asbestosis

Asbestosis: description

Asbestosis occurs when lung tissue is abnormally altered by inhaled asbestos dust. It is one of the inorganic dust fumes. According to the World Health Organization, those asbestos fibers that are over five microns long and less than three microns in diameter are particularly dangerous. By inhaling such fiber dust, the connective tissue of the lung is scarred and hardened. Experts speak of fibrosis during this rebuilding process. This pulmonary fibrosis worsens over time, which is why asbestosis is one of the malignant pneumoconiosis diseases.

What is asbestos?

Asbestos describes a group of fibrous, crystallized, siliceous minerals. It is mined in the mining underground or overground. White asbestos (chrysotile), which is used in industry, is particularly common. In addition, there are blue and brown asbestos and other asbestos-like minerals.

Asbestos was industrially processed in many products during the 19th and 20th centuries. Asbestos was used early on to make fireproof protective clothing. In addition, it was also part of roof shingles, cladding, electrical equipment, piping, toothpaste and refractory insulation materials. In the period between 1950 and 1985, 4.4 million tons of asbestos were consumed in West Germany alone, even though at the turn of the century they had recognized the damaging and, above all, carcinogenic effects. In 1995, the use of asbestos was finally banned.

Asbestosis by work

In most cases, certain occupational groups are exposed to more harmful asbestos fibers. Therefore, asbestosis is one of the recognized occupational diseases. It is notifiable. In Germany, more than 17,000 occupational diseases caused by asbestos have been recognized since 1978.

Worldwide, approximately 100 000 deaths per year are asbestos and its sequelae. An average of 30 years elapse between pronounced asbestos exposure and the occurrence of malignant growths in the lungs, lung, larynx or pericardium. Experts predict that the number of asbestosis diseases will increase significantly by the year 2020.

Asbestosis: symptoms

If the lung tissue has changed as a result of the inhaled asbestos fibers, the first symptoms appear. Their severity depends on the extent of pulmonary fibrosis.

pulmonary fibrosis

The most progressive pulmonary fibrosis leads to irritable cough with a tough expectoration and shortness of breath. First of all, those affected get less air, especially when they make an effort (exercise dyspnea). In the later course of the respiratory distress can also occur during rest periods (Ruhedyspnoe). Due to the modified lung tissue of asbestosis, less oxygen can pass into the blood. As a result, the signs of asbestosis also become visible externally. The finger tips thicken and resemble the shape of drumsticks. The skin, especially the oral mucosa, lips and finger tips, turn bluish.

mesothelioma

The mesothelium is a kind of skin that lines the chest and abdomen as well as the pericardium. It produces a liquid that, as a kind of lubricant, facilitates the movement of the individual organs against each other. As a result of an asbestos load degenerates most often the skin that rests on the ribs and covers the lung as a lung fur. Less common are growths of the peritoneum (peritoneum).

In the case of so-called pleural mesothelioma, patients suffer from slowly increasing chest pain (thorax), which can spread to the neck, shoulder or arm. There is also a dry cough and shortness of breath. Those affected feel choppy, have a fever and lose weight. Some sweat at night so much that they have to change the nightgown or the sheets. Mesothelioma of the peritoneum is accompanied by abdominal pain and abdominal water.

Lung cancer and throat cancer

Patients with lung cancer often suffer from a persistent cough and shortness of breath. Some patients feel chest pain. A bloody sputum is one of the late signs of lung cancer. Those affected complain of mild fever, sweat extremely at night and lose weight.

The throat cancer manifests itself mostly by hoarseness and a feeling of pressure in the throat. In order for the two cancers to be recognized as occupational diseases caused by asbestos, physicians must prove so-called bridging symptoms. That is, the cancer occurs with other manifestations of asbestos disease.

Asbestos exposure at the workplace

Proven asbestos exposure at the workplace of at least 25 fiber years confirms lung cancer as an occupational disease. “Fiber years” is a medical term. He indicates the risk for those affected by cancer of inhaled asbestos fibers. One fiber year corresponds to one million asbestos fibers per cubic meter of respiratory air over the period of one working year. For example, if a worker has inhaled two million asbestos fibers in one year, two fiber years are counted. The risk of lung cancer doubles at about 25 fiber years. In mesothelioma, however, there is no direct relationship to the number of inhaled fibers.

Asbestosis: causes and risk factors

Asbestosis is produced by inhaling asbestos-containing dust and settling in the lung tissue, especially in the alveoli. From there, the asbestos fibers enter the connective tissue of the lung and split into the smallest fibers. These fibers migrate to the pleura (pleura, lung pelt), accumulate there and trigger inflammation.

Risk factor occupation

Asbestos fibers are usually inhaled at the workplace. Protective measures did not exist before. In part, the protective clothing itself contained asbestos. Among the vulnerable occupations that increase the risk of asbestosis include:

• Asbestos treatment in which asbestos-containing rock was crushed and raw asbestos was loosened up
• Production and processing (spinning, twisting, weaving, cutting, etc.) of asbestos textiles such as yarns, threads, tapes, cords, ropes, tubes, cloths, packs, clothing, etc.
• asbestos-containing protective clothing
• industrial production and processing of asbestos cement products (weather-resistant boards and building materials such as prefabricated form elements for roofing, facade construction, structural fire protection, etc.)
• Repair of asbestos cement products (sawing, drilling, grinding, etc.)
• industrial production, processing and repair (grinding, drilling, milling) of asbestos-containing friction linings (mainly clutch and brake linings)
• Manufacture, use and repair of asbestos-containing spray masses for thermal, acoustic and fire insulation (insulation)
• Production and processing of rubber asbestos products, in particular acid and heat resistant gaskets
• Production and processing of asbestos-containing papers, cardboard and felt materials
• Use of asbestos as an additive in the manufacture of paints, floor coverings, sealants, rubber tires, thermoplastics, plastic resin molding mats etc.
• Removal of asbestos-containing products (for example, demolition work)

In addition, various minerals such as talc (soapstone) may contain asbestos and thus lead to an asbestosis via a Mischstaublunge. In addition, the risk of malignant lung cancer in smoking asbestos workers is ten to forty times higher than non-smoking.

Reaction of the defense system

Fretting cells of the defense system try to absorb and decompose the inhaled asbestos fibers. They can badly degrade the asbestos and emit messengers, which in turn attract connective tissue cells (fibroblasts). The fibroblasts cause scarring of the connective tissue.

In addition, the messenger substances attract more immune cells. These trigger the smallest inflammation in the lung tissue, which further drives the scarring of the lung. The asbestos fibers migrate into the pleural space, where they are stored for life.

Asbestosis: examinations and diagnosis

Pulmonary specialists or occupational physicians are specialists in asbestos-related diseases. In the diagnosis of asbestosis, a detailed survey of the patient is at the top of the list. The doctor asks the person concerned about typical asbestosis symptoms. Information about the past and the current work situation are particularly relevant:

• What is your profession? How long have you been working in this profession?
• What profession did you practice before your current employment?
• Do you breathe dust?
• Have fine dust measurements been carried out?
• Are protective masks or goggles provided?
• Since when do you have complaints, such as coughing?
• Do you have tough expectoration when coughing?
• Are you getting bad air?
• Do you feel like you are taking your discomfort?
• Have you noticed a slight fever? Do you sweat hard at night?
• Do you smoke? If so, since when and how many cigarettes a day?

After the doctor’s talk follows an examination of the body. Also, an X-ray or CT scan of the upper body can substantiate the suspicion of asbestosis. If necessary, further investigations such as:

• Lung function test
• Blood gas analysis
• lung biopsy
• Bronchoalveolar lavage
• Effusion cytology (sampling from a fluid accumulation in the lung skin)

Asbestosis: treatment

Asbestos-related lung fibrosis continues to progress. There is no cure for this condition. Drugs that reduce the immune system (cortisone) have no effect. In the advanced stage, those affected usually need additional oxygen via an oxygen device.

Malignant growths are treated in specialized centers. At the beginning of a therapy of a pleural mesothelioma or lung cancer is usually an operation. It aims to remove the entire tumor and cure the patient. Usually followed by chemotherapy to kill any remaining cancer cells. In some cases, the affected area is irradiated to reduce malignant proliferation before surgery.

Asbestosis: disease course and prognosis

The development of asbestosis depends primarily on how long and to what extent a person was exposed to asbestos fibers. In about 30 percent of all people asbestos bodies can be detected without further illness. 30 fiber years cause asbestosis in almost every case. But only the pleural mesothelioma can be caused by a low asbestos load. Pulmonary fibrosis gets worse over time and with increasing exposure to asbestos. It leads to an increasing shortage of air, which limits life expectancy.

Cor pulmonale

Due to the hardened lung tissue, the blood flows more slowly through the lungs. It jams to the heart. The heart function is limited, which eventually leads to heart failure. This is called a cor pulmonale. Shortness of breath and water retention especially on the feet and lower legs are the result. Sometimes cardiac arrhythmias occur that can be life-threatening.

Asbestosis: life expectancy

Patients with a pleural mesothelioma live on average only one to one and a half years after the diagnosis. After four years, only ten percent live. The prognosis of lung cancer depends on how early the carcinoma was detected. Two-thirds of those affected can no longer be operated on after the diagnosis has been made. After five years, only about 15 percent of sufferers live.

Prevent asbestosis

As the risk of lung or throat cancer in smoking asbestosis increases enormously, smoking should be avoided.

Asbestos production and processing has been banned since 1995. Nevertheless, there are activities such as demolition or rehabilitation work, which can be expected due to old components with an increased asbestos load. To protect the workers, there is a legal regulation of the protective measures, which is recorded in the Hazardous Substances Ordinance. So the employer must provide suitable protective equipment, such as protective masks.

Occupational disease asbestosis

If the doctor suspects an occupational disease, he must report that to the statutory accident insurance. He draws up a medical report, on the basis of which the accident insurance determines whether an occupational disease exists. If so, occupational and medical measures will be taken to relieve the condition and support those affected.

In 2013, 1920 asbestos was recognized as an occupational disease. The asbestosis is thus the second most frequent occupational disease (most common: noise deafness). Asbestos-related malignancies follow immediately thereafter (mesothelioma: 970, lung and throat cancer: 793).