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10/03/2020 Asbestosis: Dr. A. Sau MBBS, MD (Gold Medalist) DD (Medical) 1

The document discusses asbestosis, a lung disease caused by inhalation of asbestos fibers. It describes the types and past/current uses of asbestos, occupational exposures, epidemiology showing thousands of deaths and hospitalizations annually from asbestosis, and the pathogenesis involving cellular damage from fibers. Asbestosis manifests as interstitial lung fibrosis and can lead to pleural abnormalities or cancers like mesothelioma after long latency periods from exposure. The summary provides an overview of asbestosis and its health effects.

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151 views20 pages

10/03/2020 Asbestosis: Dr. A. Sau MBBS, MD (Gold Medalist) DD (Medical) 1

The document discusses asbestosis, a lung disease caused by inhalation of asbestos fibers. It describes the types and past/current uses of asbestos, occupational exposures, epidemiology showing thousands of deaths and hospitalizations annually from asbestosis, and the pathogenesis involving cellular damage from fibers. Asbestosis manifests as interstitial lung fibrosis and can lead to pleural abnormalities or cancers like mesothelioma after long latency periods from exposure. The summary provides an overview of asbestosis and its health effects.

Uploaded by

puneet
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPTX, PDF, TXT or read online on Scribd
You are on page 1/ 20

Asbestosis : Dr. A.

Sau; MBBS,MD (Gold


10/03/2020 1
Medalist) ; DD(Medical)
Regional Labour Institute - Kanpur

Directorate General of Factory Advice Services and Labour Institutes


Ministry of Labour & Employment
Govt. of India

10/03/2020 Asbestosis : Dr. A. Sau; MBBS,MD (Gold Medalist) ; DD(Medical) 2/20


Asbestosis

Presented By

Dr. Arkaprabha Sau


MBBS, MD (Gold Medalist), DPH, Dip. Geriatric Medicine, Ph.D.(Research Fellow)

Deputy Director (Medical), Group-A, Central Civil Services, DGFASLI


Ministry of Labour & Employment
Govt. of India

10/03/2020 Asbestosis : Dr. A. Sau; MBBS,MD (Gold Medalist) ; DD(Medical) 3/20


Description of Asbestos
• Asbestos is a generic term for a group of mineral silicates
• Asbestos fibers are (Length: L ≥ 5 μm, Diameter: D < 3 μm) :
 Very strong
 Highly flexible
 Resistant to breakdown by acid, alkali, water, heat, and flame
 Non-biodegradable
 Environmentally persistent

10/03/2020 Asbestosis : Dr. A. Sau; MBBS,MD (Gold Medalist) ; DD(Medical) 4/20


Types of Asbestos
Serpentine / Chrysotile Amphibol

99% Actinolite
Amosite
Anthophyllite
Crocidolite
Tremolite

10/03/2020 Asbestosis : Dr. A. Sau; MBBS,MD (Gold Medalist) ; DD(Medical) 5/20


Current Use (Maximum)
• Automobile clutches

• Brake pads

• Corrugated sheeting

• Cement pipe

• Roofing materials

• Fireproof materials
10/03/2020 Asbestosis : Dr. A. Sau; MBBS,MD (Gold Medalist) ; DD(Medical) 6/20
Past Use / Minimum Current Use
• Boilers and heating vessels • Laboratory furniture
• Cement pipe • Paper products
• Conduits for electrical wire • Pipe covering
• Corrosive chemical containers • Roofing products
• Electric motor components • Sealants and coatings
• Heat-protective pads • Insulation products

10/03/2020 Asbestosis : Dr. A. Sau; MBBS,MD (Gold Medalist) ; DD(Medical) 7/20


Occupational Exposure to Asbestos 
• Auto mechanics • Operating engineers
• Boilermakers
• Painters
• Bricklayers
• Pipefitters
• Building Inspectors
• Plasterers
• Carpenters
• Demolition workers • Plumbers
• Electricians • Roofers
• Floor covering workers • Refinery workers
• Furnace workers  • Shipyard workers

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Epidemiology
• Number of deaths from asbestosis is approx. 1500 per year (USA)
• Hospitalizations per year 10,000 to 20,000 (USA)
• In 2016 in the UK, 1050 new cases of asbestosis identified
• There is a latency period of around 20 years from time of first
exposure to asbestos to development of radiographic changes
• Exposures to workers in Africa, Asia, and South America are
significantly greater than those currently occurring in the USA,
Canada, Australia and Europe

10/03/2020 Asbestosis : Dr. A. Sau; MBBS,MD (Gold Medalist) ; DD(Medical) 9/20


Route of Exposure
• Most common exposure pathway:
 Inhalation of fibers
• Minor pathways:
 Ingestion
 Dermal contact

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Pathogenesis
• Asbestos fibers induce pathogenic changes via:

 Direct interaction with cellular macromolecules

 Generation of reactive oxygen species (ROS)

 Other cell-mediated mechanisms

• lead to cell injury, fibrosis, and possibly cancer

• Asbestos is genotoxic and carcinogenic

10/03/2020 Asbestosis : Dr. A. Sau; MBBS,MD (Gold Medalist) ; DD(Medical) 11/20


Asbestos Associated Diseases
• Respiratory diseases:
 Parenchymal asbestosis
 Asbestos-related pleural abnormalities
 Lung carcinoma
 Pleural mesothelioma
• Nonrespiratory diseases:
 Peritoneal mesothelioma
 Possibly, other extrathoracic cancers
 Rarely, cor pulmonale or constrictive pericarditis
10/03/2020 Asbestosis : Dr. A. Sau; MBBS,MD (Gold Medalist) ; DD(Medical) 12/20
Parenchymal Asbestosis
• Diffuse interstitial fibrosis with:
 Restrictive pattern of disease on PFT
 Impaired gas exchange
 Progressive exertional dyspnoea
• Radiographic changes: >10 years
• Latency period: 20-40 years

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Pleural Abnormalities

• Four types of abnormalities:


 Pleural plaques
 Benign asbestos pleural effusions
 Diffuse pleural thickening
 Rounded atelectasis
• Mostly asymptomatic, though some can cause dyspnea or cough
• Latency periods: 10-30 years

10/03/2020 Asbestosis : Dr. A. Sau; MBBS,MD (Gold Medalist) ; DD(Medical) 14/20


Mesothelioma
• Risk depends on
 Level, frequency, and duration of exposure
 Time elapsed since exposure
 Age at time of exposure
 Smoking history (synergistic)
 Individual susceptibility factors
• Mostly asymptomatic
• Latency periods: 20-30 years

10/03/2020 Asbestosis : Dr. A. Sau; MBBS,MD (Gold Medalist) ; DD(Medical) 15/20


Health Surveillance

• Pre-employment medical examination to detect any pre existing


lung abnormality and to establish a baseline for comparison in
any further evaluation of the worker

• Periodic medical examinations aimed at detecting any early


specific adverse health effects attributable to the asbestosis

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Monitoring
• Air Sampling
 PEL (NIOSH): TWA 0.1 fiber/cc (8hour shift of a 40
hour workweek)
 Excursion limit (1.0 f/cc over 30-minute period) 
• Environmental Monitoring
 Maximum Contaminant Level (EPA): 7 MFL (million
fibers per liter) > 10 μm in length  

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Medical Monitoring
• Medical evaluation of all patients should include:
 Assessment of clinical presentation
 Exposure history
 Medical history
 Physical examination
 Chest radiograph and pulmonary function tests
• Radiologic and laboratory testing can include:
 CT or HRCT
 BAL
 Lung biopsy (rarely needed)

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Management
Asbestos-
associated Disease Treatment Strategy
Parenchymal • Stopping additional exposure
Asbestosis and • Careful monitoring to facilitate early diagnosis
Asbestos-Related • Smoking cessation
Pleural Abnormalities • Regular influenza and pneumococcal vaccines
• Pulmonary rehabilitation as needed
• Disability assessment
• Aggressive treatment of respiratory infections
Lung Cancer and • Early diagnosis
Mesothelioma • Surgery
• Chemotherapy
• Radiation

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Thank You
10/03/2020 Asbestosis : Dr. A. Sau; MBBS,MD (Gold Medalist) ; DD(Medical) 20

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