Loscalzo J . Harrisons Principles of Internal Medicine . New York, NY: McGraw-Hill Medical Publishing Division; 2016.
  • 4. International Labour Office. Guidelines for the use of the ILO International Classification of Radiographs of Pneumoconioses, Revised edition 2011. https://www.ilo.org/wcmsp5/groups/public/---ed_protect/---protrav/---safework/documents/publication/wcms_168260.pdf. Updated November 17, 2011. Accessed September 23, 2020.
  • 5. Norbet C, Joseph A, Rossi SS, Bhalla S, Gutierrez FR. Asbestos-Related Lung Disease: A Pictorial Review. Curr Probl Diagn Radiol. 2015; 44(4): pp. 371–382. doi: 10.1067/j.cpradiol.2014.10.002.
  • 6. Di Salvo M, Gambaro G, Pagella S, Manfredda I, Casadio C, Krengli M. Prevention of malignant seeding at drain sites after invasive procedures (surgery and/or thoracoscopy) by hypofractionated radiotherapy in patients with pleural mesothelioma. Acta Oncol (Madr). 2008; 47(6): pp. 1094–1098. doi: 10.1080/02841860701754182.
  • 7. Huang W-J, Li Z-H, Wang Z, Yang M-Q, Xu H-T. Primary malignant mesothelioma of the diaphragm with liver invasion. Medicine. 2019; 98(15): p. e15147. doi: 10.1097/md.0000000000015147.
  • 8. Bibby AC, Tsim S, Kanellakis N, et al. Malignant pleural mesothelioma: an update on investigation, diagnosis and treatment. European Respiratory Review. 2016; 25(142): pp. 472–486. doi: 10.1183/16000617.0063-2016.
  • 9. Arif Q, Husain AN. Malignant Mesothelioma Diagnosis. Arch Pathol Lab Med. 2015; 139(8): pp. 978–980. doi: 10.5858/arpa.2013-0381-ra.
  • 10. Newman LS. Mesothelioma. http://www.merckmanuals.com/professional/pulmonary-disorders/environmental-pulmonary-diseases/mesothelioma. Updated May 1, 2014. Accessed February 14, 2017.
  • Lemen R, Landrigan P. Toward an Asbestos Ban in the United States. Int J Environ Res Public Health. 2017; 14(11): p. 1302. doi: 10.3390/ijerph14111302.
last updated 09/23/2020
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