Asbestosis (Pleural Disease and Pulmonary Disease)

Probably the most common asbestos-related illness is asbestos-related pleural disease. Sometimes called pleural asbestosis, pleural plaques or pleural thickening, asbestos-related pleural disease is a scarring of the lining of the lung caused by asbestos exposure. Asbestos-related pleural disease has a long latency period (10 to 30 or more years from first exposure) and can be detected on a chest x-ray or CT-scan. Like pulmonary asbestosis, asbestos-related pleural disease is untreatable and incurable. It may, on occasion, progress to a more severe condition.

There are many different degrees of asbestos-related pleural disease. Discrete, small areas of pleural scarring are called pleural plaques. While they usually begin as very small areas of scarring, they can grow over time and become calcified and hard. Pleural plaques alone are usually not symptomatic, but they can be.

Diffuse pleural thickening is a scarring of a large area of the lining of the lung caused by asbestos. While there can also be no symptoms suffered by a person with diffuse pleural thickening, it is more likely that someone with this injury will experience shortness of breath. Over time, the amount of the lining of the lung that becomes scarred can grow, constricting the lungs and making it more difficult to take a breath.

While much more rare than pleural plaques or pleural thickening, atelectasis can also be caused by exposure to asbestos. Atelectasis is pleural scarring that causes a portion of the lung to fold onto itself, usually causing pain and discomfort with each breath.

Asbestosis & Cancer Detection

Pulmonary asbestosis and asbestos-related pleural disease are often not recognized on chest x-rays and CT-scans reviewed by radiologists and pulmonologists. Specially trained doctors who are certified by the National Institute of Safety and Health (NIOSH) (who are called "B" readers) may sometimes detect asbestos-induced x-ray changes that other doctors miss. It is generally recommended that anyone who has been occupationally exposed to asbestos have a chest x-ray taken every 18 to 24 months and reviewed by a certified "B" reader or someone experienced in diagnosing asbestos-related diseases.

In the past, the standard way to diagnose asbestos-related pleural and pulmonary disease and cancers was through x-rays. Over time it has become clear that the use of an x-ray, while an excellent diagnostic technique, has short-comings. The major short-coming is that it fails to detect with significant clarity, early signs of cancer and/or pleural and pulmonary disease. In this regard, recent advances in science have developed two new procedures that can detect asbestos disease at an earlier stage.

These new procedures, low-dose spiral computed tomography and high resolution computed tomography (HRCT), are based upon computer tomography (CT).

When screening for early detection of various forms of cancer, low dose spiral computed tomography is exceptional in detecting early peripheral lung cancer. In various studies, it has been shown to be far superior to normal x-rays and CT scans of the entire lung. If the spiral CT shows indications of early nodules, then HRCT should be used.

HRCT has been shown to be extremely sensitive in diagnosing pleural and pulmonary asbestos-related disease. In one particular study, x-rays indicated that 33% of subjects had asbestos-related pleural disease. When those same individuals were examined with HRCT, 66.5% showed pleural thickening. In the same study, x-rays found pulmonary asbestosis in 5.3% of the individuals tested while HRCT found that 20.6% of those individuals had pulmonary asbestosis. As is clear from this study and many others, the sensitivity to HRCT in detecting pleural and pulmonary disease is far superior to that of standard x-rays. HRCT is also superior to x-rays in regard to early diagnosis of cancer.

In light of the above, individuals at risk for asbestos-related disease today are far better off than individuals even a few years ago. Because of low-dose spiral computed tomography and HRCT, individuals can now be subjected to a painless examination to provide early detection of cancer and/or pleural or pulmonary disease. By providing early detection of cancer, the cure rate should rise substantially in the future.