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Asbestosis lung Wallpaper Photos Pictures Pics Images 2013

Asbestosis lung Biogarphy

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The inhalation of asbestos fibers may lead to a number of respiratory diseases, including lung cancer, asbestosis, pleural plaques, benign pleural effusion, and malignant mesothelioma. Although exposure is now regulated, patients continue to present with these diseases because of the long latent period between exposure and clinical disease. Presenting signs and symptoms tend to be nonspecific; thus, the occupational history helps guide clinical suspicion. High-risk populations include persons in construction trades, boilermakers, shipyard workers, railroad workers, and U.S. Navy veterans. Every effort should be made to minimize ongoing exposure. Patients with a history of significant asbestos exposure may warrant diagnostic testing and follow-up assessment, although it is unclear whether this improves outcomes. Patients with significant exposure and dyspnea should have chest radiography and spirometry. The prognosis depends on the specific disease entity. Asbestosis generally progresses slowly, whereas malignant mesothelioma has an extremely poor prognosis. The treatment of patients with asbestos exposure and lung cancer is identical to that of any patient with lung cancer. Because exposure to cigarette smoke increases the risk of developing lung cancer in patients with a history of asbestos exposure, smoking cessation is essential. Patients with asbestosis or lung cancer should receive influenza and pneumococcal vaccinations.
The inhalation of asbestos fibers may lead to a number of respiratory diseases, including lung cancer, asbestosis, pleural plaques, benign pleural effusion, and malignant mesothelioma. Although exposure is now regulated, patients continue to present with these diseases because of the long latent period between exposure and clinical disease. Presenting signs and symptoms tend to be nonspecific; thus, the occupational history helps guide clinical suspicion. High-risk populations include persons in construction trades, boilermakers, shipyard workers, railroad workers, and U.S. Navy veterans. Every effort should be made to minimize ongoing exposure. Patients with a history of significant asbestos exposure may warrant diagnostic testing and follow-up assessment, although it is unclear whether this improves outcomes. Patients with significant exposure and dyspnea should have chest radiography and spirometry. The prognosis depends on the specific disease entity. Asbestosis generally progresses slowly, whereas malignant mesothelioma has an extremely poor prognosis. The treatment of patients with asbestos exposure and lung cancer is identical to that of any patient with lung cancer. Because exposure to cigarette smoke increases the risk of developing lung cancer in patients with a history of asbestos exposure, smoking cessation is essential. Patients with asbestosis or lung cancer should receive influenza and pneumococcal vaccinations.
Asbestos, a crystalline mineral that occurs in deposits throughout the world, is the smallest naturally occurring fiber. Because of its flexibility, durability, and resistance to heat and chemical corrosion, it became widely used in industry. The inhalation of asbestos fibers was first linked to the development of lung disease in 1890, and the first deaths attributable to asbestos exposure were reported in 1907. Legislation controlling exposure was introduced in the United Kingdom in 1931, but the United States did not enact its first legislation limiting exposure until 1971.
SORT: KEY RECOMMENDATIONS FOR PRACTICE
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The peak global incidence of asbestos-related disease is expected to occur 30 to 40 years after the period of peak usage (i.e., the 1960s and 1970s). For diffuse malignant mesothelioma, the condition with the longest latency, the incidence is expected to rise in Europe until 2020.1 The prevalence of asbestosis in the United States is not known, but in 2000, there were an estimated 20,000 hospital discharges with this diagnosis and 2,000 deaths with asbestosis as the underlying or contributing cause, and these numbers are expected to rise through this decade.2,3 The incidence of malignant mesothelioma in the United States was thought to peak at 2,000 cases per year from 2000 to 2004; another study suggested there would be a yearly average of 3,200 deaths from asbestos-related lung cancer from 1985 to 2009.4,5
Asbestos-Related Lung Disease
Inhalation of asbestos fibers can result in a number of distinct pathologic processes (Table 1).2–5 These include the development of pleural-based abnormalities such as benign plaques, benign pleural effusions, and malignant mesothelioma. In addition, new cases of asbestosis, an important pneumoconiosis, and many asbestos-related lung cancers continue to occur. Most patients with asbestos-related lung disease have a strong exposure history; however, significant disease can occur with minimal exposure and, rarely, with unknown exposure.
TABLE 1 Symptoms, Prevalence, and Treatment of Asbestos-Related Lung Diseases
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Although occupational exposure is now regulated in the United States, past exposure must be recognized. It is important to take a comprehensive occupational and environmental history to identify persons at risk because of previous exposure. Factors to establish include the specific occupation (Table 2), the duration of that occupation, and the intensity of exposure (e.g., was the dust visible or not). A significant exposure can be defined as at least several months' exposure to visible dust that began more than 10 years earlier. Although much attention is focused on industrial exposure, environmental sources also play a role. These include residence near asbestos or vermiculite mines and prolonged exposure in buildings with open sources of contamination.6 Undisturbed insulation in good condition is not hazardous.7
TABLE 2 Potential Sources of Occupational and Environmental Asbestos Exposure
View TableScreening for asbestos-related disease may be appropriate in persons with a history of significant asbestos exposure; however, screening of the general population is not warranted. If a person with a history of significant exposure reports exertional dyspnea, the initial assessment should include spirometry and chest radiography in addition to a history and physical examination. If there is no evidence of abnormalities, high-resolution computed tomography (CT) may be considered because this may reveal pleural-based plaques and is more sensitive than chest radiography at detecting these lesions and mild fibrosis. The presence of plaques indicates significant asbestos exposure. Full pulmonary function tests, including measurement of lung volumes and diffusion capacity, should be performed in patients with abnormal spirometry results, imaging abnormalities, or suspected asbestos-related conditions.7 Symptomatic patients may be entitled to workers' compensation if there is loss of employment or functional impairment.
The presence of asbestosis is an independent risk factor for the development of lung cancer. Thus, the appearance of symptoms such as dyspnea, cough, chest discomfort, or weight loss necessitates a prompt and full assessment. Current recommendations support lifelong surveillance for persons with a significant exposure history or ongoing exposure. The American Thoracic Society recommends performing chest radiography and pulmonary function testing every three to five years in patients with disease.7 There is no good evidence that screening improves outcomes, although it may help identify lung cancer earlier. Screening for mesothelioma is not helpful.
LUNG CANCER
Asbestos exposure significantly increases the risk of developing small cell and non–small cell lung carcinoma.8 A number of studies suggest an increased incidence of non–small cell lung carcinoma in patients with asbestosis compared with those who have been exposed to asbestos but do not have asbestosis.8 Lung cancer can occur in nonsmokers exposed to asbestos; however, the risk is magnified several-fold by smoking.9–11 All patients who smoke cigarettes must be warned about this risk, and every attempt should be made to assist patients with smoking cessation. Nonmesothelioma asbestos-related lung cancers are indistinguishable clinically from lung cancers related to smoking alone. Thus, evaluation of a new noncalcified pulmonary nodule is similar in patients with or without a history of asbestos exposure. Patients with lung cancer should receive influenza and pneumococcal vaccines.12
ASBESTOSISAsbestosis is a fibrotic lung disease, or pneumoconiosis, resulting from the inhalation of asbestos fibers. In many patients, it is characterized by a very mild and indolent fibrosis that usually produces relatively minor symptoms. In general, the latent period between the peak asbestos exposure and diagnosis is 20 to 30 years.
Complaints of exertional dyspnea associated with auscultatory crackles on physical examination should prompt further investigation. The first changes in pulmonary function may be decreased diffusion capacity and exertional oxygen desaturation. As the process becomes more advanced, pulmonary function tests will reveal a restrictive pattern with a decreased total lung capacity and vital capacity.
Chest radiography typically demonstrates increased interstitial markings, usually more prominent in the lower lobes, and often pleural plaques. Typical findings on high-resolution CT of the chest include increased interstitial markings, predominantly at the bases; later, honeycombing may be apparent (Figure 1). In many respects, asbestosis is clinically similar to idiopathic pulmonary fibrosis, but asbestosis usually progresses slowly, whereas idiopathic pulmonary fibrosis has a rapidly progressive course. No current treatment effectively alters the natural course of asbestosis. Patients will benefit from influenza and pneumococcal vaccines.12