Agency for Toxic Substances and Disease Registry
Case Studies in Environmental Medicine (CSEM) 

Asbestos Toxicity
How Should Patients Exposed to Asbestos Be Managed and Treated?

Learning Objectives

Upon completion of this section, you should be able to:

• identify two primary strategies for managing asbestos-associated diseases.
• describe specific strategies for managing parenchymal asbestosis.

Introduction

In general, asbestos-associated diseases such as asbestosis and pleural plaques are not treatable. Management focuses on prevention and amelioration of symptoms whether the patient is asymptomatic or already ill. Therefore, the primary goals are to

• remove the patient from the workplace or source of exposure (if possible) or provide proper respiratory protection according to OSHA standards
• in states, where asbestosis is a reportable disease, report new cases to the appropriate health authorities.
• monitor the patient to facilitate early diagnosis of any treatable respiratory conditions

Patients who are symptomatic may need documentation of impairments caused by asbestos-associated disease for the purpose of filing for worker compensation, social security disability, or other claims. Degree of disability should be stated in the terms required by the program to which the patient is applying. Recording these impairments is an important task and may require the assistance of a specialist. To locate a specialist, please refer to the Web resources listed under Where Can I Find More Information? at the end of this CSEM

The remainder of this section focuses on patient care.

All Exposed Patients

Care of patients who have been exposed to asbestos, whether or not they are symptomatic, involves routine follow up to facilitate early diagnosis and intervention. This includes

• taking exposure and medical histories and regular physical examinations
• periodic chest X-rays and pulmonary function tests to look for early signs of asbestos-associated disease
• gathering information on smoking cessation
• educating patients regarding the possible consequences of asbestos exposure

Information and Instructions for Patients

Parenchymal Asbestosis

Parenchymal asbestosis is irreversible, and the rate of disease progression varies (American Thoracic Society 2004). Currently, there is no effective treatment. Patients with advanced disease and hypoxemia at rest, during exercise, or during sleep will benefit from continuous home oxygen therapy, which can prevent or attenuate cor pulmonale. However, primary management strategies for parenchymal asbestosis are listed below

• remove the patient from the source of exposure (if possible) or provide personal protective equipment to OSHA standards
• notify employer of exposures to asbestos so that medical surveillance and personal protective equipment can be instituted (if occupational exposure).
• in states, where asbestosis is reportable, notify the appropriate health authorities
• assess the patient’s level of disability
• treat respiratory infections aggressively.
• provide annual influenza and regular pneumococcal vaccines at intervals recommended by CDC
• provide respiratory therapies and pulmonary rehabilitation as needed
• counsel patients who smoke to quit.
• follow the general strategies listed for all patients

Patients should be monitored periodically (per doctor-patient consultation) for disease progression and closely observed for asbestos-associated malignancies such as lung cancer, mesothelioma, and gastrointestinal cancers (American Thoracic Society 2004).

Pleural Abnormalities

Pleural plaques are benign, but they can occasionally result in pulmonary impairment. In addition, patients with asbestos-related pleural abnormalities are likely to have or eventually get parenchymal asbestosis or asbestos related cancers. Therefore, management of asbestos-related pleural abnormalities involves monitoring for parenchymal asbestosis and the general strategies listed for all patients.

Mesothelioma

Diffuse malignant mesothelioma is almost always fatal. According to the British Thoracic Society, the mean life expectancy following diagnosis is 8 to 14 months (British Thoracic Society 2001).

For more information about the diagnosis and treatment of mesothelioma, see:

• British Thoracic Society’s Standards of Care Committee, Statement on malignant mesothelioma in the United Kingdom (Thorax 2001; 56:250-265).
• The National Cancer Institute’s latest news on the treatment of mesothelioma at URL: http://www.nci.nih.gov/cancertopics/types/malignantmesothelioma/.

Lung Cancer

The treatment and management of asbestos-associated lung cancer is the same as that of lung cancer from other causes.

Key Points

• The two primary strategies for managing asbestos-associated diseases are
  • Remove the patient from further exposure to asbestos (if possible) or provide of personal protective equipment up to OSHA standards.
  • Monitoring the patient carefully to facilitate early diagnosis of treatable complications.
• The primary strategies for managing parenchymal asbestosis are to stop exposure, stop smoking, avoid or aggressively treat respiratory infection, and assess the level of impairment.
• Notify employer of exposure so that medical surveillance and appropriate PPE can be provided (if occupational exposures are over OSHA standards).

Progress Check