The National Asbestos Helpline

Asbestos related diseases are one of the biggest causes of death in this Country. We are lucky that we have the National Asbestos Helpline

The National Asbestos Helpline helps thousands of people every year from across Great Britain with all types of asbestos related enquiries.

Such is their experience and depth of knowledge in this field, they are regularly called upon by other organisations and healthcare professionals to provide advice and guidance.

Health professionals, GPs, Consultants, construction companies, health and safety groups, government agencies, charities and the Citizens Advice Bureau all utilise the experience of the National Asbestos Helpline from time to time.

Asbestosis is described as a diffuse pulmonary fibrosis caused by the inhalation of excessive amount of asbestos.

The helpline are able to give advice on a wide range of Asbestos related diseases. One of the most common which affects people who have worked in the Construction Industry is Asbestosis.

What is Asbestosis

Asbestosis is described as a diffuse pulmonary fibrosis caused by the inhalation of excessive amount of asbestos.  It is a chronic lung condition. Pathologically both pulmonary fibrosis and evidence of asbestos in the lungs must be present.

The interval between onset of asbestos exposure and the development of symptoms of asbestosis is usually between 20-40 years or more. Those who have worked in Construction Industry for a long period of time could be at risk. Modern day health and safety measures have gone a long way to improving exposure to asbestos.

You are at risk of developing asbestosis if you have been subject to prolonged asbestos exposure.

Some of the common occupations thought to be most at risk are:

  • Surveyors
  • Carpenters and joiners
  • IT cable installers
  • Construction workers
  • Demolition workers
  • Electricians
  • Fire fighters
  • Building maintenance workers
  • Plasterers
  • Laggers
  • Plumber and boiler maintenance engineers
  • Insulation workers
  • Air conditioning engineers
  • Roofing Contractors

Diagnosis

The first recorded diagnosis of Asbestosis was made in 1924.

A diagnosis of Asbestosis will exclusively apply to pulmonary interstitial fibrosis which is asbestos induced. The term Asbestosis is often misused to describe other asbestos diseases.

Asbestosis will usually be diagnosed based on the following findings:

  • An exposure to asbestos that is considered moderate to heavy;
  • Clinical signs of interstitial fibrosis;
  • X Ray finding opaque masses in the lung fields;
  • Impairment of the lung function.

Diagnosing a person may take a long period of time as your doctor will want to rule out all possible lung conditions.

It will begin with your doctor looking at  your medical history and carrying out a physical examination.  The doctor will also discuss your work history with you, and more specifically, if you have ever knowingly worked with asbestos and your known levels of exposure;

Depending on the physical examination and the findings from the medical history, your Foctor may request one or more of the following tests:

  • X-Ray of the Chest and/or Abdomen
  • Computerised Tomography  (CT)Scan
  • Lung Function Tests
  • MRI

With an X Ray Asbestosis will show as shadowing in the lower parts of the lungs, however if a person is suffering with a minor level of Asbestosis then it will be likely that a CT Scan will also be required, as it is more sensitive because it takes cross sectional images of the lungs. If a CT Scan is required to pick up signs of Asbestosis because it is an early case of the illness then they will usually considered as having little if any disability.

Lung function tests will be used to assess the disability of person and measure how effective your lungs work.

  • how much air you can take into your lungs and when compared with people of the same ages, height, sex etc the doctor can assess if you are within the normal range.
  • how much air you can blow out of your lungs and how fast you can do it.
  • how well your lungs deliver oxygen to your blood.
  • the strength of your breathing muscles

Once investigations have been carried out then the doctor may decide that it is necessary to carry out a biopsy to confirm the diagnosis.  A biopsy is when a sample of cells or tissue is removed to be examined under a microscope.  To determine if a person has Asbestosis, a biopsy will be used to detect if there are any asbestos fibre and/or cancer in the lungs.  There are various ways in which a biopsy can be performed and the one that is used will depend where the sample needs to be taken from:

  • Thoraccentesis – a long needle is used to remove fluid for examination from the chest;
  • Bronchoscopy – a thin, lighted tube called a bronchoscope is inserted either through the nose or mouth and then down into the lung to make it possible to examine the lung/s and air passages.
  • Fine-needle aspiration – a thin hollow needle is used to remove tissue or fluid from the lung.  It may be necessary for the doctor taking the biopsy to be guided by a CT Scan.Thoracoscopy – a small incision is made in the chest and back.  A thin, lighted tube called a thorascope is then placed into the chest between two ribs and the doctor can then have a clear view inside the chest to take the tissue sample.  Anaesthesia is used when this is performed.
  • Peritoneoscopy – a small incision is made in the abdomen and the doctor then inserts an instrument called a peritoneoscope.More extensive surgery will be necessary if a larger sample is required.  It is not always necessary for a biopsy to be used in giving a diagnosis of Asbestosis however if a patient is thought to be at a higher risk of developing mesothelioma or lung cancer it is usually performed.
  • More extensive surgery will be required if a larger sample is required.

The finding of asbestos bodies on their own in the lungs is insufficient to lead to a diagnosis of Asbestosis as this only indicates an exposure to asbestos however it will assist in differentiating between the various Pneumoconiosis.

A diagnosis of Asbestosis is likely to follow excessive exposure to asbestos – a diagnosis of Asbestosis requires exposure of a minimum dose of 25 fibre mil years.  To quantify fibres on the lungs there are several different methods which can be used: a light microscopy; scanning electronic microscopy or a transmission electron microscopy.

In most Asbestosis diagnosis, Pleural Plaques will also be visible from the radiography.

It is not uncommon for Asbestosis to begin in the respiratory system and advance down into the lungs however fibrosis limited only to the walls of the bronchioles does not indicate Asbestosis.

When a diagnosis of Asbestosis is being given it needs to be distinguished between other types of Pneumoconiosis such as:

  • Anthracosis (miners lung) from exposure to coal dust;
  • Silicosis exposure to silica and sometimes known as Potters rot or Grinders disease;
  • Siderosis, from exposure to iron;
  • Silicosiderosis exposure to both iron and silica.

It is possible however to have a diagnosis of more than one of the above Pneumoconiosis.  A diagnosis of Asbestosis should also not be confused with lung diseases which are caused as a result of cigarette smoking such as:

  • Emphysema – Obstructive lung disease which destroys the lung tissue round the bronchioles (smaller airways) causing them to lose their shape when we exhale and therefore making them inefficient in transferring oxygen into the blood and taking carbon dioxide out;
  • COPD – chronic obstructive pulmonary disease;
  • Respiratory bronchiolitis-associated interstitial lung disease.

A more difficult distinction which needs to be made when diagnosing Asbestosis is between a diagnosis of Idiopathic Pulmonary Fibrosis and one of Asbestosis, (also known as Pulmonary Fibrosis of Asbestosis).  Idiopathic Pulmonary Fibrosis is very similar to Asbestosis however the two main differences between these two conditions are that Asbestosis will have inflammation which will be more advanced that in a diagnosis of Idiopathic Pulmonary Fibrosis and it will also have mild fibrosis of the pleura.  The usual pattern of Idiopathic Pulmonary Fibrosis is called Usual Interstitial Pneumonia.  Honeycomb changes in the lung are also common however in an advanced case of Asbestosis they can also be found.

The presence of asbestos bodies in the lung will generally assist in making a diagnosis of Asbestosis over another lung condition.

Prognosis

The severity of asbestosis much depends on the length and amount of exposure to asbestos.  Unfortunately there is no cure for asbestosis once it has developed. The reason being is that it is not possible to repair lung damage caused by asbestos exposure. The condition cannot be reversed or cured but the symptoms can be managed.

In the majority of cases the condition progresses slowly or even not at all. Asbestos fibres remain in the lung for long time periods and the scarring continues to develop many years, even after the exposure has ceased. Because the development is slow an otherwise healthy person may not develop any significant disability.  In the most severe cases asbestosis can often place a significant strain on a persons health and unfortunately shorten their life expectancy.

How the condition may progress?

Progression of asbestosis may often lead to:-

Finger Clubbing

Finger clubbing is the  more severe form of the disease and can possibly lead to an increased risk of progression.  Finger clubbing is the  where the tips of a persons fingers become rounder and more spread out.

Coughing and Breathing

Breathing may become more difficult and very painful. In the first instance this may only be on exertion but as the disease progresses it can happen even at rest.

Crackling

Fine bilateral inspiratory crackles – crackles are fine and usually occur with each inspiratory effort, that is to say when an individual breathes in. The dry crackling sound can be heard with a stethoscope while listening to the lungs fill with air when a person breathes in.

Heart Disease

The significant lung scarring can reduce total lung capacity. The  ability to transfer oxygen from air into the blood and remove carbon dioxide becomes difficult.  This can then go on to result in heart failure.  The heart has to work harder which in turn weakens the heart.

There has been a study reported in the Occupational & Environmental Medicine Journal in 2012 which looked into cardiovascular disease mortality among British asbestos workers (1971-2005).This indicated a link between those working with asbestos and those with cardiovascular disease.

Mesothelioma and lung cancer

Unfortunately, asbestosis also carries an increased risk of developing mesothelioma and lung cancer.

Factors that might affect an individual’s life expectancy who has asbestosis include:-

  • Smoking – life expectancy will be greatly affected if an individual is also a smoker.
  • Other respiratory diseases – if an individual has, for example, COPD then their life expectancy might be reduced as the individuals lungs have to work harder to keep up healthy oxygen levels in the blood stream.
  • Other health problems – if an individual has developed other immune system problems then it will be more difficult for that individual to fight off infections. It will be  recommended that if you have asbestosis that you have eg the flu vaccine.

Deaths from asbestosis

The Health and Safety Executive have reported that deaths from asbestosis are continuing to increase and in fact in 2010 there were 412 deaths where asbestosis is likely to have contributed as a cause compared with 109 in 1978. There were 169 deaths in 2010 where asbestosis was specifically recorded as a cause of death.

What treatments are available for Asbestosis

Unfortunately there are no treatments that will cure Asbestosis. Once the lungs have been scarred and the Asbestosis has developed, however there are numerous steps that someone suffering with this illness can take to ease their symptoms and in doing so improve their quality of life.

  • Oxygen therapy/Inhalers
  • Medication and/or Vaccinations
  • Smoking cessation

Oxygen Therapy Treatment

One of the problems caused by asbestos is lung impairment.  The body is not receiving all the oxygen which it needs to be able to function properly and this will cause sufferers to become breathless very quickly, for example a short walk on an incline, walking up a flight of stairs.

Oxygen therapy is provided through an Oxygen Concentrator, this device concentrates the oxygen from ambient gas to give an oxygen enriched atmosphere.  The concentrator will be plugged into a mains socket in a room and when turned on it will purify the oxygen in the room to provide a more oxygen rich air supply and the air is then breathed in through a small plastic tube which will be placed inside the nostrils.  A mask is also worn to hold the small plastic tube in place.

If this type of treatment is used, the sufferer will also be provided with a small portable tank for when they are not by a mains plug.
For sufferers whose condition and breathlessness is mild use of an inhaler will be sufficient to ease their breathlessness as it relaxes the airways.

Medication and/or Vaccinations

Small doses of morphine will help a sufferer of asbestosis in suppressing the urge to cough whilst also reducing their sensation of breathlessness.

Steroids may be prescribed to a person with Asbestosis to ease their symptoms.  Aspirin may also be used to reduce inflammation and pain caused by Asbestosis.

A person suffering from Asbestosis are prone to infections in their lungs such as bronchitis, sinusitis, septicaemia, pneumonia and meningitis to name a few therefore are usually given a pneumococcus vaccine, pneumococcal polysaccharide vaccine, and possible boosters if necessary and they will also receive the influenza vaccination from their GP.

Smoking Cessation

Once a person has been diagnosed with Asbestosis who is a smoker they are advised to give up smoking as soon as possible as smoking will accelerate their breathlessness and will also make them more susceptible to go on to develop lung cancer.

Contact the National Asbestos Helpline

For more information about the National Asbestos Helpline visit https://www.nationalasbestos.co.uk

Health and Safety at Inner City Environmental

Inner City Environmental work to highest standards when it comes to our workforce. We have a three year HSE licence and are ARCA gold accredited. We provide advice to our workforce at all times on occupational health matters.

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