Dr. M.J. Bazos, MD Patient Handout

About Your Diagnosis

Asbestos is a name applied to a group of natural fibrous materials that have been used in a variety of ways because of their durability, flame resistance, and insulation properties. Lung damage can occur as a result of inhalation of asbestos. Significant exposure occurs most commonly in the workplace. Employees at greatest risk include those who mine, mill, or transport unfinished asbestos materials, or those who install, modify, or demolish asbestos products, such as automotive repair and construction workers. Exposures can also occur in individuals whose trades bring them near where asbestos is used (such as painters and carpenters), those who clean the workers’ clothes carrying asbestos fibers, or those who live near asbestos factories or mines. The likelihood of developing lung disease increases with longer and more intense asbestos exposures. There is usually at least a 10-year delay between initial asbestos exposure and the development of disease. Asbestos-related diseases are not contagious. Some types of asbestos fibers are more likely to cause disease than others. Individuals may
differ in their sensitivity to asbestos. Fortunately, asbestos-related disease develops in only a minority of workers.

Living With Your Diagnosis
Asbestos exposures can cause a variety of diseases of the lung and pleura (layer of tissue covering the outside surface of the lung):
• Pleural plaques: Areas of thickening of the external lining of the lungs that are often detected when a chest x-ray is done for some other reason. They do not cause symptoms, impair lung function, or increase the risk of cancer, but they may be associated with an increased risk of developing asbestosis.
• Asbestosis: Scarring of the lungs in response to inhalation and accumulation of asbestos fibers over at least a 10-year period. Diagnosis is usually made in the symptomatic patient with prior asbestos exposure who has the characteristic lung examination findings and chest x-rays changes. The scarring may remain stable or progress to involve greater amounts of the lung. Asbestosis results in small, stiff lungs, which explains why shortness of breath is the most frequent symptom. Chronic cough and phlegm production are also common. Breathing tests are used to assess and follow-up how asbestos is affecting the lungs. Lung cancer may be more common in asbestos workers with asbestosis than those without.
• Lung cancer: By itself, asbestos exposure increases the risk for developing lung cancer. This risk greatly increases if an individual also smokes. Lung cancer usually arises 20 years after initial asbestos exposure.
• Pleural effusion: Fluid that accumulates in the space between the lung and chest wall because of asbestos exposures in the past 15 years. Effusion may be asymptomatic or cause fever, chest pain, and shortness of breath. Effusions do not increase the risk for future cancer but can result in permanent scarring of the pleura.
• Malignant mesothelioma: A rare tumor of the pleura that arises 20–40 years after initial asbestos exposure. Symptoms usually develop slowly and include chest pain, weight loss, and shortness of breath. The tumor may cause other symptoms if it expands to involve structures outside the pleura.

Treatment options are limited for asbestos-related lung/pleural diseases. Avoidance of all asbestos is generally recommended when asbestos-related disease is diagnosed, because cumulative exposure appears to increase risk for further disease, and uncertainties remain about what constitutes a safe,
low-level exposure.
• Pleural plaques: No treatment is required. However, because plaques are a marker of prior asbestos exposure, regular follow-up is recommended to look for other asbestos-related diseases.
• Asbestosis: There are no treatments that are reliably effective at reversing or preventing the progression of lung scarring. Lung transplantation is considered in certain individuals. Supplemental oxygen may be prescribed to decrease shortness of breath and improve stamina. Inhalers to help open the bronchial tubes may be prescribed if there is also smoking-related lung disease.
• Pleural effusion: Drainage of the fluid as necessary for diagnostic purposes. This is usually done in the doctor’s office, but occasionally surgery is required to help exclude cancer. Most effusions resolve on their own over weeks to months, al- though they may recur over several years.
• Mesothelioma: Prognosis is very poor because there are no consistently effective treatments. Surgery and chemotherapy may be tried. Relief of pain and shortness of breath are the main treatment goals.

The DOs
• Workers in industries with asbestos exposures should follow all recommended procedures, such as wearing protective masks, to decrease asbestos exposures.
• Obtain an influenza vaccination each fall.
• Obtain/update the pneumococcal vaccination.
• Maintain good cardiovascular fitness by participating in an exercise program.
• Maintain close contact with your health care provider.
• No special diet requirements.

The DON’Ts
• If asbestos-related diseases such as pleural plaques or asbestosis are diagnosed, all further asbestos exposures should be avoided.
• Avoid individuals with acute respiratory infections.
• Avoid exposures to other known lung irritants such as smoke, strong fumes, and very cold or very humid air.
• Stop smoking.

When to Call Your Doctor
Call your doctor if any of the following occurs:
• If you suspect you have an acute lung infection as suggested by increased cough, yellow or green sputum production, increased shortness of breath, fever, or chills.
• Blood in the sputum.
• Dusky-colored skin, fingertips, or lips.
• Chest pain.
• New ankle swelling.
• Weight loss.