Asbestosis
In the wake of industrialization, humanity has reaped countless benefits—from faster transportation and massive infrastructure to advanced manufacturing. However, lurking beneath these achievements are silent threats, and asbestosis is one of the most insidious. Specifically, it’s a chronic lung disease caused by inhaling asbestos fibers, primarily affecting workers exposed in industries such as construction, shipbuilding, insulation, and mining. Despite this global awareness, asbestosis continues to afflict thousands, often decades after exposure.
What is Asbestosis?
To clarify, asbestosis is a serious lung disease caused by asbestos exposure that results in lung scarring. Once inhaled, asbestos fibers cause inflammation and prevent the immune system from working properly. Consequently, this can lead to scar tissue, known as pulmonary fibrosis, forming in the lungs.
This scarring in the lungs, in turn, makes them stiff and less able to provide the body with oxygen. As a result, gas exchange in the lungs becomes impaired as the scar tissue thickens and stiffens. Ultimately, these changes lead to respiratory symptoms, including breathing problems, cough, and chest pain.
Key Facts About Asbestosis
For context, here are some key facts about asbestosis:
- First and foremost, it is an incurable lung disease that makes breathing progressively more difficult.
- It usually develops after years of occupational asbestos exposure.
- As a contributing cause of death, it affects approximately 600 to more than 1,000 Americans each year.
- Furthermore, it signifies an elevated risk of developing asbestos-related cancer.
Asbestosis Symptoms
Initially, the first symptoms of asbestosis include a dry cough, difficulty breathing, and crackling sounds when breathing. These crackling sounds, in particular, are the result of scarring that stiffens the lungs.
Beyond these initial signs, common asbestosis symptoms include:
- Chest pain or tightness
- Clubbing of fingers and toes
- Crackling sounds when breathing
- Fatigue
- Loss of weight and appetite
- Persistent dry cough
According to medical professionals, “Asbestosis symptoms can be similar to many illnesses or diagnoses, so your physician may not immediately consider it. Therefore, discussing asbestos exposure history will be important. This information will help physicians in ordering appropriate testing quickly.”
As the disease progresses, advanced symptoms of asbestosis include pulmonary hypertension. This occurs because scar tissue can tighten arteries and lead to pulmonary hypertension. Ultimately, this makes blood pressure rise because the heart must work harder to pump blood to the lungs.
Similarly, when the lungs deliver insufficient oxygen to the blood, a symptom called “clubbing” may arise. This condition causes the tips of the toes and fingers to be broader and rounder than usual. Interestingly, this symptom may occur early in disease progression for some patients.
It’s also important to note that asbestosis takes less time to develop than asbestos-related cancer. In fact, an asbestosis diagnosis signals a risk of developing lung cancer or mesothelioma in the future.
What Causes Asbestosis?
Simply put, the only cause of asbestosis is asbestos exposure. As a form of pneumoconiosis, asbestosis is a condition caused by the inhalation of different types of dust. For instance, silicosis is a form of pneumoconiosis from exposure to silica dust.
When a person inhales them, asbestos fibers accumulate in the lungs. This, in turn, leads to inflammation and fibrous changes in lung tissue over time. Consequently, scarring develops, and tissue movement becomes limited. More specifically, the interstitium, alveoli, and nearby tissue become inflamed and fibrotic.
Risk Factors for Asbestosis
Several factors can increase a person’s risk of developing asbestosis, including:
- The amount and concentration of asbestos
- The size, shape, and type of asbestos fibers
- The length of time of exposure to asbestos
- Health factors such as smoking or a history of lung disease
- Genetic factors or specific mutations in DNA that increase the risk of disease
Diagnosis
To diagnose asbestosis, doctors require a combination of medical history, occupational exposure history, and imaging studies. Furthermore, key diagnostic tools include:
- A chest X-ray or CT (computed tomography) scan: These may show evidence of fibrosis, like pleural thickening or honeycombing of lung tissue.
- Pulmonary function tests (PFT): These tests measure the amount of air you can breathe out and how well your lungs are working.
- A bronchoscopy or lung biopsy (rarely): In certain cases, these procedures may be done to rule out other diagnoses.
Furthermore, physicians utilize a detailed occupational history, as it is common for patients to relate their current condition to an exposure that occurred decades before.
Treatment and Management
Asbestosis has no cure because the damage to the lungs is irreversible. Nonetheless, there are treatment options with the intent of maximizing the patient’s quality of life and managing the symptoms:
- Smoking cessation: This is very important, as it not only limits the risk of lung cancer, but further damage to the lungs.
- Oxygen therapy: In the later stages, this can help with breathing problems.
- Pulmonary rehabilitation: This will include breathing exercises and a physical therapy program to help improve endurance.
- Vaccines: The flu and pneumonia vaccines will protect from respiratory infections.
- Lung transplant in worst-case scenarios – but in reality, this is rare and only with end-stage disease.
Recent Updates: Approvals & Advancements
Here are the recent updates on asbestos treatment and public health measures:
- Pemetrexed (Pemrydi RTU) – Amneal Pharmaceuticals As of April 2024, Amneal Pharmaceuticals launched PEMRYDI RTU, the first ready-to-use injected formulation of pemetrexed. This new format requires no reconstitution, dilution, or refrigeration, which consequently streamlines preparation and administration for healthcare professionals.
- Keytruda FDA Approval – Merck In September 2024, Merck & Co. announced that the FDA approved Keytruda (pembrolizumab) for malignant pleural mesothelioma, a major asbestos-induced cancer. This approval represents a significant advancement in immunotherapy for asbestos-related disease.
- ADI PEG20 + Chemotherapy Trial (ATOMIC meso) In late 2023–early 2024, the ATOMIC meso phase III trial published results demonstrating that ADI PEG20 (pegargiminase) and chemotherapy led to overall survival advantages in patients with pleural mesothelioma: median survival extended from 7.7 to 9.3 months, and the 36-month survival increased four-fold from control chemotherapy.
- Combination Immunotherapy Advances – Bristol and Others. In addition, reports have emerged in 2024, 2025 about phase II and phase III clinical trials conducted by Merck, Roche, Boehringer Ingelheim, AstraZeneca, and Gilead about new anti-inflammatory and antioxidant, and immune-modulatory treatments in asbestosis and other lung diseases.
- Regulatory Measures and Public Health Initiatives In March 2024, the U.S. EPA issued a final rule prohibiting any further uses of chrysotile asbestos, the last type that was still being imported or used in the U.S. Additionally, starting in October 2024, China’s National Health Commission began implementation of 829 provided treatment sites for pneumoconiosis (including asbestosis) to address free treatment to increased access in industrially affected areas.
Asbestosis is a tragic reminder of how industrial progress without safe work practices leads to large-scale and very difficult healthcare issues.
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