Asbestosis

Florian Tiefenböck studied human medicine at the LMU Munich. In March 2014, he joined as a student and has supported the editorial team with medical articles ever since. After receiving his medical license and practical work in internal medicine at the University Hospital Augsburg, he has been a permanent member of the team since December 2019 and, among other things, ensures the medical quality of the tools.

More posts by Florian Tiefenböck All content is checked by medical journalists.

Asbestosis (asbestos lung) is a disease of the lungs caused by inhalation and deposition of asbestos dust in the airways. It can lead to scarring of the lung tissue, but it can also lead to lung cancer. The risk of asbestosis increases with years of exposure to asbestos. Find out everything you need to know about asbestosis here.

ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. J61

Asbestosis: description

Asbestosis occurs when the lung tissue changes pathologically due to inhaled asbestos dust. It is thus a form of inorganic pneumoconiosis (inorganic pneumoconiosis).

Asbestos fibers with critical dimensions

According to the World Health Organization, those asbestos fibers that are more than five micrometers long and less than three micrometers in diameter and whose length-to-diameter ratio is at least three to one are particularly dangerous for the lungs. Inhaling such fiber dust scars and hardens the connective tissue of the lungs. Experts speak of fibrosis in this remodeling process. This pulmonary fibrosis worsens over time, which is why asbestosis is a malignant pulmonary disease.

What is asbestos

Asbestos is a group of fibrous, crystallized, silica-containing minerals. It is mined underground or above ground. Around 90 percent of all asbestos extracted in the world is so-called white asbestos (chrysotile), which is used in industry. In addition, there is blue and brown asbestos as well as other asbestos-like minerals, which make up less than ten percent of the total production worldwide.

In the 19th and 20th centuries, asbestos was used industrially in many products, for example to manufacture fire-resistant protective clothing. In addition, asbestos has long been a component of roof shingles, facade cladding, electrical equipment, piping, toothpaste and fire-resistant insulation materials. In the period between 1950 and 1985, 4.4 million tons of asbestos were consumed in West Germany alone, although the damaging and, above all, carcinogenic effects of the material had already been recognized at the turn of the century. In 1995 the use of asbestos was finally banned.

Asbestosis as an occupational disease

Certain occupational groups are increasingly exposed to harmful asbestos fibers. Therefore, asbestosis is one of the recognized and notifiable occupational diseases. In Germany, over 17,000 occupational illnesses caused by asbestos have been recognized since 1978.

If the doctor suspects an occupational disease in a patient, he must report this to the statutory accident insurance. Then he prepares a medical report, on the basis of which the accident insurance determines whether there is an occupational disease. If so, professional and medical measures will be taken to alleviate the disease and support those affected.

Asbestosis: frequency

In 2019, 1,471 asbestoses were confirmed as an occupational disease. Asbestos-related mesothelioma (see below) was found in 827 patients and asbestos-related lung cancer, larynx cancer or ovarian cancer in 599 patients.

In Germany, there are still over 1,000 new cases per year. According to forecasts, as a result of the asbestos ban, the number will only decrease from 2030.

Around 100,000 deaths each year worldwide are caused by asbestos and its complications.

Asbestosis: symptoms

If the lung tissue has changed as a result of the inhaled asbestos fibers, the first symptoms appear. Their severity depends on the extent of the pulmonary fibrosis. In the case of secondary diseases (such as lung cancer), there are additional complaints.

Many years or decades usually pass between a pronounced asbestos exposure and the appearance of malignant growths, for example in the lungs or larynx.

Pulmonary fibrosis

The mostly progressive pulmonary fibrosis leads to dry cough with dry sputum and shortness of breath (dyspnoea). First of all, those affected get less air, especially when they exert themselves physically (exertional dyspnea). Later on, the shortness of breath can also occur in phases of rest (dyspnea at rest).

The remodeling of the lung tissue means that less oxygen can pass into the blood. As a result, the signs of asbestosis are also visible externally: the ends of the fingers thicken (drumstick fingers). The skin and mucous membranes (especially the phalanxes of the fingers and lips) are discolored bluish due to the lack of oxygen (cyanosis).

Mesothelioma

The mesothelium is a type of skin that lines the chest area (as the pleura = pleura) and the abdomen (also the peritoneum) and forms the pericardium. It produces a liquid that acts as a kind of lubricant and facilitates the movement of neighboring tissue layers and organs against each other. The mesothelium can degenerate as a result of exposure to asbestos. This type of tumor is called mesothelioma.

Most often, the lung pleura (the inner sheet of the pleura) degenerates, which doctors then call pleural mesothelioma. Patients report slowly increasing chest pain that can spread to the neck, shoulder, or arm. In addition, there is a dry, tickly cough and shortness of breath. Affected people feel exhausted, have a fever and lose weight. Some sweat so much at night that they have to change their nightgown or bed linen.

Peritoneal mesothelioma - a malignant growth of the peritoneum - is rarer than pleural mesothelioma. Those affected suffer from abdominal pain and abdominal fluid (ascites).

Pericardial mesothelioma is very rare. The patients show the clinical picture of an inflammation of the pericardium (pericarditis) with fluid accumulation in the pericardium (pericardial effusion). Sometimes cardiac arrhythmias also occur.

Lung, larynx and ovarian cancer

Some patients develop lung cancer (lung cancer, bronchial cancer) as a result of asbestosis. The first, non-specific signs include a persistent cough and chest pain. Fatigue and heavy night sweats are also common. In advanced stages, many lung cancer patients experience bloody sputum, rapid weight loss and difficulty breathing.

Laryngeal cancer usually manifests itself as hoarseness and a feeling of pressure in the throat.

Exposure to asbestos can also lead to ovarian cancer. The symptoms that usually appear late include digestive problems such as gas, bloating, unexplained abdominal pain, an increase in abdominal girth and an increased urge to urinate.

"Fiber years"

Lung, larynx and ovarian cancer can be recognized as an occupational disease if there is evidence of cumulative asbestos exposure of at least 25 fiber years in the workplace. "Fiber years" is a medical term. It indicates the risk for those affected to get cancer from inhaled asbestos fibers. A fiber year corresponds to a one-year working day (8 hours) exposure to one million asbestos fibers of critical dimensions (see above) per cubic meter of breathable air over 240 working days (shifts) per year.

Asbestosis: causes and risk factors

Asbestosis occurs when dust containing asbestos is inhaled and settles in the lung tissue - primarily in the alveoli. From there, the asbestos fibers get into the connective tissue of the lungs and split into tiny fibers. These fibers migrate to the pleura (pleura), collect there and trigger inflammation.

Occupation risk factor

Asbestos fibers are mostly inhaled in the workplace. There used to be no protective measures against it. In addition, some of the protective clothing itself contained asbestos.

Occupational activities that increase the risk of asbestosis include:

• Asbestos processing, in which asbestos-containing rock is crushed and raw asbestos is loosened
• Production and processing (spinning, twisting, weaving, cutting, etc.) of asbestos textiles such as yarns, twisted threads, tapes, cords, ropes, hoses, towels, packings, clothing, etc.
• industrial production and processing of asbestos cement products (weather-resistant panels and building materials such as prefabricated shaped elements for roof coverings, facade constructions, structural fire protection, etc.)
• Repair of asbestos cement products (sawing, drilling, grinding, etc.)
• industrial production, processing and repair (grinding, drilling, milling) of asbestos-containing friction linings (especially clutch and brake linings)
• Production, application and repair of asbestos-containing gunning mixes for heat, sound and fire insulation (insulation)
• Manufacture and processing of rubber-asbestos products, especially acid and heat-resistant seals
• Manufacture and processing of asbestos-containing papers, cardboard and felt materials
• Use of asbestos as an additive in the production of paints, floor coverings, sealants, rubber tires, thermoplastics, plastic resin press mats, etc.
• Removal of asbestos-containing products (e.g. during demolition work)

In addition, various minerals such as talc (soapstone) can contain asbestos and thus lead to asbestosis - more precisely mixed dust asbestosis - via a mixed dust lung (a dust lung due to the inhalation of different types of dust).

The combination with smoking is particularly dangerous: the risk of lung cancer for asbestos workers who smoke is ten to forty times higher than for colleagues who do not smoke.

Response of the immune system

Scavenger cells of the immune system try to absorb and break down the inhaled asbestos fibers. They are difficult to break down asbestos and send out messenger substances, which in turn attract connective tissue cells (fibroblasts). The fibroblasts cause scarring of the connective tissue.

In addition, the messenger substances attract other immune cells. These trigger the smallest inflammation in the lung tissue, which further drives the scarring of the lungs. The asbestos fibers migrate into the pleural space, where they are stored for life. The pleural space is the space between the two sheets of the pleura (pleura and pleura).

Asbestosis: examinations and diagnosis

Pulmonologists or occupational physicians are specialists in asbestos-related diseases. The first step in diagnosing asbestosis is a detailed doctor-patient discussion to collect the medical history (anamnesis). The doctor asks the person concerned about their symptoms, professional past and current work situation:

• What is your profession? How long have you been working in this job?
• Did you have another job before your current job?
• Do you breathe dust in the workplace?
• Have particulate matter measurements been carried out at the workplace?
• Are you using a protective mask or glasses?
• How long have you had symptoms such as a cough?
• Do you have thick sputum when you cough?
• Is it difficult for you to breathe?
• Do you feel your discomfort is increasing?
• Have you noticed a slight fever? Do you sweat heavily at night?
• Do you smoke? If so, since when and how many cigarettes a day?

After the consultation with the doctor, there will be a physical examination. The focus is on listening to and tapping the lungs.

An x-ray (chest x-ray) or computed tomography (chest CT) scan is done to get an image of the chest. Characteristic changes in the recordings can corroborate the suspicion of asbestosis - such as the detection of so-called asbestos bodies. These are rod-shaped, brownish structures in the lung tissue with a length of up to five micrometers. They consist of a central dust fiber and piston-shaped swellings (caused by an iron-containing protein coat).

Asbestos particles, despite their name, can also be caused by other fibrous dust crystals. The term "ferruginous bodies" is therefore more correct.

If necessary, further examinations follow such as:

• Pulmonary function test
• Blood gas analysis
• Lung biopsy
• Lung lavage (bronchoalveolar lavage)
• Effusion cytology (sampling from an accumulation of fluid in the lung membrane)

Asbestosis: treatment

Asbestosis is incurable: Asbestos-related pulmonary fibrosis is progressing steadily. One can only try to relieve symptoms, such as shortness of breath, with bronchodilator drugs (bronchodilators) and cortisone (as a spray). At an advanced stage, those affected usually need additional oxygen via an oxygen device (oxygen therapy).

Many patients who struggle with physical limitations as a result of the disease also benefit from rehabilitation for patients with lung diseases (pulmonary rehabilitation).

Heart failure as a result of asbestos-related lung fibrosis can be treated with medication - such as those that relieve the heart. In addition, the doctor recommends other measures as needed, such as weight loss through exercise and a healthy diet. Excess pounds represent an additional burden on the heart.

If exposure to asbestos has led to cancer, this is treated appropriately. In the case of lung cancer, for example, one usually tries to cut out the tumor as completely as possible. The operation can be followed by chemotherapy to kill any cancer cells that may have remained in the body. For very large tumors, patients are sometimes given radiation before surgery to reduce the size of the tumor. Read more about lung cancer treatment here.

Asbestosis: disease course and prognosis

The development of asbestosis primarily depends on how long and to what extent someone has been exposed to asbestos fibers. 30 fiber years cause asbestosis in almost everyone affected. Pleural mesothelioma can also be caused by a low exposure to asbestos.

The pulmonary fibrosis on which asbestosis is based cannot be reversed and, in most cases, can hardly be stopped with medication. Their progression leads to increasing shortness of breath, which limits life expectancy. Secondary diseases such as cancer worsen the prognosis.

Therefore, the earlier an asbestosis is detected, the better. If one then avoids further exposure to asbestos and the inhalation of other dusts and implements consistent occupational safety measures, secondary diseases can be prevented or at least delayed. It is also important not to smoke: the risk of lung or larynx cancer with asbestosis is significantly increased by nicotine consumption.

Cancer from asbestosis: life expectancy

Patients suffering from pleural mesothelioma only live on average one to one and a half years after the diagnosis. After four years, only ten percent are still alive.

The prognosis for lung cancer depends largely on how early the cancer was diagnosed and treatment started. Because it causes hardly any or only unspecific symptoms for a long time, the malignant lung tumor is usually only discovered late. Two thirds of those affected can therefore no longer be operated on after the diagnosis has been made. Five years after being diagnosed with lung cancer, only about 15 percent of those infected are still alive.

Asbestosis: prevention

Asbestos production and processing has been banned since 1995. Nevertheless, there are activities such as demolition or renovation work in which an increased asbestos load is to be expected due to old components. There are therefore legally regulated protective measures for workers, which are laid down in the Ordinance on Hazardous Substances. The employer must provide his employees with suitable protective equipment. For example, wearing suitable protective masks can prevent asbestos-containing dust from being inhaled.

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