Asbestosis: History And Treatment}

Submitted by: Seomul Evans

Knowing the exact extent of each patient’s asbestosis is necessary so to plan the appropriate management strategy.

Although a histopathologic examination of lung tissue is not necessary in diagnosing asbestosis, this serves a great role in determining the extent of the patient’s disease. The American College of Pathologists have put out a grading scheme for these histopathological abnormalities, which runs from Grade 1 through 4. Grade 1 embodies fibrotic changes that are confined to the walls of the respiratory bronchiole without affecting the distal alveoli. Both Grades 2 and 3 label changes that identify a more advanced stage of asbestosis. Finally, Grade 4 represent fibrosis in the alveoli and septum. Honeycombing is also evident in the Grade 4 level of changes.

Asbestos bodies or ferruginous bodies can also be seen in histopathological specimens of lung tissues afflicted with Asbestosis. Ferruginous bodies are simply asbestos fibers that have come to develop a coat. This coating is made up of protein and ferritin (storage form of iron). These asbestos bodies have a characteristic appearance of long beads. Asbestos or ferruginous bodies however are not pathognomonic for asbestosis. Incidental findings of these are found in people who have no history of exposure to asbestos.

Management of asbestosis mainly revolves around the prompt cessation of exposure to asbestos once a diagnosis is reached, and a proper treatment and follow-up plan. Continued exposure to asbestos will enhance the progression of the disease. Although even when cessation of exposure has been established, asbestosis will still progress albeit at a much slower phase. Controlling asbestos exposure in places of work still remains as the most effective prevention. The wearing of respiratory protective gear as mandated by federal law should be done.

Physicians should advise patients who are smokers to quit smoking. These patients should also be referred to smoking cessation clinic to facilitate their quitting the habit. Careful search for any concurrent respiratory infections should be done. Prompt and proper anti-microbial treatment should be given if any are detected. Immunizations against seasonal Influenza virus and Pneumococcal bacteria should also be given. Particular attention must be paid to each individual patient’s oxygenation status, both at rest and during exercise. If hypoxemia is detected, supplemental oxygen should be prescribed.

Treatments and follow-up plans should be tailored to each individual patient according to the severity of each patient’s asbestosis and the level of functional impairments documented. The frequency of clinic visits, as well as the frequency of imaging studies and pulmonary function tests to be done should also complement the prepared treatment plan. This goes to show that an accurate and precise assessment of each individual patient’s disease severity as well as level of functioning must be accomplished.

Provisions for hospice referral and palliative care should also be given appropriately once the disease reaches its terminal stages.

Medical therapy with corticosteroids and immunosuppressant drugs has not been found to alter the course of asbestosis. Although such is the case, these drugs may still be use for symptomatic relief from aggravating symptoms brought about by the various inflammatory, vasculitic and fibrosing processes that are at play.

Treatment of asbestosis revolves around basic symptomatic relief methods and a sound referral plan. Prompt recognition and diagnosis still is absolutely necessary for the apt execution of these plans.

About the Author: Seomul Evans is a senior

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