Asbestos-related Lung Disease

Question 1

What is asbestos?

Answer 1

a silicate of iron, magnesium, nickel, cadmium and aluminium that occurs naturally as fibres

Question 2

What is the most common form of asbestos? (90%)

Answer 2

Chrysotile/ white asbestos (soft, long, thin fibre)

Question 3

What is the second most common form of asbestos? (6%)

Answer 3

Crocidolite/ blue asbestos (long, thick fibre)

Question 4

Which type of asbestos fibre is most likely to cause asbestosis and mesothelioma?

Answer 4

Crocidolite

Question 5

Give two working environments where asbestos levels have been historically high:

Answer 5

1) shipping yards
2) power stations

Question 6

What cancer does asbestos starkly increase the risk of?

Answer 6

primary lung adenocarcinoma

Question 7

What are pleural plaques?

Answer 7

benign, scarred, calcified areas of thickened tissue that form in the pleura or lung lining secondary to asbestos exposure

Question 8

What symptoms are associated with pleural plaques?

Answer 8

they are often asymptomatic but can cause mild restrictive ventilatory defects such as mild effort dyspnoea

Question 9

What CXR signs would be associated with pleural plaques? (2)

Answer 9

1) parietal pleural thickening
2) calcification

Question 10

Name 6 asbestos-related lung pathologies:

Answer 10

1) pleural plaques
2) pleural effusion
3) bilateral diffuse pleural thickening
4) mesothelioma
5) asbestosis
6) primary lung adenocarcinoma

Question 11

How long after asbestos exposure can a pleural effusion occur?

Answer 11

within the first two decades

Question 12

Give two presentations associated with pleural effusion:

Answer 12

1) pleuritic pain
2) dyspnoea

Question 13

True or false: asbestos-associated pleural effusions are often recurrent

Answer 13

True

Question 14

How does bilateral diffuse pleural thickening present on CXR?

Answer 14

thickening of both parietal and visceral pleural on both lungs(>5mm think and extending over more than 1/4 of the chest wall)

Question 15

What is mesothelium?

Answer 15

simple squamous epithelium that lines the lungs and other serous cavities and internal organs

Question 15

What is the main clinical presentation of bilateral diffuse pleural thickening?

Answer 15

Dysponoea

Question 16

How long after initial asbestos exposure do mesotheliomas arise?

Answer 16

20-40 years

Question 17

What 2 CXR findings are associated with mesotheliomas?

Answer 17

1) pleural thickening
2) pleural effusion (usually unilateral)

Question 18

Give 6 signs and symptoms associated with mesothelioma:

Answer 18

1) pleuritic pain
2) progressive dyspnoea
3) haemoptysis
4) fatigue
5) anaemia
6) wheeze, hoarseness or cough

Question 19

Give 4 sites where mesothelioma metastasis is common:

Answer 19

1) other lung
2) liver
3) adrenal gland
4) kidney

Question 20

How is a mesothelioma diagnosed?

Answer 20

biopsy via thoracoscopy

Question 21

What two chemotherapy drugs have shown promising results when combined?

Answer 21

1) cisplatin
2) pemetrexed

Question 22

What is asbestosis?

Answer 22

fibrosis of the lung due to asbestos exposure

Question 23

Is asbestosis associated with high or low exposure to asbestos?

Answer 23

high

Question 24

How long after initial exposure to asbestos does asbestosis present?`

Answer 24

5-10 years

Question 25

Give 4 symptoms associated with asbestosis:

Answer 25

1) progressive, worsening SOB
2) cough
3) wheeze
4) chest tightness

Question 26

What hand sign is associated with asbestosis?

Answer 26

clubbing

Question 27

True or false: there are many treatments available for asbestosis

Answer 27

false - there are no specific treatments and so has a poor prognosis

Question 28

Describe the pathophysiology of asbestos-related lung diseases: (2)

Answer 28

1) asbestos fibres in pulmonary tissues activate a chronic inflammatory response, stimulating macrophages to activate fibroblasts - these deposit connective tissue
2) asbestos can bind to chromosomes and cause mutations