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Asbestosis

Asbestosis

Definition

Asbestosis is chronic, progressive inflammation of the lung. It is not contagious.

Description

Asbestosis is a consequence of prolonged exposure to large quantities of asbestos, a material once widely used in construction, insulation, and manufacturing. When asbestos is inhaled, fibers penetrate the breathing passages and irritate, fill, inflame, and scar lung tissue. In advanced asbestosis,, the lungs shrink, stiffen, and become honeycombed (riddled with tiny holes).

Legislation has reduced use of asbestos in the United States, but workers who handle automobile brake shoe linings, boiler insulation, ceiling acoustic tiles, electrical equipment, and fire-resistant materials are still exposed to the substance. Asbestos is used in the production of paints and plastics. Significant amounts can be released into the atmosphere when old buildings or boats are razed or remodeled.

Asbestosis is most common in men over 40 who have worked in asbestos-related occupations. Smokers or heavy drinkers have the greatest risk of developing this disease. Between 1968 and 1992, more than 10,000 Americans over the age of 15 died as a result of asbestosis. Nearly 25% of those who died lived in California or New Jersey, and most of them had worked in the construction or shipbuilding trades.

Causes and symptoms

Occupational exposure is the most common cause of asbestosis, but the condition also strikes people who inhale asbestos fiber or who are exposed to waste products from plants near their homes. Family members can develop the disease as a result of inhaling particles of asbestos dust that cling to workers' clothes.

It is rare for asbestosis to develop in anyone who hasn't been exposed to large amounts of asbestos on a regular basis for at least 10 years. Symptoms of the disease do not usually appear until 15-20 years after initial exposure to asbestos.

The first symptom of asbestosis is usually shortness of breath following exercise or other physical activity. The early stages of the disease are also characterized by a dry cough and a generalized feeling of illness.

As the disease progresses and lung damage increases, shortness of breath occurs even when the patient is at rest. Recurrent respiratory infections and coughing up blood are common. So is swelling of the feet, ankles, or hands. Other symptoms of advanced asbestosis include chest pain, hoarseness, and restless sleep. Patients who have asbestosis often have clubbed (widened and thickened) fingers. Other potential complications include heart failure, collapsed (deflated) lung, and pleurisy (inflammation of the membrane that protects the lung).

Diagnosis

Screening of at-risk workers can reveal lung inflammation and lesions characteristic of asbestosis. Patients' medical histories can identify occupations, hobbies, or other situations likely to involve exposure to asbestos fibers.

X rays can show shadows or spots on the lungs or an indistinct or shaggy outline of the heart that suggests the presence of asbestosis. Blood tests are used to measure concentrations of oxygen and carbon dioxide. Pulmonary function tests can be used to assess a patient's ability to inhale and exhale, and a computed tomography scan (CT) of the lungs can show flat, raised patches associated with advanced asbestosis.

Treatment

The goal of treatment is to help patients breathe more easily, prevent colds and other respiratory infections, and control complications associated with advanced disease. Ultrasonic, cool-mist humidifiers or controlled coughing can loosen bronchial secretions.

Regular exercise helps maintain and improve lung capacity. Although temporary bed rest may be recommended, patients are encouraged to resume their regular activities as soon as they can.

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 101°F (38.3°C) or higher
  • develops unfamiliar, unexplained symptoms

KEY TERMS

Asbestos A silicate (containing silica) mineral that occurs in a variety of forms; it is characterized by a fibrous structure and resistance to fire.

Prognosis

Asbestosis can't be cured, but its symptoms can be controlled. Doctors don't know why the health of some patients deteriorates and the condition of others remain the same, but believe the difference may be due to varying exposures of asbestos. People with asbestosis who smoke, particularly those who smoke more than one pack of cigarettes each day, are at increased risk for developing lung cancer and should be strongly advised to quit smoking.

Prevention

Workers in asbestosis-related industries should have regular x rays to determine whether their lungs are healthy. A person whose lung x ray shows a shadow should eliminate asbestos exposure even if no symptoms of the condition have appeared.

Anyone who works with asbestos should wear a protective mask or a hood with a clean-air supply and obey recommended procedures to control asbestos dust. Anyone who is at risk of developing asbestosis should:

  • not smoke
  • be vaccinated against influenza and pneumonia
  • exercise regularly to maintain cardiopulmonary fitness
  • avoid crowds and people who have respiratory infections

A person who has asbestosis should exercise regularly, relax, and conserve energy whenever necessary.

Resources

BOOKS

Burton, George G., John E. Hodgkin, and Jeffrey J. Ward, editors. Respiratory Care: A Guide to Clinical Practice. 4th ed. Philadelphia: Lippincott, 1997.

ORGANIZATIONS

American Lung Association. 1740 Broadway, New York, NY 10019. (800) 586-4872. http://www.lungusa.org.

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asbestosis

as·bes·to·sis / ˌasbesˈtōsis; ˌaz-/ • n. a lung disease resulting from the inhalation of asbestos particles, marked by severe fibrosis and a high risk of mesothelioma (cancer of the pleura).

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asbestosis

asbestosis (ass-best-oh-sis) n. a lung disease – a form of pneumoconiosis – caused by fibres of asbestos inhaled by those who are exposed to the mineral. See also mesothelioma.

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asbestosis

asbestosis See asbestos.

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Asbestosis

Asbestosis

Asbestos is a fibrous, incombustible form of magnesium and calcium silicate used in making insulating materials. By the late 1970s, over 6 million tons of asbestos were being produced worldwide. About two-thirds of the asbestos used in the United States is used in building materials, brake linings, textiles, and insulation, while the remaining one-third is consumed in such diverse products as paints, plastics , caulking compounds, floor tiles, cement, roofing paper, radiator covers, theater curtains, fake fireplace ash, and many other materials.

It has been estimated that of the eight to eleven million current and retired workers exposed to large amounts of asbestos on the job, 30 to 40 percent can expect to die of cancer . Several different types of asbestos-related diseases are known, the most significant being asbestosis. Asbestosis is a chronic disease characterized by scarring of the lung tissue. Most commonly seen among workers who have been exposed to very high levels of asbestos dust, asbestosis is an irreversible, progressively worsening disease. Immediate symptoms include shortness of breath after exertion, which results from decreased lung capacity. In most cases, extended exposure of 20 years or more must occur before symptoms become serious enough to be investigated. By this time the disease is too advanced for treatment. That is why asbestos could be referred to as a silent killer.

Exposure to asbestos not only affects factory workers working with asbestos, but individuals who live in areas surrounding asbestos emissions. In addition to asbestosis, exposure may result in a rare form of cancer called mesothelioma, which affects the lining of the lungs or stomach. Approximately 510% of all workers employed in asbestos manufacturing or mining operations die of mesothelioma.

Asbestosis is characterized by dyspnea (labored breathing) on exertion, a nonproductive cough, hypoxemia (insufficient oxygenation of the blood), and decreased lung volume. Progression of the disease may lead to respiratory failure and cardiac complications. Asbestos workers who smoke have a marked increase in the risk for developing bronchogenic cancer.

Increased risk is not confined to the individual alone, but there is an extended risk to workers' families, since asbestos dust is carried on clothes and in hair. Consequently, in the fall of 1986, President Reagan signed into law the Asbestos Hazard Emergency Response Act (AHERA), requiring that all primary and secondary schools be inspected for the presence of asbestos; if such materials are found, the school district must file, and carry out an asbestos abatement plan. The Environmental Protection Agency (EPA) was charged with the oversight of the project.

[Brian R. Barthel ]


RESOURCES

BOOKS

Agency for Toxic Substances and Disease Registry. Annual Report. Atlanta, GA: U. S. Department of Health and Human Services, 1989 and 1990.

Nadakavukaren, A. Man & Environment: A Health Perspective. Prospect Heights, IL: Waveland, 1990.

PERIODICALS

Mossman, B. T., and J. B. L. Gee. "Asbestos-Related Diseases." New England Journal of Medicine 320 (29 June 1989): 172130.

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