Dr Leena Deol

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Asbestosis and related lung conditions.

• Dr Leena Deol

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What is asbestos

• Asbestos is a naturally occurring fibre which is
  mined in various parts of the world, notably
  South Africa and Canada.
• There are two families of asbestos, the Amphibole
  family and the Serpentine family, which differ
  based on the structure of their mineral crystals.

• (British Lung Foundation)

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What is asbestos

• There are five different types of Amphiboles
  Amosite ("brown asbestos"), Crocidolite ("blue
  asbestos"), Anthophyllite, Tremolite, and
  Actinolite.
• Serpentine Asbestos
• The most common type of asbestos, it is also
  known as "white asbestos,"

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Asbestos fibres

• Crocidolite (blue)
• Amosite (brown)
• Chrysotile (white)

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What is asbestos

• It can be processed in several ways for
  industrial use.
• Its properties of resistance to heat, electricity
  and sound, make it useful for a variety of
  purposes, particularly brake linings and
  insulation.

• (British Lung Foundation)

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Where can it be found in the home

• Exterior
• 1)   Roof garage and shed sheets, tiles  or roof
  felt
• 2)   Gutters and down pipes
• 3)   Fascia 

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Where can it be found in the home

• Interior
• 4)   Partition walls
• 5)   Panels beneath windows
• 6)   Cupboards around domestic boilers
• 7)   Panels behind electrical equipment
• 8)   Panels behind fires or heaters
• 9)   Panels on or inside fire doors

• 10)  Bath panels 
• 11)  Floor titles
• 12)  Textures coatings (artex)
• 13)  Gaskets and rope seals inside gas
  appliances
• 14)  Cold water storage tanks

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Where can it be found in the home
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An example of asbestos slate

• Asbestos slate

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When is it dangerous

• Discovery of asbestos in a building often causes
  alarm among people living and working in it.
• It is only the inhalation of loose asbestos
  fibres which causes disease.

• (British Lung Foundation)

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Exposure to asbestos causes 5 types of lung
disease

• Pleural Plaques
• Diffuse Pleural Thickening
• Asbestosis
• Asbestos-related Lung Cancer
• Mesothelioma
• www.asbestos-victims-support.org/diseases.

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Lung diagram

•  

lung
 

• www.asbestos-victims-support.org/diseases.

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Pleural plaques

• Pleural plaques are localised, well-defined areas
  of pleural thickening, rather like calluses on
  other parts of the body.
• They are patches of tough tissue formed on the
  pleura on the chest wall.
• The pleura is a two-layered membrane surrounding
  the lungs, shown on the diagram. Sometimes these
  plaques are calcified and may be referred to as
  calcified pleural plaques.
• www.asbestos-victims-support.org/diseases.

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Pleural plaques

• Usually, you will not experience any symptoms of
  breathlessness or discomfort because of pleural
  plaques and it is unlikely that you will know
  that you have them.  
• Pleural plaques are seen as the least serious
  form of asbestos disease and are not in
  themselves dangerous.

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Pleural plaques

• They are seen as an indicator of exposure to
  asbestos and there is a small chance, because of
  that exposure, that you may develop one of the
  other types of asbestos disease in the future.
•  You cannot claim Industrial Injuries Disablement
  Benefit for pleural plaques.
• www.asbestos-victims-support.org/diseases.

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Pleural plaques
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Diffuse pleural thickening

• Pleural thickening The pleura is a two-layered
  membrane which surrounds the lungs and lines the
  inside of the rib cage.
• Some asbestos fibres inhaled into lungs work
  their way out to the pleura and may cause
  fibrosis or scarring to develop there.
• This causes the pleura to thicken and this may
  show up on a chest X-ray.
• www.asbestos-victims-support.org/diseases.

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Diffuse pleural thickening
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Diffuse pleural thickening

• Sometimes a build up of fluid in the pleural
  cavity occurs before diffuse pleural thickening
  develops.
• This condition is called a pleural effusion and
  can cause breathlessness and, in some instances,
  pain. 
• It can take up to 10 to 20 years to develop
  pleural plaques and pleural thickening after
  exposure to asbestos

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Diffuse pleural thickening

• You can claim Industrial Injuries Disablement
  Benefit from the Dept. for Works and Pension for
  diffuse pleural thickening if you were exposed to
  asbestos at work.
• You can also claim compensation from your
  employer through the courts if you were
  negligently exposed to asbestos, or from the DWP
  if your employer is no longer trading . 

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Asbestosis

• Asbestosis is a type of scarring of the lung
  caused by asbestos fibres which have lodged in
  the lungs after being inhaled from the air.
• The scarring causes the lungs to shrink
• Symptoms of asbestosis include breathlessness,
  especially on exertion, a dry cough, and chest
  tightness

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Abestosis

• Asbestosis develops in some people who have
  breathed in a substantial amount of asbestos dust
  in the course of their work.
• It usually shows itself a long time after dust
  inhalation, often twenty or thirty years after
  exposure.

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Asbestosis

• You can claim Industrial Injuries Disablement
  Benefit from the Benefits Agency for asbestosis
  if you were exposed to asbestos at work.
• www.asbestos-victims-support.org/diseases.

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Asbestosis
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Symptoms of asbestos related disease

• Shortness of breath, wheezing, or hoarseness.
• A persistent cough that gets worse over time.
• Blood in the sputum (fluid) coughed up from the
  lungs.
• Pain or tightening in the chest.
• Difficulty swallowing.
• Swelling of the neck or face.
• Loss of appetite.
• Weight loss, fatigue or anaemia.

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Findings on clinical examination

• Often there is very little to find on chest
  examination.

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Investigations

• GP may want to carry out a Chest Xray, however in
  the early stages of the disease there is little
  to find.
• GP will then refer to a Chest Consultant who may
  want to do the following tests
• CT Scan
• Spirometry
• Broncoscopy and Biopsy

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Treatment

• This will be determined by the disease process.
• Oxygen /Inhalers
• Regular monitoring.

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More information

• http//www.hse.gov.uk/asbestos/
• Contact no 0845 345 0055

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Break
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Mesothelioma

• Mesothelioma used to be a relatively rare cancer.
  It is also known as diffuse or malignant
  mesothelioma.
• It can affect the pleura (the lining of the
  lungs), and less commonly, the peritoneum (the
  lining of the abdomen).
• It can also affect the pericardium (the area
  around the heart).

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Mesothelioma
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Mesothelioma

• The connection between mesothelioma and asbestos
  was discovered in 1960. By 1960, the production
  and use of all forms of asbestos had increased
  world-wide. It continued to grow for at least 15
  more years. This has been reflected by widespread
  cases of mesothelioma, 30 to 40 years later.
• Asbestos is the cause of over 90 per cent of
  cases of mesothelioma.
• (British Lung Foundation

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Mesothelioma

• All types of asbestos can cause mesothelioma if
  you breathe in or swallow the fibres.
• Blue and brown asbestos are known to be the most
  dangerous.
• White asbestos does increase the risk of
  mesothelioma, but is not as strong.
• Another fibre called tremolite may also be a
  cause.

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Who is at risk

• Initially mesothelioma mainly affected
• laggers
• thermal insulation engineers
• shipyard workers
• asbestos manufacturing workers
• women who assembled gas masks during the war

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Who is at risk

• However, recent cases show that
• building workers
• plumbers
• gas fitters
• carpenters
• electricians
• are now the largest high-risk group.

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Who is at risk

• People who come across asbestos while doing DIY
  (getting rid of an old boiler, for example), are
  also at risk.

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Who is at risk

• Some other people have a lower risk of
  mesothelioma, if they have come into contact with
  asbestos, but not directly in their work.
• For example
• People working in places where other workers are
  handling asbestos
• People who have washed worker's overalls
• People who lived and played near asbestos
  factories when they were children

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Fibres
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Symptoms

• The most common symptoms are
• Breathlessness due to build-up of fluid
• Chest pain
• Weight loss/loss of appetite
• Fever/night sweats
• Pain and/or swelling in their abdomen
• Unexplained tiredness

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How is it diagnosed?

• If you have been in contact with asbestos, and a
  chest x-ray shows a build-up of fluid, then you
  will probably have further tests to confirm (or
  rule out) that you have mesothelioma.
• It can be difficult to be certain of a diagnosis
  of mesothelioma. The doctor will need to examine
  some fluid and/or tissue.

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How is it diagnosed?

• Bronchoscopy
• CT scan and /Biopsy

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Ct scanner
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How does mesothelioma develop?

• Mesothelioma usually spreads slowly, taking the
  path of least resistance.
• This is initially within the space between the
  layers of the lining of your chest/abdomen.
• In later stages, the tumour can grow to be very
  large.
• Mesothelioma does not usually spread around the
  body like other cancers sometimes do.

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Treatment

• SYMPTOM CONTROL
• Treatment with steroids
• Painkillers
• Drugs to improve appetite
• Laxatives
• Drugs to improve the breathing

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Treatment

• The fluid that can build up in your chest can be
  removed on a regular basis.
• Pleuradesis

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Treatment

• Surgery to remove tumours has had varying
  success.
• Trials are underway at the moment for an
  operation that would remove the whole of the
  affected lung
• This operation is only suitable for a very small
  number of people

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Radiotherapy

• Radiotherapy treats cancer by using high-energy
  x-rays to destroy cancer cells.
• Radiotherapy is given there to stop the tumour
  growing through your chest wall and into your
  skin
• Radiotherapy can be aimed directly at the tumour
  to try and make it smaller.
• This will help reduce pain and discomfort, and
  possibly breathlessness.

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Radiotherapy
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Chemotherapy

• This is treatment with drugs directly into your
  veins and/or in pill form.
• The aim is to kill or control the growth of
  cancer cells, which would help with your symptoms
  and improve your quality of life.
• Doctors use a variety of drugs in chemotherapy -
  and there is one drug, Alimta (Pemetrexed), that
  has been licensed to treat mesothelioma in
  particular.
• (British Lung Foundation

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Chemotherapy

• But chemotherapy will not benefit everyone, and
  will usually only be considered if you are
  generally fit and strong.
• No cure for mesothelioma has yet been found but
  the search goes on and new drugs and new
  combinations continue to be tested.

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Take care of your feelings

• If you are diagnosed with mesothelioma, it can be
  traumatic.
• Being treated for mesothelioma, as with other
  cancers, can be difficult too.
• (British Lung Foundation

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Take care of your feelings

• You may feel shock, fear, disbelief, anger,
  loneliness or resentment.
• You may find it hard to accept that you have
  mesothelioma at all.
• You may feel angry and bitter that you have a
  disease just because of where you worked. If you
  are a friend, relative or family member of
  someone who has been diagnosed with mesothelioma,
  you may feel many of the same emotions.
• (British Lung Foundation

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Compensation and benefits

• It is a good idea to seek advice quickly, either
  from the British Lung Foundation helpline on
  08458 50 50 20
• Citizens Advice Bureau, or from a specialist
  solicitor (call the Law Society).
• (British Lung Foundation

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Compensation and benefits

• Industrial Injuries Disablement Benefit (IIDB)
• To claim IIDB You should contact your local
  Jobcentre Plus, or ring the DWP enquiry line
  (0800 88 22 00) and ask to be sent form B1 100PN.
• (British Lung Foundation

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Compensation and benefits

• Other Benefits
• Statutory Sick Pay or Incapacity Benefit
• Constant Attendance Allowance
• Severe Disablement Allowance
• Disability Living Allowance (mobility)
• Income Support
• Housing Benefit/Council Tax
• (British Lung Foundation

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More information

• British Lung Foundation
• Asbestos Victim support
• Heath and Safety Executive
• Occupational health services

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End

• Many thanks to
• Mr Holden
• PPG members
• Participants.
• Questions