Asbestosis

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Asbestos causes several major diseases of the lung and pleura

An insidious feature of asbestos-related disease is that there is often a long latent period of up to 50 years between exposure and clinical onset of disease.

The diseases produced by asbestos are:

Asbestosis, a progressive chronic fibrosis of the lungs, is caused by heavy exposure to asbestos, usually with a latent period of 25 years before clinical symptoms become evident.

Pleural plaques. Benign plaques of collagenous fibrosis in the pleural surfaces.

Pleural effusions and pleural thickening. Spontaneous effusions in the absence of obvious other cause, and dense pleural thickening, which may compress the lungs.

Malignant mesothelioma. A highly malignant tumour of the mesothelium.

Carcinoma of the lung.

Occupational asbestos exposure has been extensive

Asbestos is a fibrous silicate mineral that was widely used between 1890 and 1970 as a building, insulating and fire-resistant material.
As well as the hazards of mining and refining asbestos, exposure of individuals has occurred in the building industry, and in industries using asbestos for its insulating properties, e.g. affecting dockyard workers and spray lagging operatives.

There are two main forms:

Serpentine asbestos (including white asbestos) is the most common form, and fibres persist in lung for a limited time.

Amphibole asbestos (including blue and brown asbestos), the fibres of which persist in lung for many years. This form is the main cause of malignant mesothelioma.

The risk of disease depends on duration of exposure (long exposure increases risk), intensity of exposure (heavy exposure to airborne fibres increases risk), and the type of asbestos (short fibres are not very pathogenic; fibres over 8 mm long particularly cause disease).

Diagnosis is made on the basis of occupational exposure, changes on chest radiograph (linear shadows in lung bases), and a pattern of restrictive defects on lung-function testing.

Pathological findings are of interstitial fibrosis of the lungs which, in early stages, is maximal at the lung bases. Asbestos bodies may be seen histologically.

The disease progresses with increasing restrictive defect, which is associated with interstitial fibrosis. Pulmonary hypertension and cor pulmonale develop in the late stages.

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