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Asbestosis
Overview
Asbestosis is a specific disease characteristic of people whose profession is related to the inhalation of asbestos. Most often, asbestosis is diagnosed in workers employed in the field of thermal insulation, since materials to reduce thermal conductivity contain asbestos.
The risk for this disease is also high among miners, builders, workers in the textile industry, as well as people not employed in these professions, but living near mines and large industrial enterprises.
The main types of asbestos that provoke asbestosis are chrysotile, chrocidotil and amosite.
Inhalation of the finest dust provokes the deposition of asbestos fibers in the respiratory tract and deep in the lungs. At the same time, the pleura gradually thickens and interstitial tissue fibrosis develops.
There are also cases when it is not possible to trace the connection between the occurrence of asbestosis and the presence of asbestos in the patient's environment. Benign focal lesions of the pleura and effusion, some malignant tumors of the lung and malignant pleural mesothelioma in some cases are also diagnosed as "asbestosis".
Symptoms
The severity of asbestosis symptoms depends on the duration of exposure to asbestos particles and their concentration in the air. It is believed that with an occupational hazard of 3-4 years, a mild form of asbestosis develops, 8 years - moderate, 10 or more years - a severe form. Like the course of other pneumoconiosis, the clinic of asbestosis is characterized by chronic bronchitis and signs of pulmonary emphysema. All complaints and objective manifestations fit into three groups of symptoms: general somatic, signs of damage to the respiratory system and respiratory failure . Nonspecific symptoms include malaise, fatigue, pallor, weakness, anorexia, and weight loss. Often, warty outgrowths appear on the arms and legs - the so-called "asbestos warts".
The involvement of the respiratory tract and pleura in the pathological process is indicated by the appearance of an unproductive cough or with scanty mucous sputum and severe pain in the chest. In severe cases, shortness of breath is expressed, cyanosis develops, thickening of the nail phalanges of the fingers is determined. Perhaps the development of exudative pleurisy , which has a serous or hemorrhagic character.
Causes
Prolonged inhalation of asbestos fibres is the direct cause of this kind of pneumoconiosis. At the same time, asbestosis can develop both with work experience of less than 3 years, and 15-20 years after the termination of professional contact with asbestos dust. Asbestos is a fine-fibrous mineral represented by hydrosilicate of magnesium, iron, calcium and sodium. Among the various varieties of asbestos, serpentine asbestos (chrysotile and antigorite), as well as amphibole asbestos (amosite, anthophyllite, crocidolite, tremolite) are of the greatest industrial importance - the latter are more fibrogenic and carcinogenic.
Workers in the asbestos mining and processing sector, construction, machine-building, shipbuilding, and aviation industries are in intimate contact with asbestos due to the nature of their trade. These people are in a high-risk category for developing asbestosis. Furthermore, asbestosis has been linked to relatively short and moderate exposure to asbestos-containing dust, such as when women wash their husbands' work clothing or painters and electricians operate in a room where asbestos-containing materials are utilised. Aside from professional exposure, household exposure to asbestos is conceivable when using baby powder or asbestos textile goods in residential dwellings. Smoking is known to contribute to the incidence of asbestosis, as well as its fast development and severe course.
Prevention
With the development of complications, the prognosis for working capacity and a satisfactory quality of life is not encouraging: there is a high probability of disability, the development of severe concomitant diseases and the death of patients. Prevention of asbestosis consists of industrial and medical measures. The first of them involves the provision of the required sanitary and hygienic conditions and individual protection of workers, compliance with safety regulations. All workers in contact with asbestos or materials containing asbestos should undergo periodic medical examinations according to the established schedule. Given the increased risk of developing tuberculosis and malignant tumors against the background of asbestosis, patients with an established diagnosis are recommended to be monitored from time to time.
Treatment
Since changes in the lungs in asbestosis are irreversible, the disease is treated symptomatically. First of all, it is necessary to completely stop contact with asbestos, quit smoking and exclude significant physical exertion. Influenza and pneumococcal vaccinations are recommended to avoid the addition of infections that aggravate respiratory failure.
Supportive care is aimed at relieving symptoms; it includes postural drainage, chest massage, medicinal inhalations, breathing exercises, physiotherapy, and, if necessary, oxygen therapy.
Drug treatment involves the use of inhaled bronchodilators, taking vitamins.
Tests Required for Diagnosis
Examination of patients with suspected Asbestosis is carried out by a pulmonologist with the participation of an occupational pathologist. In establishing the diagnosis of asbestosis, the study of the occupational route and the availability of data indicating exposure to asbestos dust play a decisive role. During auscultation, moist small bubbling (sometimes dry) rales, pleural rub are heard. Above the upper sections of the lungs, a box sound is determined percussion.
In blood tests, acceleration of ESR, hypergammaglobulinemia , RF, antinuclear antibodies, and a decrease in the level of oxygen in arterial blood can be detected.
Radiographic signs of asbestosis are linear-mesh deformation of the lung pattern, hilar fibrosis, pleural changes (plaques, adhesions, effusion), in the later stages - "honeycomb lung". With dubious results of lung radiography, I resort to high-resolution CT of the lungs, which allows one to reliably consider subpleural linear, focal or irregularly shaped shadows.
The study of the function of external respiration in asbestosis indicates the predominance of restrictive disorders over obstructive ones (decrease in VC and respiratory volume, etc.). Due to the similarity of the clinical and radiological picture of asbestosis with other pneumoconiosis, a differential diagnosis is made with anthracosis, pulmonary hemosiderosis, stannosis, talcosis, fibrosing alveolitis, and other diseases.
For this purpose, a microscopic analysis of sputum, a study of bronchial washings, a biopsy of lung tissue, in which asbestos bodies and fibers are found, is carried out.
