The pulmonary fibrosis caused by asbestos inhalation is called asbestos cancer. Asbestos cancer is a chronic inflammatory medical state, which affects the parenchymatous tissue of the lungs caused by the breathing and retention of asbestos fibers.
The signs and symptoms of asbestos cancer do not occur until after a waiting period, a few decades. The main symptom is the installing of a dyspnea, especially during exercise. Advanced cases of asbestos cancer can lead to respiratory failure. Pulmonary rales can be heard at the medical consult.
There is no cure for this disease. Home oxygen therapy is often necessary to relieve symptoms and correct hypoxia. The symptomatic supportive treatment includes respiratory physiotherapy to remove secretions from the lungs by postural drainage, chest percussion and vibration application. Nebulizer medication may be prescribed to humidify secretions and for chronic obstructive pulmonary disease treatment.
Doctors recommend an annual immunization for flu and pneumococcal pneumonia. It is imperative that the patients are aware that they are at risk of developing lung cancer and they should stop smoking in order not to aggravate their condition.
- Inhalation of asbestos fibers
- Working in a polluted environment
- Smoking aggravates the disease
Because the developing of asbestos cancer depends on the dose of asbestos fibers inhaled, the symptoms appear only after a latency period of about 20 years. The latency period may be shorter after intense exposures.
The condition leads to adverse effects and makes patients unable to work in most of the cases. This often leads to feelings of frustration, as well as to financial problems. This in turn, affects the quality of the relations patients have with friends and family. More than that, the condition can be fatal.
42% of the cases of asbestos cancer also suffer from digital hippocratism. This condition is not associated with the severity of the disease. The decrease of rib tours in advanced cases is correlated with restrictive respiratory impairment and reduced vital capacity. In advanced cases, patients may be also, present the following signs, usually associated with a pulmonary condition: cyanosis, jugular vein distension, hepatojugular reflux and pedal edema. Other associated conditions are:
Asbestosis is a disease that can be detected by performing X-ray in the population with risk factors, mainly on those who were exposed to asbestos and asbestos fibers at work or by accident.
The most effective asbestosis prevention method is to control the exposure to asbestos fibers at work. Working in exposed environments by using special equipment is strongly recommended. Even if the patient leaves the asbestos environment, the disease will continue to evolve with pulmonary fibrosis, but its speed is lower.
The termination of exposure once the diagnosis is set is imperative because the exposure increases the rate of progression. However, the disease can also progress outside the direct exposure. Smokers must stop smoking cigarettes.
Physical medical exam
Rales are the most important signs during patient examination. Pulmonary rales are best heard at the lower back lungs and on side areas. Initially, the rales are heard at the end of the inhaling phase. However, in advanced cases, rales may be heard during the entire inspiratory phase. Occasionally, the presence of the rales precedes in radiographies the pulmonary abnormalities and the breath test. Rales may be missing in one third of patients.
Lab studies: The diagnosis of asbestos cancer is set in the presence of three characteristics: exposure to asbestos with a latency period, revealing fibrosis by radiography, physical examination and specific tests of the influenced respiratory capacity with or without biopsy or the bronchi-alveolar lavage to highlight fibers.
Imaging Studies: Chest radiography shows reticulonodular infiltrates seen especially in the lungs. The diagnosis of asbestosis requires multiple components; radiography only has a modest positive predictive value. When combined with abnormal signs (rales) and respiratory function tests abnormal, these positive predictive values increase. The bilateral pleural thickening is obvious now. A calcified plaque located in the diaphragmatic pleura is an indicator of exposure to asbestos but not a final diagnostic. Other locations of asbestos tiles are the nine bilateral ribs.
The CT scan is useful in defining pleural abnormalities (thickening, plaques, and malignant
mesothelioma, round atelectasis) and highlighting a parenchymal density is suggestive for bronchogenic carcinoma.
Respiratory tests: reduction of diffusion capacity can precede changes in the lung volume. The first sign is an abnormal physiological hypoxemia during exercise. Total lung capacity is reduced in asbestosis as well as in other restrictive diseases.
Oximetry: The evaluation of oxygenation is important because uncorrected hypoxemia cause pulmonary and heart hypertension. The lung gases will be measured in this procedure.
Bronchoalveolar lavage has limited applications in diagnosing asbestosis. It is useful in identifying infections with diffuse infiltrates, which simulate bronchogenic asbestosis and carcinoma diagnosis. It can provide qualitative information on asbestos fibers.
The treatments for asbestos cancer include:
The prognosis depends on the amount of asbestos that was inhaled during the exposure. Patients who have asbestosis complicated with malignant mesothelioma have a more reserved prognosis, 75% of them dying within the year.
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