Asbestos-related lung disease

Question 1

What diseases can asbestos cause?

Answer 1

Asbestos can cause a variety of lung diseases from benign pleural plaques to mesothelioma.

Question 2

What are pleural plaques?

Answer 2

Pleural plaques are benign and do not undergo malignant change. They do not require any follow-up.

They are the most common form of asbestos-related lung disease and generally occur after a latent period of 20-40 years.

Question 3

What is pleural thickening?

Answer 3

Asbestos exposure may cause diffuse pleural thickening in a similar pattern to that seen following an empyema or haemothorax. The underlying pathophysiology is not fully understood.

Question 4

What is asbestosis?

Answer 4

Asbestosis is related to the length of exposure, with a latent period typically of 15-30 years. It typically causes lower lobe fibrosis.

Question 5

What are the features of asbestosis?

Answer 5

Features include dyspnoea and reduced exercise tolerance, clubbing, bilateral end-inspiratory crackles, and lung function tests showing a restrictive pattern with reduced gas transfer.

Question 6

How is asbestosis treated?

Answer 6

Asbestosis is treated conservatively; no interventions offer a significant benefit.

Question 7

What is mesothelioma?

Answer 7

Mesothelioma is a malignant disease of the pleura, with crocidolite (blue) asbestos being the most dangerous form.

Question 8

What are the possible features of mesothelioma?

Answer 8

Possible features include progressive shortness-of-breath, chest pain, and pleural effusion.

Question 9

What is the prognosis for mesothelioma?

Answer 9

The prognosis is very poor, with a median survival from diagnosis of 8-14 months.

Question 10

What is the relationship between asbestos and lung cancer?

Answer 10

Lung cancer is the most common form of cancer associated with asbestos exposure and has a synergistic effect with cigarette smoke.

Question 11

Why is smoking cessation important for those exposed to asbestos?

Answer 11

Smoking cessation is very important as the risk of lung cancer in smokers who have a history of asbestos exposure is very high.

Question 12

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Question 13

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Question 14

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Question 15

What is mesothelioma?

Answer 15

Mesothelioma is a cancer of the mesothelial layer of the pleural cavity that is strongly associated with asbestos exposure. In a small percentage of cases, other mesothelial layers such as those in the abdomen may be affected.

Question 16

What are the features of mesothelioma?

Answer 16

Features include dyspnoea, weight loss, chest wall pain, clubbing, and 30% present as painless pleural effusion. Only 20% have pre-existing asbestosis.

Question 17

What is the history of asbestos exposure in mesothelioma cases?

Answer 17

History of asbestos exposure is found in 85-90% of cases, with a latent period of 30-40 years.

Question 18

What is the basic pathology of mesothelioma?

Answer 18

It is a malignancy of mesothelial cells of the pleura, with metastases to the contralateral lung and peritoneum. The right lung is affected more often than the left.

Question 19

How is mesothelioma investigated or diagnosed?

Answer 19

Suspicion is raised by a chest x-ray showing either a pleural effusion or pleural thickening. The next step is normally a pleural CT.

Question 20

What should be done if a pleural effusion is present?

Answer 20

Fluid should be sent for MC&S, biochemistry, and cytology, but cytology is only helpful in 20-30% of cases.

Question 21

What is the role of local anaesthetic thoracoscopy in mesothelioma diagnosis?

Answer 21

Local anaesthetic thoracoscopy is increasingly used to investigate cytology negative exudative effusions as it has a high diagnostic yield (around 95%).

Question 22

What is done if an area of pleural nodularity is seen on CT?

Answer 22

An image-guided pleural biopsy may be used.

Question 23

What are the management options for mesothelioma?

Answer 23

Management includes symptomatic treatment, industrial compensation, chemotherapy, and surgery if operable.

Question 24

What is the prognosis for mesothelioma?

Answer 24

The prognosis is poor, with a median survival of 12 months.