Asbestosis

Asbestosis is scarring of lung tissue in people who breathed asbestos dust for years. Two or three decades usually pass between inhaling the fibres and the first complaints, so the disease tends to surface in someone who changed jobs long ago and has all but forgotten the old building site or boiler room. The scarring never goes away, yet the condition can be managed well, and the main job of doctor and patient is to spot in good time what is more dangerous than asbestosis itself.

What asbestos does to the lungs

Asbestos fibres are thin, sharp and almost indestructible. Once the air carries them into the furthest corners of the lungs they stay there for good: the scavenging cells cannot digest them and keep attacking the same spot year after year. Where the inflammation drags on, scar tissue grows. The lungs stiffen, expand less easily with each breath in, and oxygen has a harder time crossing from air into blood — hence breathlessness on exertion.

Asbestosis does not follow a chance encounter with asbestos; it follows years of breathing appreciable amounts of dust. It is worth telling apart from pleural plaques, thickened patches on the lining of the lung. Those are far more common, usually cause no symptoms at all and do not turn into asbestosis by themselves — they are simply a mark left by contact with asbestos.

Who may have been exposed

For decades asbestos went into cement roofing sheets, pipes, lagging on pipes and boilers, fireproof panels and brake linings. It has been banned across the European Union since 2005 and earlier still in some countries, but everything already built is still standing.

• Laggers, boilermakers, shipyard workers, roofers, bricklayers, plumbers, electricians, demolition crews and mechanics who changed brakes and clutches.
• Anyone renovating or stripping out old buildings today: dust rises whenever asbestos-containing material is drilled, cut or broken up.
• The households of such workers: fibres came home on work clothes year after year, and the person who washed them fell ill.

If you worked with asbestos, tell your doctor yourself, even if it was forty years ago. Without that one sentence the diagnosis is often looked for in the wrong place.

How it makes itself felt

The illness creeps up quietly, and people often put the first signs down to their age or to extra weight.

• Breathlessness: at first on hills and stairs or when walking fast, later during ordinary chores.
• A dry, stubborn cough that drags on for months.
• Tightness or a dull ache in the chest or in the shoulder.
• Marked tiredness and loss of stamina.
• In advanced cases, fingers that look rounded and thickened at the tips, with curved nails.

Listening to the chest, a doctor often picks up a fine, quiet crackling at the end of a breath in, low down in the lungs. It also happens that there are no complaints at all and the changes turn up on a scan taken for some other reason.

What must not be missed

This is the most important part. Asbestos raises the risk of two tumours — lung cancer and mesothelioma, a tumour of the lining of the lung. Mesothelioma develops thirty to forty years after exposure and can appear in someone who never had asbestosis. In smokers who worked with asbestos the risk of lung cancer is not added up but multiplied, and that combination is more dangerous than either factor on its own.

Book an appointment without delay if you cough up blood, lose weight for no reason, have constant pain in the chest or back, become hoarse, find swallowing difficult, or if breathlessness is worsening over weeks rather than months. Sudden chest pain with a sudden shortage of air needs emergency care: that is how fluid collecting around the lung, or a collapsed lung, announces itself. None of these signs is explained by "just asbestosis", and every one of them needs sorting out quickly.

How the diagnosis is confirmed

It all starts with a detailed conversation about where you worked, in what job, for how many years and in what conditions. The doctor then listens to your lungs and arranges tests.

• A chest X-ray is the first step, though it shows early changes poorly.
• High-resolution computed tomography is the main method: it reveals scarring, plaques and thickening of the lung lining.
• Lung function testing measures the volume of the lungs and how readily oxygen passes into the blood.
• Oxygen saturation is checked at rest and while walking.

Sometimes asbestosis has to be told apart from other diseases that scar the lungs; blood tests or a biopsy are then added.

What treatment can achieve

There is no drug that dissolves scars, and promises to "cleanse the lungs" are not worth trusting. There are, however, measures that noticeably improve how you feel and extend an active life.

The foundation is pulmonary rehabilitation: a programme of graded exercise, breathing training and education, tailored to what you are able to do. It does not repair the lungs, but it teaches the body to get by on less oxygen, so breathlessness during everyday activity eases. When the oxygen level in the blood falls, oxygen therapy is prescribed, at home or through a portable concentrator. If the airways are narrowed as well, inhalers help. Any cold that moves down below the throat is treated early and carefully in these patients: pneumonia on top of scarred lungs is far harder to weather. Follow-up carries on through the quiet spells too — it is at those appointments that a tumour is caught in time.

What is in your hands

• Stop smoking. This single step changes the outlook more than anything else, and it is worth taking at any age and at any stage.
• Get vaccinated against flu, pneumococcal infection and coronavirus, and keep the repeat doses on schedule.
• Stay away from asbestos from now on. Never saw, drill or break up old cement sheeting or lagging yourself — that is work for licensed specialist firms.
• Keep moving every day within your limits: inactivity strips away stamina fast.
• Have the illness registered as occupational. Asbestosis is recognised as an occupational disease in most countries; how it is confirmed and what rights follow depend on where you live, so ask your doctor or the relevant service about it.

Online consultation

In an online appointment the doctor goes through your work history and the pattern of your breathlessness in detail, judges whether there are grounds to look for a link with asbestos, and explains which images and breathing tests are worth doing and in what order. Separately, the doctor checks for signs that call for an urgent face-to-face examination and points you towards the right specialist.

This material is for information only and does not replace medical advice.