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Asbestosis

Asbestosis Signs and Symptoms

The signs and symptoms of asbestosis can show up many years after the asbestos exposure has ended. Manifestations rarely occur less than 10 years following first exposure and are more common after 20 years or more.

Symptoms (what a patient with asbestosis will experience)

  • Shortness of breath.
  • Asbestosis has been called a monosymptomatic disease because the earliest, most consistently reported, and most distressing symptom is shortness of breath.
  • Occurs with heavy effort and then progressively diminishing levels of effort as the disease becomes worse.
  • Persistent and productive cough.
  • Almost as common as the shortness of breath.
  • Often occurs with distressing spasms.

Other symptoms include:

  • Chest tightness, Chest pain, General ill feeling, Fitful sleep, Hemoptysis, Appetite loss.

Signs (what your doctor will look for with asbestosis)

  • Basal crackles or rales. When a stethoscope is used to listen to the lower lungs, you can hear what sounds like Velcro opening up.
  • An early distinctive feature of asbestosis.
  • Usually heard first over the basal regions.
  • Persistent (unaffected by coughing)
  • Precise timing (at first, mid to late inspiration and eventually during most of inspiration)
  • High pitched quality.
  • Small irregular opacities on X-ray (Looks like ground glass).
  • Obscures normal lung vasculature.
  • Usually first seen in the lower lateral lobes in between the rib shadows.
  • Borders of the heart, particularly the left side may be obscured.
  • Pulmonary function tests usually show restrictive disease but can also show obstructive and mixed disorders. This means that your lungs will lose the ability to breathe.
  • Reduced diffusion capacity.
  • Reduce lung volumes and capacities
  • Reduced flow rates.
  • Clubbing of fingers and toes. Swelling of the fingers and toes due to excess blood accumulating there.

None of these symptoms are specific. Something as benign as the common cold could also give you these symptoms. Keep in mind that asbestosis is a chronic progressive disease meaning that once these symptoms start, they generally do not get better. Fortunately, the disease progresses slowly giving your doctor time to catch it.

Treatment and Prevention

Treatment

Unfortunately, there currently is no cure for asbestosis. The treatment involves preventing further complications of the disease and treating its symptoms.

Prevention

A patient with asbestosis must first prevent any further contact with asbestos and if they are a smoker they should be advised to quit.

The asbestosis patient should receive aggressive medical care for any respiratory infection, with frequent use of antibiotics when warranted. Vaccinations for the flu and pnuemococcus should be kept up to date. They should also participate in respiratory therapies such as bronchial drainage or the use of an ultrasonic mist humidifier that assist in the clearing of secretions from the lungs. Patients should avoid situations that may expose them to respiratory infections such as large crowds. These steps should help to avoid the complications of serious lung infections. Finally, the asbestosis patient should undergo regular chest x-rays to screen for cancers associated with asbestosis.

Symptomatic Treatment

Shortness of breath is treated with bronchodilators that open up the bronchial tubes and allow passage of air. The patient may also receive supplemental oxygen. Respiratory treatments that remove secretions from the lung through postural drainage may also be used.

Productive cough is treated with humidifiers, breathing therapies and chest percussion. These therapies loosen and thin out bronchial secretions allowing them to be expelled by the cough. Chest pain can be treated with normal over the counter drugs such as acetaminophen or ibuprofen.

Prognosis

Once asbestosis has been established by findings on chest X-ray, regression of the disease is rare. The disease may remain unchanged, but it is generally slowly progressive due to accumulating damage caused by asbestos fibers in the lung. Rapid progression after the onset of symptoms is rare. Evidence of progression as seen on chest X-ray may require comparison of chest X-rays taken as many as 4-6 years apart.

There are several factors that determine progression, including the level and duration of exposure to asbestos, cumulative exposure, the type of asbestos fiber, and according to some studies, the status of the chest X-ray at the time of diagnosis. Progression will occur even in the absence of further exposure to asbestos, and it will likely be accelerated in the face of continued exposure.

As the disease progresses, the individualís shortness of breath becomes more pronounced. The shortness of breath initially experienced during heavy effort will be produced by lower levels of effort. It will eventually interfere with the ability to carry out everyday activities, and the individual may require oxygen. The end result of progression is failure of the lungs and eventual heart failure, resulting from the stress being placed on the heart.

Increased risk of infection may be a complication of asbestosis, although tuberculosis is uncommon. Individuals with asbestosis are at a considerably increased risk for developing lung cancer and other cancers associated with asbestos exposure, including mesothelioma and bronchogenic carcinoma.

There are certain measures a patient can take to slow the progression of the disease and prolong life. As mentioned previously, one way is to avoid further exposure to asbestos. Another thing is to stop smoking. Smoking may increase the rate of disease progression, and it definitely increases the risk of developing lung cancer.

Severe asbestosis is becoming a less common cause of death. More people are dying of other causes before their asbestosis progresses beyond the mild to moderate stage.

Definition:

Asbestosis is a respiratory disease caused by inhaling asbestos fibers. Asbestosis is one form of lung disease related to asbestos inhalation. Inhalation of asbestos fibers can cause a variety of diseases, from thickening of the lining of the lungs, which is usually asymptomatic, to malignant mesothelioma (a cancer arising from the lining of the lung).

Alternative Names:

Pulmonary fibrosis - from asbestos exposure; Idiopathic interstitial pneumonitis - from asbestos exposure

Causes, incidence, and risk factors:

Inhaling asbestos fibers can cause scar tissue (fibrosis) to form inside the lung. Scarred lung tissue does not expand and contract (elasticity) normally. The severity of the respiratory disease depends upon the duration of exposure and the amount inhaled.

Asbestos fibers were commonly used in construction before 1975. Asbestos exposure occurs from asbestos mining and milling industries, construction, fireproofing, and other industries. In families of asbestos workers, exposure can also occur from particles brought home in the worker's clothing. Asbestos-related disease includes pleural plaques (calcification), malignant (cancerous) tumor called mesotheliomas--see mesothelioma (malignant), and pleural effusion. Mesotheliomas may develop 20 to 40 years after exposure. More than 9 million workers are at risk of developing this disease. Cigarette smoking increases the risk of developing the disease. The incidence is 4 out of 10,000 people.

Symptoms:

  • shortness of breath on exertion
  • cough
  • tightness in the chest
  • chest pain
  • nail abnormalities or clubbing of fingers may occur

Signs and tests:

  • Listening to the chest with a stethoscope (auscultation) reveals a crackling sound.

These tests also help diagnose the disease:

  • a chest X-ray
  • pulmonary function tests
  • a CT scan of the lungs

This disease may also alter the results of the following test:

  • ACE levels

Treatment:

There is no cure available. Stopping further exposure to asbestos is indicated. Supportive treatment of symptoms includes respiratory treatments to remove secretions from the lungs by postural drainage, chest percussion, and vibration. Aerosol medications to thin secretions may be prescribed. Oxygen by mask or by a plastic piece that fits into the nostrils (cannula) may be needed.

Support Groups:

The stress of illness can often be helped by joining a support group where members share common experiences and problems.

Expectations (prognosis):

The outcome depends upon the duration and extent of the exposure;
mesotheliomas have a poor prognosis (probable outcome) with 75% of those affected dying within 1 year.

Complications:

  • mesothelioma (malignant)
  • pleural effusion

Calling your health care provider:

Call for an appointment with your health care provider if exposure to asbestos is suspected or if unexplained symptoms occur.

Prevention:

Early screening by chest X-ray of people who are exposed to asbestos.

 

 
 

 

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