Asbestosis can affect people who have been exposed to asbestos in their working lives. This fiber has been widely used since the 19th century, especially in the construction industry and for work clothing, because of its excellent heat resistance and insulating properties. Because of its harmful effects on health, the use of asbestos has been banned in Germany since 1993 and in the entire EU since 2005.
What is asbestosis?
Asbestosis is one of the so-called dust lung diseases. It is caused by inhalation of tiny asbestos particles, fiber dust. Asbestosis can still occur even if the patient has not been exposed to the harmful substance for many years. Between fifteen and thirty years may pass before the disease breaks out. The actual length of time depends, among other things, on how intensively the patient was exposed to the harmful asbestos material and over what period of time this occurred.
Causes
When asbestos dust is inhaled, the cells in the lungs responsible for it can neither completely decompose the fibers nor remove them, as would actually be their task. The result is an accumulation of harmful substances, which leads to a condition known as fibrosis. The term refers to a proliferation of connective tissue in the lungs between the alveoli, which must remain mobile for breathing, and the blood vessels. Parts of the lungs become scarred and hardened. The lower sections of the lungs are particularly affected. They are no longer as flexible as before, and breathing becomes increasingly difficult. As a consequence, shortness of breath usually occurs. This is accompanied by a strong irritating cough, often together with viscous sputum. When breathing, pain develops in the chest area. The patient’s physical performance is limited.
Symptoms, complaints, and signs
Depending on its severity, asbestosis can cause a variety of symptoms. Years often pass between exposure and the appearance of the first symptoms. Eventually, however, inflammation occurs in the lung and pleural tissues, manifested by various respiratory problems. Most sufferers experience shortness of breath, irritable cough and sputum, often associated with severe pain and increasing malaise. In addition, hoarseness may occur due to asbestos lung or any secondary diseases such as lung or larynx cancer. The color of the voice changes significantly and the voice sounds increasingly brittle as the disease progresses. At first, the breathing difficulties occur primarily during physical exertion. Later, problems also occur during periods of rest, and eventually asbestosis takes a chronic course. External signs of asbestos lung are the thickened ends of the fingers, which resemble the shape of drumsticks. In addition, the skin turns bluish, especially on the fingers, lips and around the mouth. In later stages, asbestosis can lead to the development of tumors. Such degeneration of cells is manifested by shortness of breath, pressure pain in the area of the lungs, and other symptoms that depend on the location and size of the tumor.
Diagnosis and progression
Because a very long time can often elapse between contact with asbestos and the appearance of the first symptoms, the connection between symptoms and disease is not always immediately apparent. For diagnosis by a specialist, it is therefore necessary to clarify in a discussion whether the patient belongs to one of the occupational groups particularly at risk for lung diseases. The symptoms are usually clearer if the general symptoms, such as breathing difficulties, are accompanied by a worsened general condition. In this case, the affected person loses weight, becomes powerless, and is often no longer able to perform his or her daily tasks. During the physical examination, the physician listens to the lungs with a stethoscope. Fibrosis causes typical sounds during breathing, which are described as crackling. The lung function test shows the extent to which values are restricted here and whether sufficient air is still moved during breathing. Blood and urine samples can complete the diagnosis. Finally, an x-ray and computed tomography scan will show where there are fibrous deposits in the lungs. During a bronchoscopy, tissue samples can confirm whether the deposits are asbestos, meaning that asbestosis is present. In advanced stages, the disease usually leads to disability of the patient. It can strongly promote the development of lung cancer.
Complications
Complications that develop in the wake of asbestosis are almost independent of treatment or therapy because there is currently no way (yet) to remove the fine crystal needles of asbestos from the alveoli. The severity and type of complications arising from asbestosis depend almost exclusively on the accumulated inhaled quantity of asbestos needles. A somewhat fatal effect is that the complications often occur years after the inhalation of the asbestos dust. Unfortunately, it is the immune system that tries to get the tiny mineral needles out of the lung tissue by activating macrophages. However, this does not work, so the macrophages subsequently cause a problem and must be cleared away by the immune system. Due to the chronic inflammatory processes that the immune system initiates and maintains, the functional lung tissue is replaced by collagenous, fibrous connective tissue, causing it to lose elasticity and functionality. Immune system responses ultimately cause progressive pulmonary fibrosis. Lung function becomes increasingly limited, resulting in further complications such as shortness of breath, irritable cough with sputum, visible cyanosis (blue discoloration) of the fingers and lips. The most serious complications that often develop from asbestosis are lung or throat cancer. Both diseases are associated with a poor prognosis.
When should you see a doctor?
Asbestosis is a fatal disease. It is caused by inhaled asbestos particles. Asbestosis can only be recognized as an occupational disease through repeated visits to the doctor. The problem is that the disease does not appear until decades after asbestos contact and is then usually far advanced. The symptoms of asbestosis are initially similar to those of chronic bronchitis. For this reason, those affected usually go to the doctor much too late. The symptoms of incipient pulmonary fibrosis, asbestos-related cancer or mesothelioma offer inadequate treatment options due to the long latency period. People who knowingly come into contact with asbestos at work should protect themselves appropriately. Asbestos dust lung is the late consequence of inhalation of particles containing asbestos. As the second most common occupational disease in the Federal Republic, asbestos-related deaths occur time and again thanks to a lack of treatment options. The doctors called in can only alleviate the suffering of their patients, not cure it. A further increase in the number of cases is expected by 2020. Only then will the ban on asbestos, which was enacted in 1993, take effect. It is important to note that people with other risk factors – especially smokers – are significantly more likely to develop asbestosis. In particular, lung tumors are the result here. Pulmonary specialists are the physicians who are usually called in when the first symptoms appear. Much for the patient to do, they usually can not.
Treatment and therapy
Asbestosis is not curable. Once developed, the scarring of the lung tissue cannot be reversed at this time. Therapy is therefore aimed at preventing or at least slowing the progression of the disease and relieving symptoms. Various methods are used to achieve this. To reduce inflammatory and allergic reactions of the organs, cortisone preparations are the appropriate means. If the oxygen content of the blood falls below a certain threshold, long-term therapy with oxygen is called for. The patient is given oxygen for about 16 hours a day. The aim is to increase the level in the blood, strengthen the patient and enable him to cope better with everyday life. Drugs that reduce the defense reactions of the patient’s own immune system, so-called immunosuppressants, can also slow down the course of the disease. Physiotherapy plays a particularly important role in treatment. Breathing exercises, relaxation techniques and an adapted, moderate sports program can alleviate symptoms and improve quality of life. Nutritional counseling can also significantly improve the general condition. Since smoking greatly aggravates the disease, a cessation program is essential for smokers. In severe cases, a lung transplant may be useful.
Outlook and prognosis
Asbestosis is one of the most dangerous dust lung diseases affecting the respiratory tract. Inhaled asbestos fibers become permanently lodged in the lungs.First, pulmonary fibrosis develops, later usually mesothelioma. Lung cancer and laryngeal cancer are further consequences. All in all, this does not allow for a positive prognosis. Asbestos exposure is assessed on the basis of inhaled fibers over a period of at least 25-30 “fiber years”. The problem is that the disease often does not occur until 30 years after occupational or other acquired asbestos exposure. Exposure to asbestos fibers happens occupationally and often not just once. In addition, people can inhale asbestos fibers without their knowledge. The prognosis depends on the total amount of asbestos exposure. With one-time or minor asbestos exposure, the affected person may remain asymptomatic. With repeated and pronounced asbestos exposure without adequate protection, there is no hope of recovery after 30 fiber years, even with the best treatment. If other risk factors are added – especially long-term nicotine use – the hope for longer-term survival is even slimmer. Currently, treatment of asbestosis can only alleviate the symptoms, but not eliminate the causes. As asbestosis inevitably progresses with the onset of pulmonary fibrosis. Respiratory aids can be used for pulmonary fibrosis. Surgery can be performed for tumors if they are detected early enough.
Prevention
Asbestosis is a recognized occupational disease. Occupations at particular risk are those that have been involved in the manufacture and processing of asbestos. The disease can occur long after handling of the harmful substance has ceased. Since there is no cure for asbestosis as yet, prevention is of great importance. Every member of a risk group is therefore entitled to regular examinations to detect asbestosis in good time. The examinations are offered on behalf of the employers’ liability insurance association and are free of charge for those affected.
Follow-up care
Precaution and protection against inhalation of the asbestos fibers would have been the better way to go when it comes to asbestosis. But that is not always possible. Serious events such as a high-rise fire or terrorist attacks such as on the World Trade Center often abruptly release so many asbestos fibers that no one can protect themselves from inhalation. Aftercare is a difficult issue, however, because inhaled asbestos fibers become deeply embedded in the tissues of the respiratory tract. Once this happens, they cannot be removed from the lung and bronchial tissue. The development of several types of cancer is likely as a result of asbestos contact. Multiple unprotected exposures significantly increase the risk of disease. Often, contact with the fibers occurred years ago. Follow-up consists of lifelong monitoring of individuals who have had asbestos contact. How often interviews and examinations need to be performed varies from individual to individual. For example, it depends on the amount of fibers inhaled and the frequency of suspected asbestos contacts. Another branch of follow-up comes into effect after cancer surgery has become necessary. Asbestosis is often followed by asbestos-related cancer. The problem is that those affected by asbestos contacts in the private sphere often had no knowledge of the presence of the hazardous substance. Therefore, follow-up care refers only to sequelae that have already occurred.
What you can do yourself
Asbestosis must first be diagnosed by a physician. Complementary to conventional medical treatment, the symptoms can be alleviated by some self-help measures. First, lifestyle habits should be adapted to the disease. These include dietary measures and physical exercise, but also smoking cessation and the development of new habits. For example, the symptoms can be alleviated by relaxation techniques such as yoga or meditation. In large cities, those affected can find lung sports groups. There they can exercise under medical supervision and talk to other sufferers. The exchange with other asbestosis patients helps sufferers and their relatives to understand the disease. In this way, a certain level of acceptance can be built up in the long term. In some cases, the former quality of life can be regained through comprehensive therapy measures. Affected persons should remain in consultation with their family doctor in order to be able to react quickly in the event of complications. Further contacts are internists and specialists for lung diseases.A first point of contact for those affected is the website of the Bundesverband der Asbestose Selbsthilfegruppen e.V. (Federal Association of Asbestosis Self-Help Groups), which not only provides further therapy and counseling services. Information on the compensation to which every asbestosis patient is entitled can also be found there.
