Asbestosis 
Dean Bartholomew - Andrea Gainey - Wason Louie - Charlie Phillips - Noel Sonnek Asbestosis Historical Aspects Asbestos is a group of silicate fibers with a crystalline structure. These naturally occurring fibers have been mined and used for about the last 100 years with peak use in the 1970’s. At that time adverse health effects were widely associated with the use of asbestos. Although asbestos use has drastically declined in the United States, it continues to be used in developing countries. Of importance is the fact that the negative health effects associated with asbestos may take years to develop. Thus, workers exposed years ago and even people within close contact of workers (family members who may inhale asbestos fibers from worker’s clothing) may begin to encounter the symptoms of asbestos-related disease today. Asbestos is a serious threat to one’s health because it can cause severe forms of lung disease. One form of disease and the topic of this pamphlet is asbestosis. Asbestosis is a fibrosis or scarring of the lung tissue. The lung is made of a delicate tissue which allows the blood to pick up oxygen and drop off carbon dioxide. As can be imagined, scarring of the lung tissue decreases the ability of the lung to exchange these gases. Second, one’s chances of developing a tumor or cancer of the lung is five times greater than normal if exposed to asbestos. If the lung is also subjected to the deleterious effects of smoking on top of the asbestos exposure, one’s chance of developing cancer is about 55 times greater than normal. Incidence and Cause 
When people inhale air, it always contains small particles. These particles have to be filtered out because the lungs need to remain sterile. The nose and the bronchi (the airways leading down to the lungs) are the main air filters for the lungs. Asbestos particles (called amphiboles) are long, extremely thin, microscopic glass-like fibers that are not filtered by the nose or the bronchi because they are so thin and light. Asbestosis development starts when a person inhales an amphibole. This particle travels deep into the lungs to one of the 300 million gas exchanging structures called an alveolus. Each alveolus has many cleaning cells called macrophages that eat up any particles that made it down to the alveoli. Unfortunately the macrophages can not eat the amphibole because it is too long, but they still try. In trying to eat this particle the macrophage essentially cuts itself open and the digestive molecules that were contained inside the macrophage have now spilled on the alveolus. These molecules injure the alveolus and cause it to form a scar. This scarring formation is called fibrosis. The same amphibole that could not be eaten attracts other macrophages from neighboring areas. They try to eat the particle and also fail, and this further damages the lungs. In reality, people who are exposed to asbestos inhale hundreds and thousands of amphiboles, which causes large-scale injury. Such large-scale injury is when major lung damage (fibrosis) develops and is named "Asbestosis" after the disease-causing particle. Asbestosis is found in people who are chronically exposed to asbestos material. Those who are at the highest risk are the people who directly handle asbestos material at their job. This group includes vehicle mechanics, construction workers, shipyard workers, electricians and other workers in the building trades. Of importance to workers in the United States is the fact that old asbestos can be encountered during refurbishing and demolition of old buildings or other structures in which asbestos is still found. Exposure to asbestos is not limited to those who directly handle the material. The painter who works with the construction worker or the construction worker’s wife who shakes out her husband’s clothes have also been known to be at risk for developing asbestosis. A study conducted on Finnish asbestos workers who either worked construction for ten years or worked in shipyards for one year showed that 22% of the workers showed signs of asbestosis development. If one examines the entire population of a country instead of just those at high risk, Asbestosis is a relatively uncommon disease.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 individual’s 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. Works Cited Fig.1 "Respiratory System Web Quiz 2". Creighton University School of Medicine Web Site. http://medicine.creighton.edu/medschool/M2courseware/RespiratoryStuff/RespQuiz2/RespQuiz2.html Fig.2 "Malignant Pleural Mesothelioma". Radiological Society of North America Web Site. http://www.rsna.org/REG/publications/rg/afip/privateM/1996/0016/0003/0613/F3aA.htm
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