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Asbestosis

Asbestosis is a chronic pneumoconiosis disease in which the parenchymal tissue of the lungs undergoes slow and repetitive fibrosis, or scarring. Pneumoconiosis is a general term used to describe a lung disease associated with inhalation of large amounts of a specific type of dust. Asbestosis is exclusively caused by the inhalation and retention of asbestos dust or fibers and is most prevalent among workers who had an extensive exposure to mining, manufacturing, handling or removal of asbestos.

The form of asbestos that is particularly responsible for asbestosis is the straight, thin amphibole fibers. Because of their shape and size, amphibole asbestos fibers are capable of penetrating deeply into the lung's air sacs, or alveoli, where oxygen moves into the bloodstream and carbon dioxide is carried away. Here, the amphiboles provoke the body's immune system into rejecting them by marshalling defensive cells called macrophages, which attempt to envelop and digest the fibers. In addition, the amphiboles stimulate the lungs' fibroblast cells to lay down connective, or fibrous tissue in an attempt to "heal" the wounds caused by the razor-sharp fibers.

The continual creation of scar tissue over time causes the alveolar walls to thicken, reducing the lungs' capacity to take in oxygen and remove the carbon dioxide. Breathing becomes increasingly painful and difficult while less purifying oxygen reaches the blood. In the more severe cases of asbestosis, the drastic reduction in lung function may cause the heart to have to pump at a faster rate than is healthy. Therefore, a person with asbestosis may ultimately die from heart failure, even though the asbestosis is the contributing factor.

Learn more about asbestosis and other diseases caused by exposure to toxic asbestos dust by requesting a free informational packet from the Mesothelioma Center.

What are the Symptoms of Asbestosis?

Although the symptoms of asbestosis may not be noticed for decades after a person has been exposed to asbestos, the primary symptoms of the disease are decreased tolerance for physical exertion and shortness of breath. The severities of the symptoms are often related to the amount and length of asbestos exposure.

Other symptoms of asbestosis usually include:

• Coughing
• Chest pain
• Blood in the sputum
• Swelling in the neck or face
• Difficulty swallowing
• Loss of appetite
• Weight loss

Fast Fact: Asbestosis can develop fully in as little as seven years and cause death within 13 years. In other cases, it can take 20 years or more before a victim can begin to feel the symptoms.

Clinical Symptoms of Asbestosis

Asbestosis patients exhibit dry inspiratory crackles, which are clicking or rattling noises made by the lungs during inhalation, and "clubbing" of the fingers, which may include softening of the fingernail beds, bulging of the last part of the finger(s) and misshapen nails – all caused by a decrease of oxygenated blood flow to the extremities.

There is always evidence of fibrosis in the lower lung lobes where asbestosis is most prevalent, and more than 50 percent of people affected with asbestosis develop plaques in the parietal pleura, which is the space between the chest wall and the lungs.

Fast Fact: Asbestosis patients have an 8-10 times higher risk of developing lung cancer than those without asbestosis.

How is Asbestosis Diagnosed?

Recommended diagnostic tools for determining if a patient has asbestosis include:

• Complete physical examination
• Chest X-ray
• Lung function tests

In addition, a lung biopsy, in which tissue is removed by surgery, is the most reliable way to confirm the presence of microscopic asbestos fibers because X-rays cannot detect asbestos fibers in the lungs.
Learn more about mesothelioma surgery

How is Asbestosis Treated?

While there is no known cure for asbestosis, supportive treatment of symptoms includes:

• Oxygen therapy to relieve shortness of breath
• Respiratory physiotherapy to remove secretions from the lungs
• Medications to thin secretions and relieve pain

Find out more about specific treatment options for patients with asbestosis.

What Occupations are at Risk of Developing Asbestosis?

Throughout most of the twentieth century, millions of American workers have been exposed to asbestos. The greatest risk for contracting diseases like asbestosis has fallen upon those in the asbestos mining and milling trades; those manufacturing asbestos textiles and other products; shipbuilders; and insulation workers in the construction and building trades.

After the early 1970s, when the use of asbestos declined in the U.S., those individuals most at risk have been demolition workers, drywall removers, asbestos removal workers, firefighters and automobile workers.

Asbestosis is a painful, crippling disease. Its only cause is exposure to asbestos. As the aging population of asbestosis sufferers continues to sicken and die, it is imperative upon the rest of society to continue to hold accountable those responsible for their suffering  –  the asbestos mining and manufacturing companies, who knew of the dangers of asbestos contact, yet continued to expose their workers to the dangerous and ultimately lethal fiber.

Find out more about occupations at risk for asbestos exposure.

Additional factors of how asbestos can affect an individual:

• the dose (how much asbestos the individual was exposed to)
• the duration (how long an individual was exposed)
• the type of asbestos
• the source of the exposure
• the source of the exposure

Histologic Grades of Asbestosis

Grade of Severity
Grade 0:	No fibrosis associated with bronchioles, or the airway passages in the lungs.
Grade 1:	Early fibrosis involving walls of at least one respiratory bronchiole, with or without extension into nearby tissue. Fibrosis is confined to alveolated walls of respiratory bronchioles and ducts and not present in more distant alveoli. Inflammation similar to that caused by cigarette smoking may be observed.
Grade 2:	More severe fibrosis involving alveolar ducts and/or two or more layers of adjacent alveoli. Normal lung tissue remains in an area between adjacent bronchioles.
Grade 3:	Fibrosis is advanced and involves alveolar ducts and all layers of adjacent alveoli. All lung tissue between at least two adjacent bronchioles is affected. Some alveoli are completely damaged.
Grade 4:	Honeycomb-like appearance and large (up to 1 cm) dilated spaces largely visible in lung parenchyma, or the alveolar tissue.

Grade of Extent
A	Only occasional bronchioles are involved. Most appear normal.
B	More than occasional but less than half of bronchioles are involved.
C	More than half of bronchioles are involved.

Developed in 1980 by a committee of the College of American Pathologists.

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When was Asbestos Exposure First Linked to Deadly Asbestosis?

The first documented death of an asbestos worker because of pulmonary failure was recorded at London's Charring Cross Hospital by Dr. Montague Murray in 1906. The autopsy of a 33- year-old victim revealed large amounts of asbestos fibers in his lungs.

In 1924, Dr. W.E. Cooke, a British pathologist, wrote a case report on a young woman named Nellie Kershaw, who had worked for the Turner Brothers Asbestos Company since she was 13. By the time she was 31, Kershaw was totally disabled, and she died soon thereafter. Dr. Cooke named her disease "pulmonary asbestosis" and formally attributed Kershaw's cause of death to prolonged asbestos exposure.

Fast Fact: Overall, there have been more than 13,000 asbestosis deaths recorded in the U.S. from 1995-2004.

Are You at Risk for Developing Asbestosis?

Anyone exposed to asbestos in the air, water, soil or manufactured products is at risk for an asbestos-related disease like asbestosis. If you would like more information about your risks, call (800) 615-2270 to speak with one of our Patient Advocates who can help you understand more about these disease and the doctors who treat them.

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