| Asbestosis is a chronic lung condition caused by inhalation of asbestos particles (also called asbestos dust). A commercial product, asbestos is derived from a naturally occurring group of minerals (silicates) that form strong, flexible, heat- and acid-resistant fibers. Asbestos particles irritate lung tissue when inhaled, resulting in inflammation as the body tries to remove the irritating particles. Prolonged inflammation scars lung tissue (pulmonary fibrosis) and eventually results in decreased lung capacity.
Asbestosis increases the risk of developing lung cancer. Studies have shown that the combination of smoking and asbestos exposure is particularly hazardous. A smoker exposed to asbestos fibers is at least 50 times more likely to develop lung cancer than a nonsmoker exposed to asbestos. The total number (cumulative dose) of fibers inhaled over a period of time and the type, durability, and dimensions of the fiber influence the development of fibrosis and lung cancer, particularly cancer of the lung lining (mesothelioma).
There is a long gap between exposure to asbestosis dust and the onset of symptoms of asbestosis. In fact, it is common for 20 years or more to pass before symptoms are noted. Production of asbestos products peaked in the 1970s and, given the long latency period, the incidence of asbestosis is likely to increase over the next several years. The disease occurs predominantly between the ages of 40 to 75.Risk: Occupations with heavier exposures to asbestos and longer exposure times increase the risk of developing asbestosis. At risk occupations include miners and millers of asbestos, plumbers, pipe fitters, steamfitters, electricians, insulation workers, carpenters, laborers (except construction), supervisors of precision production occupations, boilermakers, welders and cutters, janitors and cleaners. Workers who may not have worked directly with asbestos but whose jobs were located near contaminated areas may also develop asbestosis. However, not all workers exposed to asbestos will develop the disease.
Men have a greater risk than women due to greater occupational exposure. Incidence and Prevalence: Between 1940 and 1979, an estimated 27 million workers were exposed to asbestos fibers ("Asbestos Toxicity"). Development of asbestosis is related to length of time of the exposure. According to one study covering workers in the industry, 10% developed asbestosis at 10 to 19 years, 73% at 20 to 29 years, and 92% at more than 40 years (Chun). In 1992, 959 deaths were attributed to asbestosis, or 6 deaths per 1 million individuals (Chun; Varkey). |
Source: Medical Disability Advisor
| History: The individual may describe a history of exposure to asbestos. However, symptoms may occur long after exposure and the individual may not comprehend the connection. Symptoms may include shortness of breath, a cough or change in cough pattern, blood in fluid coughed up from the lungs (sputum), pain in the chest or abdomen, difficulty in swallowing, prolonged hoarseness, or significant weight loss. Patients may complain of fatigue and increased shortness of breath with activity (dyspnea on exertion). Some individuals will have no symptoms. Physical exam: Listening through a stethoscope (auscultation) may reveal changes in breath sounds (crackling) that indicate inflammatory lung disease. Slight swelling and discoloration of the nail beds (clubbing) may be noted. The skin may appear bluish gray (cyanosis), and signs of right-sided heart failure (prominence of the veins in the neck and swelling of the feet and ankles) may be noted. Tests: Chest x-rays may reveal changes in the lungs. If x-ray films reveal any shadows on the lungs suggestive of early asbestosis, the individual is advised to stop working with asbestos even if no symptoms are present. X-ray evidence of asbestosis may not occur until five or more years after exposure. A high resolution CT scan of the lungs is the best, non-invasive method for diagnosis.
Tests to evaluate lung capacity and function (pulmonary function tests) can assist in the diagnosis. These studies include spirometry and lung volume measurements (to detect any restriction of normal lung expansion or obstruction of air flow), blood gases (to assess the efficiency of gas exchange in the lungs), and diffusing lung capacity (to assess the efficiency of oxygen transportation from the lungs into the blood).
Additional tests include examining fluid obtained from the lungs via a lighted scope (bronchoalveolar lavage). Examining this fluid may rule out diagnosis of other lung infections mimicking asbestosis on chest x-ray. Lung biopsies can be used to identify asbestos bodies in the lung, although performing a biopsy is not necessary for the diagnosis of asbestosis. |
Source: Medical Disability Advisor
| There is no effective cure or treatment for asbestosis. Damage to lung tissue is permanent and often progressive. Oxygen therapy may help minimize symptoms and/or accompanying heart failure (cor pulmonale). Influenza and pneumococcal vaccines are often administered to reduce infection risk. Prompt treatment of other respiratory infections is advised. Smokers should stop smoking. The individual should also be informed of risks and associated signs and symptoms of lung cancer and tuberculosis. In severe or advanced cases of asbestosis, lung transplant may be indicated. |
Source: Medical Disability Advisor
| The outcome of asbestosis depends on the combination of exposure duration, the degree to which the ability of the lungs to take up oxygen is impaired, and the presence or absence of complications. Lung damage is permanent and usually results in some degree of disability. Death is a possibility. If a lung transplant is performed, the condition may be resolved. |
Source: Medical Disability Advisor
| Complications include pneumonia, lung cancer, tuberculosis, decreased function of the right ventricle (right heart failure), cor pulmonale, pulmonary hypertension, progressive pulmonary insufficiency and possibly colon cancer. Surgical complications following lung transplantation include infection, pneumonia, problems with wound closure, medication or anesthesia reaction, and transplant failure or rejection. |
Source: Medical Disability Advisor
| Contact with asbestos dust should be eliminated. Prolonged sick leave may be required in severe cases, particularly if a lung transplant is performed. Individuals whose jobs require strenuous or prolonged exercise or activity may need reassignment to more sedentary duties depending on their lung capacity and oxygenation status, especially when tested during or after exercise. Individuals using oxygen therapy should not work with certain flammable materials. |
Source: Medical Disability Advisor
| If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case. Regarding diagnosis:
- Does individual have a history (either recent or long ago) of exposure to asbestos, particularly in the workplace?
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Does individual smoke or have a history of smoking?
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Does individual complain of shortness of breath, a cough or change in cough pattern, blood in the fluid coughed up from the lungs (sputum), pain in the chest or abdomen, difficulty swallowing, prolonged hoarseness, or significant weight loss?
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Were changes in breath sounds (crackling) in the lungs heard during examination by stethoscope (auscultation)?
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Does individual exhibit slight swelling and discoloration of the nail beds (clubbing)?
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Does skin appear bluish gray?
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Were arterial blood gases (ABGs) drawn to assess the efficiency of gas exchange in the lungs?
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Was chest x-ray abnormal? Were pulmonary function studies done and results analyzed?
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Was the diagnosis of asbestosis confirmed?
Regarding treatment:
- Has further exposure to asbestos been eliminated or minimized through protective measures?
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Has medication to open the airways (bronchodilators) been given? Is individual compliant with the medication regimen?
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Is home oxygen therapy required, based on the severity of symptoms and the blood oxygen level?
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Has individual been counseled about smoking cessation, if appropriate?
Regarding prognosis:
- How long was/has individual been exposed to asbestos?
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How severely impaired are the lungs? If very severe, is individual a candidate for lung transplant?
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Would individual be willing to participate in a smoking cessation program, if appropriate?
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Does individual have underlying illnesses that could prevent improvement?
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Has individual developed pneumonia, tuberculosis, or lung cancer? If any of these complications have occurred, how will they be treated? What is expected outcome with treatment for the complication?
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Source: Medical Disability Advisor
| "Asbestos Toxicity." Agency for Toxic Substances and Disease Registry. Centers for Disease Control and Prevention. 12 Oct. 2004 <http://www.atsdr.cdc.gov/HEC/CSEM/asbestos/who%27s_at_risk.html>.Chun, Sam, and William B. Dawson. "Asbestosis." eMedicine. Eds. Judith K. Amorosa, et al. 11 Aug. 2004. Medscape. 12 Oct. 2004 <http://emedicine.com/radio/topic52.htm>. Varkey, Basil. "Asbestosis." eMedicine. Eds. Sat Sharma, et al. 11 Nov. 2004. Medscape. 12 Oct. 2004 <http://emedicine.com/med/topic171.htm>. |
Source: Medical Disability Advisor
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