Asbestosis related lung disease

Question 1

What is asbestosis?

Answer 1

Long-term inflammation + scarring of the lungs caused by inhalation of asbestos fibres
(asbestos-related interstitial fibrosis)

Question 2

What is mesothelioma?

Answer 2

Malignancy of mesothelial cells of the pleura
Asbestos is the main causative agent
POOR PROGNOSIS 8-14 months

Question 3

What is the mesothelium?

Answer 3

Thin epithelium that lines several body cavities inc. the pleura, peritoneum, mediastinum + pericardium

Question 4

What is the severity of asbestosis related to? What is the latent period?

Answer 4

Length of exposure
Latent period 15-30y

Question 5

What type of fibrosis is usually seen in asbestosis?

Answer 5

Lower lobe fibrosis

Question 6

2 symptoms of asbestosis

Answer 6

Dyspnoea
Reduced exercise tolerance

Question 7

2 signs of asbestosis

Answer 7

Clubbing
Bilateral end-inspiratory crackles

Question 8

What is seen on lung function tests in asbestosis?

Answer 8

Restrictive pattern with reduced gas transfer

Question 9

Describe management of asbestosis

Answer 9

Conservative
No interventions offer significant benefit

Question 10

What is the most dangerous form of mesothelioma?

Answer 10

Crocidolite (blue) asbestos

Question 11

What are the 3 types of asbestosis?

Answer 11

Chrysotile (white asbestos): least fibrogenic.
Crocidolite (blue asbestos): most fibrogenic.
Amosite (brown asbestos): intermediate fibrogenicity.

Question 12

Give 5 presenting features of mesothelioma

Answer 12

Dyspnoea
Weight loss
Chest wall pain
Clubbing
Pleural effusion (30% present with painless pleural effusion)

Question 13

How does exposure relate to disease in mesothelioma?

Answer 13

Even very limited exposure to asbestos can cause disease

Question 14

Where does mesothelioma metastasise to?

Answer 14

Contralateral lung + peritoneum

Question 15

Which lung is more commonly affected in mesothelioma?

Answer 15

Right

Question 16

How is mesothelioma managed?

Answer 16

Palliative chemo
Also a limited role for surgery + radiotherapy

Question 17

What is the most common form of cancer associated with asbestos exposure?

Answer 17

Lung cancer

Question 18

What does asbestos have a synergistic effect with, increasing risk of lung cancer?

Answer 18

Cigarette smoking
Thus cessation very important

Question 19

Describe the aetiology of mesothelioma

Answer 19

Hx of aspestos exposure in 90%
20% have pre-existing asbestosis.

Question 20

What is the latent period between exposure and development of mesothelioma?

Answer 20

30 – 50y

Question 21

What investigations should be performed for mesothelioma?

Answer 21

CXR: pleural effusion/ pleural thickening
Pleural CT
Thoracentesis: MC+S, biochemistry + cytology
Pleural biopsy

Question 22

What is seen on CXR in mesothelioma?

Answer 22

Unilateral pleural effusion
Irregular pleural thickening
Reduced lung volumes +/- parenchymal changes related to asbestos exposure (e.g., lower zone linear interstitial fibrosis)

Question 23

What does the spectrum of asbestos-related thoracic diseases comprise of?

Answer 23

Pleural plaques
Diffuse pleural thickening
Asbestosis, mesothelioma + lung cancer.

Question 24

4 features of pleural plaques

Answer 24

Benign, don’t undergo malignant change
No f/u
Most common form of asbestos related lung disease
Latent period 20-40y

Question 25

How is asbestos exposure related to pleural thickening?

Answer 25

Exposure can cause diffuse pleural thickening
(similar to that seen following empyema or haemothorax)