Asbestosis : Symptoms & treatment

What is Asbestosis?

Asbestosis is a chronic disease of the lungs (pulmonary fibrosis) caused by prolonged exposure to asbestos fibers.

Asbestos is a natural hydrated calcium and magnesium silicate. It is defined by a set of fibrous varieties of certain minerals. Asbestos was very often used in construction work and in the building industry until 1997.

Asbestos represents a health risk if it is damaged, chipped or pierced, resulting in the formation of dust containing asbestos fibers. These can be inhaled by exposed people and thus be the source of health impacts.

When dust is inhaled, these asbestos fibers reach the lungs and can cause long-term damage. This dust comprising asbestos fibers is therefore harmful to the individual who is in contact with it. (1)

For asbestosis to develop, prolonged exposure to a high number of asbestos fibers is necessary.
Prolonged exposure to a significant amount of asbestos fibers, however, is not the only risk factor for developing the disease. Furthermore, prevention of exposure of populations to this natural silicate is essential in order to avoid any risk of development of the pathology. (1)


The disease is characterized by inflammation of the lung tissue.
It is an irreversible disease with no curative treatment developed.

The characteristic symptoms of asbestosis are shortness of breath, persistent cough, severe fatigue, rapid breathing and chest pain.
This pathology can affect the patient’s daily life and cause certain complications. These complications can be fatal for the affected subject. (3)

 Symptoms of Asbestosis

Prolonged exposure to a large number of particles containing asbestos fibers can lead to asbestosis.
In the event of the development of asbestosis, these fibers can cause lesions in the lungs (fibrosis) and lead to the development of certain characteristic symptoms: (1)
– shortness of breath which may appear after physical activity at first then develop steadily in a second;
– a persistent cough;
– wheezing;
– intense fatigue;
– chest pain;
– swelling at the fingertips.

The current diagnosis of people with asbestosis is often linked to chronic and long-standing exposure to asbestos fibers. Usually, exposures relate to the individual’s workplace.

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People with this type of symptom who have been chronically exposed to asbestos in the past are strongly advised to consult their doctor in order to diagnose the disease.

 The origins of Asbestosis

Asbestosis is a disease that develops following repeated exposure to a large number of asbestos fibers.
Exposure usually takes place at the subject’s workplace. Certain sectors of activity may be more affected by the phenomenon. Asbestos was used for a long time in the construction, building and mineral extraction sectors. (1)

Within a healthy organism, during contact with a foreign body (here, during inhalation of dust containing asbestos fibers), cells of the immune system (macrophages) make it possible to fight against it. and to prevent it from reaching the bloodstream and certain vital organs (lungs, heart, etc.).
In the case of inhalation of asbestos fibers, macrophages have great difficulty in eliminating them from the body. By wanting to attack and destroy inhaled asbestos fibers, macrophages damage the pulmonary alveoli (small bags present in the lungs). These alveolar lesions caused by the body’s defense system are characteristic of the disease.


These alveoli have a fundamental role in the transfer of oxygen within the body. They allow the entry of oxygen into the bloodstream and the release of carbon dioxide.
In the context where the alveoli are injured or damaged, this process of regulating gases in the body is affected and atypical symptoms appear: shortness of breath, wheezing, etc. (1)

Certain more specific symptoms and diseases can also be associated with asbestosis, such as: (2)
– calcification of the pleura forming pleural plaques (accumulation of lime deposits in the membrane covering the lungs);
– a malignant mesothelium (cancer of the pleura) which can develop 20 to 40 years after chronic exposure to asbestos fibers;
– pleural effusion, which is the presence of fluid inside the pleura;
– lung cancer.

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The severity of the disease is directly related to the duration of exposure to asbestos fibers and the amount of these inhaled. The specific symptoms of asbestosis generally appear about 20 years after exposure to asbestos fibers. (2)

The current regulatory aspects make it possible to reduce the exposure of populations to asbestos through controls, treatment and monitoring, particularly for old installations. The ban on the use of asbestos in the building sector is the subject of a decree dating from 1996.

 Risk factors

The major risk factor for developing asbestosis is chronic (long-term) exposure to a large number of dusts containing asbestos fibers. Exposure occurs through inhalation of small particles in the form of dust, deterioration of buildings, mineral extraction, and the like.

Smoking is an additional risk factor for the development of this pathology. (2)

 Prevention and treatment

The first phase of the diagnosis of asbestosis is the consultation with a general practitioner, who during his examination, realizes the presence in the subject of atypical symptoms of the disease.

Against the background of this disease affecting the lungs, when diagnosed with a stethoscope, they emit a characteristic crackling sound.
In addition, the differential diagnosis is defined by responses to the subject’s history of working conditions, the possible period of exposure to asbestos, etc. (1)

If the development of asbestosis is suspected, a consultation with a pulmonologist is necessary for confirmation of the diagnosis. The identification of lung lesions is carried out using: (1)
– an x-ray of the lungs in order to detect abnormalities in the lung structure;
– a computed tomography of the lungs (CT). This visualization method provides more detailed images of the lungs, the pleura (membrane surrounding the lungs) and the pleural cavity. Computed tomography shows obvious abnormalities in the lungs.
– pulmonary tests make it possible to assess the impact of damage to the lungs, to determine the volume of air contained in the pulmonary alveoli and to have a view of the passage of air from the membrane of the lungs. lungs to the bloodstream.

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To date, there is no curative treatment for the disease. However, alternatives exist in order to reduce the consequences of the pathology, limit the symptoms and improve the daily life of patients.

As tobacco is an additional risk factor for developing the disease as well as a worsening factor in symptoms, patients who smoke are strongly recommended to stop smoking. For this, solutions exist such as therapies or drugs.

In addition, in the presence of asbestosis, the subject’s lungs are therefore more sensitive and more vulnerable to the development of infections.
It is therefore advisable that the patient be up to date with his vaccinations concerning in particular the agents responsible for influenza or even pneumonia. (1)

In severe forms of the disease, the subject’s body is no longer able to properly perform certain vital functions. In this sense, oxygen therapy may be recommended if the oxygen level in the blood is lower than normal.

In general, patients with asbestosis do not benefit from specific treatments.
However, in the presence of other lung conditions, such as Chronic Obstructive Pulmonary Disease (COPD), medications may be prescribed.
More severe cases may also benefit from medications such as small doses of morphine to reduce shortness of breath and coughing. In addition, adverse effects (side effects) to these small doses of morphine are often visible: constipation, laxative effects, etc. (1)

From a preventive standpoint, people chronically exposed for more than 10 years must have radiographic monitoring of the lungs every 3 to 5 years in order to detect any associated diseases as quickly as possible.
In addition, significantly reducing or even completely stopping smoking greatly reduces the risk of developing lung cancer. (2)


References

(1). NHS CHOICES. 2014.  Asbestosis . [In line]. http://www.nhs.uk/conditions/Asbestosis/Pages/Introduction.aspx.

(2). HADJILADIS.D. Asbestosis.  [In line]. https://www.nlm.nih.gov/medlineplus/ency/article/000118.htm. 

(3). HEALTH AND SAFETY EXECUTIVE. 2015.  Statistics.  Asbestosis.  . http://www.hse.gov.uk/Statistics/causdis/asbestosis/index.htm.