Asbestos Related Lung Disease Flashcards
What is Asbesttosis?
Interstitial restrictive lung disease:
- diffuse interstitial fibrosis due to exposure to asbestos fibres
- Pleural abnormalities may be present with or without parenchymal fibrosis
What is the Aetiology of Asbestosis?
Inhalation of Asbestos fibres
- The more the higher the risk
What are the risk factors for the development of Asbestosis?
- Cumulative dose of inhaled asbestos (occupational construction or ship workers)
- Smoking (weak)
What is the epidemiology of Asbestosis?
- Incidence increasing
- Latency of about 20 years between first exposure and asbestosis
- Ofen >50, male (due to occumpation) (1-2% female)
- 2016: 1050 new cases of asbestosis in the UK
How do Asbestos Fibres in the lungs cause asbestosis?
- Asbestos fibres inhaled –> deposition at alveolar duct bifurcation (too small so be coughed up, too big to be successfully removed my immune cells) –> attraction of macrophages –> Alveolar macrophage alveolitis
- Cytokine release –> Fibrosis (ususally starting in lower lobes) and later Honeycombing
What are the presenting symptoms of Asbestosis?
- Restrictive lung disease
- Chest tighness
- dyspnoea on exertion
- dry, non-productive cough
- Getting progressively worse
- Normally no chest pain
- (Later: Symptoms of Cor Pulmonale)
What are signs on examination of Asbestosis?
- Crackels (fine, often bibasal crackels)
- late inspiratory
- Clubbing
- Cyanosis
- Decreased chest expansion
Which investigations would you do in a patient with suspected Asbestosis?
- CXR
- Pulmonary function test
What are the findings in a CXR in a patient with Asbestosis?
- linear interstitial changes, first seen in lower lobe
- Pleural plaques
- Pleural thickening at the mid-thoracic level may be present alone or in conjunction with linear changes in the parenchyma
- Majority of pleural changes not calcified –> not visible on X-Ray
What are your finding in a spiromtry /Pulmonary function test of a patient with Asbestosis?
Restrictive Lung disease
- Restrictive Pulmonary Disease
- Reduction in FVC, FEV1
- Normal FEV1 to FVC ratio
- Reduced vital/total lung capacity
What is Mesothelioma?
Aggressive Malignancy of mesothelium normally found in the Pleura (90%), but might be also seen in Peritoneum (5-10%). This article: Pulmonary
What is the Mesotheliom?
Single-cell membrane lining several body cavities and interstital organs
What is the epidemiology of a Mesothelioma?
- Men
- White
- Older adults (60-90) –> due to occupational exposure and risk factors
- Relativeyl rare expected to peak between 2011 and 2015, with 1950 to 2450 deaths
What is the Aetiology of a Mesothelioma?
Asbestos exposure (80% of patients)
Latency 20-40 years after exposure
What are risk factors for the development of a mesothelioma?
- Asbestos exposure
- Smoking
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Explain the pathophysiology of Asbestos related mesothelioma
- Asbestos fibres get inhaled, wonder in tissues until they get to epithelium of lung (mesothelium)
- Cause irritation –> inflammation might lead to DNA damage –> mutation and malignancy
What are the symptoms of a pleuritic Mesothelioma?
Symptoms of Asbestosis
- SOB
- Dry, non-productive cough
- Chest pain
- Haemoptysis
- Systemic
- Fever, night sweat, lethargy, weight losss
What are signs of a pleuritis Mesothelioma?
- Due to pleural effusion
- Decreased breath sounds
- can also indicate trapped lung or bronchial obstruction caused by mesothelioma
- Dullness to percussion
Which investigations would you consider in someone with a suspected Mesothelioma?
- ImagingCXR (not very sensitive)
- If suspected mesothelioma: CT
- circumferential or nodular pleural thickening or involvement of the mediastinal pleura
- Pulmonary function test
- Biopsy
What is the prognosis in a patien with suspected Mesothelioma?
- Poor
- median survival is 10 to 15 months, with only 5% to 10% of patients alive 5 years after diagnosis
What are the findings on an X-Ray that you would expect in a patient with Mesothelioma?
- unilateral pleural effusion
- pleural thickening
- reduced lung volumes, or parenchymal changes related to asbestos exposure
