ASBESTOSIS

Asbestosis is a disease characterized by diffuse pulmonary fibrosis from the inhalation of

asbestos dust. Current laws restrict the use of asbestos, but many industries used it in the past.
Therefore, exposure occurred, and may still occur, in numerous occupations, including asbestos
mining and manufacturing, shipbuilding, demolition of structures containing asbestos, and
roofing. Materials such as shingles, cement, vinyl asbestos tile, fireproof paint and clothing,
brake linings, and filters all contained asbestos at one time, and many of these materials are
still in existence. Additional diseases related to asbestos exposure include lung cancer,
mesothelioma, and asbestos pleural effusion.
Pathophysiology
Inhaled asbestos fibers enter the alveoli, where they are surrounded by fibrous tissue. The
fibrous tissue eventually obliterates the alveoli. Fibrous changes also affect the pleura, which
thickens and develops plaque. The result of these physiologic changes is a restrictive lung
disease, with a decrease in lung volume, diminished exchange of oxygen and carbon dioxide,
and hypoxemia.
Clinical Manifestations
The onset of the disease is insidious, and the patient has progressive dyspnea, persistent, dry
cough, mild to moderate chest pain, anorexia, weight loss, and malaise. Early physical findings
include bibasilar fine, end-inspiratory crackles and in more advanced cases clubbing of the
fingers. Cor pulmonale and respiratory failure occur as the disease progresses. A high
proportion of workers who have been exposed to asbestos dust die of lung cancer, especially
those who smoke or have a history of smoking. Malignant mesotheliomas may also occur.
These are rare cancers of the pleura or peritoneum that are strongly associated with asbestos
exposure.
Medical Management
There is no effective treatment for asbestosis as the lung damage is permanent and often
progressive. Management is directed at controlling infection and treating the lung disease.
When oxygen– carbon dioxide exchange becomes severely impaired, continuous oxygen
therapy may help improve activity tolerance. The patient must be instructed to avoid additional
exposure to asbestos and to stop smoking. A significant contributing cause to mortality in this
population is the high incidence of lung carcinoma.