Asbestosis

The Asbestosis is a disease of the lungs and is one of the so-called pneumoconiosis ( black lung disease ). It is caused by inhaled dust from asbestos, its use for this reason in Austria and Switzerland since 1990, in Germany is forbidden in the EU since 2005 and since 1993.

• 4.1 lung dysfunction
• 4.2 ILO classification
• 4.3 pleural plaques
• 4.4 asbestos particles

Pathophysiology

Fibrosis

Depending on the duration of exposure and concentration of fine dust and asbestos personal disposition lead inhaled asbestos particles after a delay of 15 to 20 years to fibrosis of the lung parenchyma in very different degrees. Most often lead to fibrosis of the lower lobes and pleuranahen lung sections because the asbestos fibers accumulate here.

The inhaled fibers are taken up by alveolar macrophages (scavenger cells of the alveoli ). However, the asbestos fibers can not be completely eliminated, so that the alveolar macrophages messengers ( interleukin 1 and growth factors) exits. Sequence is the migration of T-helper cells and granulocytes. Furthermore, fibrocytes are stimulated ( Lungengewebszellen ) for the formation of type III collagen. This ultimately leads to fibrosis of the lung tissue.

Lung cancer

After a latency of a total of usually 25 to 40 years, asbestosis may lead to the development of lung cancer.

Pleural cancer

In addition to asbestosis inhalation of asbestos dust can also cause pleural plaques and calcifications. The plaques are not precancerous (forerunner of cancer ) that can ( malignant) degenerate non-malignant. In addition, the formation of a mesothelioma is possible. It is a malignant tumor of the pleura, which can also form after 20 to 40 years after exposure to asbestos. Typical of the pleural already required to trigger low exposure to asbestos fibers.

Of the types of asbestos used the carcinogenic properties of crocidolite are rated higher because of its fiber geometry and high biopersistence than that of chrysotile.

Symptoms

The after cessation of exposure occasionally progressive pulmonary fibrosis leading to shortness of breath, cough, tenacious sputum, weight loss, and in the advanced stage of disability.

Complications

Among the most important complications include COPD, bronchopneumonic processes, cor pulmonale, and pleural effusions.

Diagnostics

The diagnosis of asbestosis is based mainly on clinical examination ( here especially the auscultation of the lungs with a stethoscope ), lung function testing, the X-ray image of the lungs and the occupational history. Endangered professions are: Insulators, chemical worker, locksmiths, plumbers, spinners, tailors, manufacturers of building materials, masons, roofers, shipbuilders, aircraft manufacturer, Schmelzer, former, welder. Computed tomography (CT ) can be especially in high-definition technology, the lung changes earlier and more detailed display than the conventional X-ray technology.

Lung dysfunction

In the lung function test often shows a so-called restrictive ventilatory disorder. A diffusion error ( gas exchange ) is possible.

ILO classification

The signs of asbestosis in the X-ray image can be described using a standardized procedure. This ILO classification (International Labour Office ) is known worldwide and describes through letter-number code, the X-ray image changes:

Image quality: 1-4 = good - unacceptable

Lung findings:

• Small roundish shadow p = diameter ≤ 1.5 mm
• Q = diameter > 1.5 to ≤ 3 mm
• R = diameter of> 3 to 10 mm

• S = caliber <1.5 mm
• T = caliber > 1.5 to ≤ 3 mm
• D = caliber of > 3 to 10 mm.

• A = diameter of> 10 to 50 mm
• B = larger or more numerous than A shadow, shadow equivalent < right Oberfeld
• C = sum of Shadows > right Oberfeld

• R (right lung field ) and
• L (left lung field ) can be divided into three fields: upper (O), medium (M) and subdivision ( U)

• 0 = small shadow missing
• 1-3 represents increasing scattering density

Pleurabefund:

• Width a = maximum width <5 mm
• B = 5 to ≤ 10 mm
• C = > 10 mm

Diaphragmatic involvement yes (Y ) No ( N)

Pleural plaques

Typical of asbestosis are calcified deposits ( plaques) in the pleura ( the pleura ), which can be represented in computer tomography. Pleural plaques do not cause any discomfort in the rule, but are important for the diagnosis of asbestosis, and for the proof of an asbestos- induced lung cancer. Even better than in CT pleural plaques can be part of a chest (thoracoscopy ) prove.

Asbestos particles

During a bronchoalveolar lavage ( BAL lung lavage ) samples may be obtained and examined. Microscopically so-called asbestos particles can be found in asbestosis. This is to asbestos fibers with ferruginous protein shell. They arise when alveolar macrophages try to eat up to long asbestos fibers, and thereby perish. See the protruding asbestos fibers under the microscope " skewer " like from.

Activities with significant exposure to asbestos

• Asbestos processing
• Manufacture or processing of asbestos textile products
• Manufacturing, processing or repair of asbestos products
• Use of asbestos as a filler in the production of various materials, such as: colors, flooring, sealants, tire, thermoplastics resin molding compounds, ...

Asbestosis as an occupational disease

In professional asbestos exposure, asbestosis is an occupational disease that is indemnified if it causes physical defect or a cancer caused. After the occupational disease regulation as amended on September 5, 2002 asbestosis are the

• No. 4103 " asbestos dust lung disease ( asbestosis ) or caused by asbestos dust diseases of the pleura " and the
• No. 4104 "Lung cancer or cancer of the larynx

• No. 4105 " caused by asbestos mesothelioma of the pleura, peritoneum or the pericardium "
• No. 4114 " Lung cancer caused by the interaction of asbestos fiber dust and polycyclic aromatic hydrocarbons, if evidence of exposure to a cumulative dose that a causation probability of at least 50 % of the plant 2 ( Second Ordinance amending BKV, Federal Law Gazette 2009 No. 30, S. 1273-1276) corresponds "

Performed. Asbestos -caused occupational diseases - including addition of asbestosis and mesothelioma and lung cancer caused by asbestos exposure - are in Germany right of great importance. In 2005, the BGs recorded more than 3,700 new occupational diseases caused by asbestos and had to perform services of a total of well over 300 million euros annually in 27,000 cases. Asbestos leads the list of carcinogenic substances by a large margin. 2001, there were 1480 cases or 77.1 percent of all recognized as an occupational disease cancers that were attributed to asbestos. 2005 1540 deaths were registered by asbestos-related occupational diseases. Because of the large time lag between asbestos exposure and cancer development is expected with most annual new cases of asbestos- related lung cancer only in the years 2015 to 2020.

In asbeststaubassoziiertem Lung cancer is tobacco smoking represents a significant additional risk factor, but includes a recognition of an occupational disease by no means, if a professional asbestos exposure has been demonstrated and has either been submitted asbestosis or a plausible " cumulative asbestos fiber dust dose " is assigned.