Asbestosis is a chronic inflammatory medical condition affecting the
parenchymal tissue of the lungs. It occurs after long-term, heavy exposure to asbestos, e.g. in
mining, and is therefore regarded as an occupational
lung disease. Sufferers have severe dyspnea (shortness of breath) and are at an increased
risk regarding several different types of lung cancer.
As clear explanations are not always stressed in non-technical literature, care should be taken to distinguish between several
forms of relevant diseases. According to the World Health Organisation (WHO), these may defined as; asbestosis (the subject of this
article), lung cancer, and mesothelioma
(generally a very rare form of cancer, but increasing in frequency as people exposed to asbestos age).
Signs and symptoms
The primary symptom of asbestosis is generally the slow onset of shortness of breath on
exertion.[1] In severe, advanced cases, this
may lead to respiratory failure. Coughing is not
usually a typical symptom, unless the patient has other, concomitant respiratory tract diseases.
People with extensive occupational exposure to the mining, manufacturing, handling or removal of asbestos are at risk of
developing asbestosis.[2] There is also an
increased risk of lung cancer and mesothelioma.
Asbestosis and lung cancer require prolonged exposure to asbestos. However, cases of mesothelioma have been documented with even
1-3 months of exposure,[3][4] and only indirect exposure (through air ventilation
system.) Most cases of asbestosis do not present until 5-10 years after exposure to the material.
Pathogenesis
Asbestosis is the scarring of lung tissue (around terminal bronchioles and alveolar ducts) resulting from the inhalation of
asbestos fibers.[5] There are two types of fibers, amphibole (thin and straight) and serpentine (curved). The
former are primarily responsible for human disease as they are able to penetrate deeply into the lungs. When such fibers reach
the alveoli (air sacs) in the lung, where oxygen is transferred into the blood, the foreign bodies (asbestos fibers) cause the
activation of the lung's local immune system and provoke an inflammatory reaction. This inflammatory reaction can be described as
chronic rather than acute, with a slow ongoing progression of the immune system in an attempt to eliminate the foreign fibres.
Macrophages phagocytose (ingest) the fibers and stimulate fibroblasts to deposit connective tissue. Due to the asbestos fibres' natural resistance to digestion, the
macrophage will die off, releasing certain cytokines and attracting further lung macrophages
and fibrolastic cells to lay down fibrous tissue, which eventually forms a fibrous mass. The result is interstitial fibrosis. The
fibrotic scar tissue causes alveolar walls to thicken, which reduces elasticity and gas diffusion, reducing oxygen transfer to
the blood as well as the removal of carbon dioxide.
Asbestosis presents as a restrictive lung disease. The total lung capacity (TLC) may be
reduced through alveolar wall thickening. In the more severe cases, the drastic reduction in lung function due to the stiffening
of the lungs and reduced TLC may induce right-sided heart failure (cor pulmonale).[6][7]
More than 50% of people affected with asbestosis develop plaques in the parietal
pleura, in the space between the chest wall and lungs. Clinically, patients present with dry inspiratory crackles,
clubbing of the fingers, and a diffuse fibrotic pattern in the lower lung lobes (where
asbestosis is most prevalent).
Treatment
There is no curative treatment [8].
Oxygen therapy at home is often necessary to relieve the shortness of breath. Supportive
treatment of symptoms includes respiratory physiotherapy to remove secretions from the
lungs by postural drainage, chest percussion, and vibration. Nebulized medications to thin
secretions may be prescribed.
Legal issues
-
The first lawsuits against asbestos manufacturers were in 1929. Since then, many lawsuits have been filed against asbestos
manufacturers and employers [8] , for
neglecting to implement safety measures after the link between asbestos, asbestosis and mesothelioma became known (some reports
seem to place this as early as 1898 in modern times). The liability resulting from the sheer
number of lawsuits and people affected has reached billions of dollars. The amounts and method of allocating compensation have
been the source of many court cases, and government attempts at resolution of existing and future cases.
See also
References
- ^ Pathology of Asbestos-Associated Diseases, Victor L. Roggli,
Tim D. Oury and Thomas A. Sporn, Springer, ISBN 0-387-20090-8
- ^ Becklake MR. Asbestos-related diseases of the lung and
other organs: Their epidemiology and implications for clinical practice. Am Rev Respir Dis 1976;114:187-227
- ^ Occupational Characteristics of Cases with Asbestos-related
Diseases in The Netherlands, ALEX BURDORF, MOHSSINE DAHHAN, and PAUL SWUSTE, Ann. Hyg., Aug 2003; 47: 485 - 492.
- ^ HYGIENE STANDARDS FOR AIRBORNE AMOSITE ASBESTOS DUST: BRITISH
OCCUPATIONAL HYGIENE SOCIETY COMMITTEE ON HYGIENE STANDARDS, Committee on hygiene standards:, J. Glover, J. M. Barnes, D. Turner,
S. A. Roach, D. E. Hickish, Sub-committee on asbestos:, J. C. Gilson, C. G. Addingley, G. Berry, S. Holmes, R. Hunt, H. C.
Lewinsohn, S. G. Luxon, W. J. Smither, and S. A. Roach, Ann. Hyg., April 1973; 16: 1 - 5.
- ^ Asbestosis: A Medical Dictionary, Bibliography, And
Annotated Research Guide, Icon Health Publications, ISBN 0-597-84339-2
- ^ Asbestos content of lung tissue and carcinoma of the lung: a
clinicopathologic correlation and mineral fiber analysis of 234 cases, Victor L. Roggli and Linda L. Sanders, Ann. Hyg., Apr
2000; 44: 109 - 117.
- ^ An Expert System for the Evaluation of Historical Asbestos
Exposure as Diagnostic Criterion in Asbestos-related Diseases, Alex Burdorf and Paul Swuste, Ann. Hyg., Jan 1999; 43: 57 -
66.
- ^ a b Asbestos: Medical and Legal Aspects, Fifth Edition, Barry I. Castleman,
Aspen Publishers, ISBN 0-7355-5260-6
External links
|
Pathology of respiratory
system (J, 460-519) |
| Acute upper respiratory infections |
Upper respiratory tract infection ·
Common cold · Rhinitis ·
Sinusitis · Pharyngitis (Strep throat) · Tonsillitis ·
Laryngitis · Tracheitis · Croup · Epiglottitis |
| Influenza and Pneumonia |
Influenza · Pneumonia
(Viral, Bacterial, Bronchopneumonia) · Severe acute respiratory syndrome |
| Other acute lower respiratory infections |
Bronchitis
(Acute, Chronic) · Bronchiolitis |
| Other diseases of upper respiratory
tract |
Vasomotor rhinitis · Hay
fever · Atrophic rhinitis · Nasal polyp ·
Deviated septum · Adenoid hypertrophy · Peritonsillar abscess · Vocal fold
nodule · Laryngospasm |
| Chronic lower respiratory diseases |
Emphysema · COPD · Asthma ·
Status asthmaticus · Bronchiectasis |
| Lung diseases due to external
agents |
Pneumoconiosis (Coalworker's pneumoconiosis,
Asbestosis, Silicosis, Bauxite fibrosis, Berylliosis, Siderosis) · Byssinosis · Hypersensitivity pneumonitis (Farmer's lung, Bird fancier's lung) |
Other, principally affecting
the interstitium |
Acute respiratory distress syndrome · Pulmonary
edema · Hamman-Rich syndrome · Interstitial lung disease |
Suppurative
and necrotic conditions
of lower respiratory tract |
Lung abscess ·
Pleural effusion · Empyema |
| Other |
Pneumothorax · Hemothorax ·
Hemopneumothorax · Mendelson's syndrome · Respiratory failure · Atelectasis ·
Mediastinal emphysema · Mediastinitis |
| see also congenital (Q30-Q34, 748) |
This entry is from Wikipedia, the leading user-contributed encyclopedia. It may not have been reviewed by professional editors (see full disclaimer)
