Asbestos-Related Lung Diseases

Asbestos-related lung diseases are diseases caused by exposure to asbestos (as-BES-tos) fibers. Asbestos is a mineral that, in the past, was widely used in many industries.

Asbestos is made up of tiny fibers that can escape into the air. When breathed in, these fibers can stay in your lungs for a long time. If the fibers build up in your lungs, they can lead to:

• Pleural plaque. In this condition, the tissue around the lungs and diaphragm (the muscle below your lungs) thickens and hardens. This tissue is called the pleura. Pleural plaque usually causes no symptoms. Rarely, as the pleura thickens, it can trap and compress part of the lung. This may show up as a mass on an x-ray image.
• Pleural effusion. In this condition, excess fluid builds up in the pleural space. The pleural space is the area between the lungs and the chest wall.
• Asbestosis (as-bes-TOE-sis). In this condition, the lung tissue becomes scarred. People who have asbestosis are at greater risk for lung cancer, especially if they smoke.
• Lung cancer. This type of cancer forms in the lung tissue, usually in the cells lining the air passages.
• Mesothelioma (MEZ-o-thee-lee-O-ma). This disease is cancer of the pleura.

Asbestos also can cause cancer in the lining of the abdominal cavity. This lining is known as the peritoneum (PER-ih-to-NE-um).

Asbestos-Related Lung Diseases

Figure A shows the location of the lungs, airways, pleura, and diaphragm in the body. Figure B shows lungs with asbestos-related diseases, including pleural plaque, lung cancer, asbestosis, plaque on the diaphragm, and mesothelioma.

Overview

Until the 1970s, asbestos was widely used in many industries in the United States. For example, it was used to insulate pipes, boilers, and ships; make brakes; strengthen cement; and fireproof many items, such as drywall.

People who worked around asbestos during that time are at risk for asbestos-related lung diseases. People at highest risk include:

• Unprotected workers who made, installed, or removed products containing asbestos. People who worked near others who did these jobs also are at risk.
• Family members of workers who were exposed to asbestos. Family members may have breathed in asbestos fibers that workers brought home on their clothes, shoes, or bodies.
• People who live in areas with large deposits of asbestos in the soil. This risk is limited to areas where the deposits were disturbed and asbestos fibers got into the air.

Asbestos fibers also can be released into the air when older buildings containing asbestos-made products are destroyed. Removing these products during building renovations also can release asbestos fibers into the air.

Generally, being around asbestos-made products isn’t a danger as long as the asbestos is enclosed. This prevents the fibers from getting into the air.

People in the United States are less likely to have asbestos-related lung diseases now because the mineral is no longer widely used.

The use of asbestos is heavily restricted, and rules and standards are now in place to protect workers and others from asbestos exposure. Asbestos is found in only a few new products, such as gaskets used in brakes.

However, many countries do not yet restrict asbestos use. People in those countries are still exposed to the mineral.

Outlook

The outlook for people who have asbestos-related lung diseases can vary. It will depend on which disease a person has and how much it has damaged the lungs.

No treatments can reverse the effects of asbestos on your lungs. However, treatments may help relieve symptoms, slow the progress of the disease, and prevent complications.

If you've been exposed to asbestos, let your doctor know. He or she can watch you for signs of asbestos-related problems and start treatment early, if needed. Early treatment may help prevent or delay complications.

Quitting smoking and making other lifestyle changes may help people who are at high risk for asbestos-related lung diseases. These lifestyle changes may prevent more serious diseases, such as cancer.

Other names for asbestos-related pleural diseases include:

• Pleural plaques
• Pleurisy
• Trapped lung

Other names for asbestosis include:

• Fibrotic lung disease
• Pneumoconiosis (NOO-mo-ko-ne-O-sis)
• Interstitial (in-ter-STISH-al) pulmonary fibrosis

Other names for lung cancer include:

• Small cell lung carcinoma (kar-sih-NO-ma)
• Nonsmall cell lung carcinoma

Another name for mesothelioma is cancer of the lining of the lung.

Significant exposure to asbestos fibers causes asbestos-related lung diseases. "Significant" usually means you were exposed for at least several months to visible dust from the fibers.

Asbestos fibers are very small. When you breathe in, they can get stuck deep in your lungs. The fibers remain in your lung tissue for a long time and may cause scarring and inflammation. This can lead to pleural plaque and widespread pleural thickening, pleural effusion, asbestosis, lung cancer, or mesothelioma.

Generally, asbestos-related lung diseases develop 10 to 40 or more years after a person has been exposed to asbestos.

Being around products that contain asbestos isn't a danger, as long as the asbestos is enclosed. This prevents the fibers from getting into the air.

Until the late 1970s, asbestos was widely used in many industries in the United States. During that time, workplace rules to ensure workers' safety around asbestos weren't required by law.

Asbestos was used in or with many products. Examples include steam pipes, boilers, furnaces, and furnace ducts; wallboard; floor and ceiling tiles; wood-burning stoves and gas fireplaces; car brakes, clutches, and gaskets; railroad engines; roofing and shingles; and wall-patching materials and paints.

Asbestos also was used in many other products, such as fireproof gloves, ironing board covers, cooking pot handles, and hairdryers.

Anyone employed for a prolonged period in mining, milling, making, or installing asbestos products before the late 1970s is at risk for asbestos-related lung diseases. Some examples of these workers include:

• Miners
• Aircraft and auto mechanics
• Building construction workers
• Electricians
• Shipyard workers
• Boiler operators
• Building engineers
• Railroad workers

In general, the risk is greatest for people who worked with asbestos and were exposed for at least several months to visible dust from asbestos fibers. The risk for asbestos-related lung diseases also depends on:

• How much asbestos you were exposed to.
• How long you were exposed to asbestos, and how often during that time you were in direct contact with it.
• The size, shape, and chemical makeup of the asbestos fibers. Different types of asbestos fibers can affect the lungs differently. For example, chrysotile asbestos (a curly fiber) is less likely to cause mesothelioma than amphibole asbestos (a straight fiber).
• Your personal risks, such as smoking or having an existing lung disease.

Family members of people exposed to asbestos on the job also may be at risk. Family members may have breathed in asbestos fibers that were brought home on workers’ clothes, shoes, and bodies.

People who live in areas that have large deposits of asbestos in the soil also are at risk for asbestos-related lung diseases. However, this risk is limited to areas where the deposits were disturbed and asbestos fibers got into the air.

Asbestos fibers also can be released into the air when older buildings containing asbestos-made products are destroyed. Removing the products, such as during a building renovation, also can release asbestos fibers into the air.

Generally, being around asbestos-made products isn’t a danger, as long as the asbestos is enclosed. This prevents the fibers from getting into the air.

People in the United States are less likely to develop asbestos-related lung diseases today than in the past. This is because the mineral no longer is widely used. Also, where asbestos is still used, rules and standards are now in place to protect workers and others from asbestos exposure.

You can prevent asbestos-related lung diseases by limiting your exposure to asbestos fibers. If your job requires you to work around asbestos, make sure to follow workplace rules for handling it. For example, make sure that air levels are measured, and wear a proper respirator to avoid breathing in asbestos fibers.

If you live in a house or work in a building that has pipes or other products containing asbestos, you generally don’t need to take special precautions. Being around products that contain asbestos isn’t a danger, as long as the asbestos is enclosed. This prevents the fibers from getting into the air.

If you smoke, quit. Smoking greatly increases your risk of lung cancer if you have pleural plaque, pleural effusion, or asbestosis. Talk with your doctor about programs and products that can help you quit smoking. Also, try to avoid secondhand smoke.

If you have trouble quitting smoking on your own, consider joining a support group. Many hospitals, workplaces, and community groups offer classes to help people quit smoking.

For more information about how to quit smoking, go to the Diseases and Conditions Index Smoking and Your Heart article and the National Heart, Lung, and Blood Institute’s “Your Guide to a Healthy Heart.” Although these resources focus on heart health, they include general information about how to quit smoking.

The signs and symptoms of asbestos-related lung diseases vary. They depend on which disease you have and how much it has damaged your lungs. Signs and symptoms may not appear for 10 to 40 or more years after exposure to asbestos.

If you have pleural plaque, you may not have any signs or symptoms. Pleural effusion may cause pain on one side of the chest. Both conditions often are found with a chest x ray. These conditions may occur earlier than other asbestos-related lung diseases.

The main symptom of asbestosis is shortness of breath with physical exertion. You also may have a dry cough and feel tired. If your doctor listens to your lungs with a stethoscope, he or she may hear a crackling sound when you breathe in.

The symptoms of lung cancer may include a worsening cough or a cough that won't go away, trouble breathing, ongoing chest pain, and coughing up blood. Other symptoms of lung cancer include frequent lung infections, fatigue (tiredness), and weight loss without a known cause.

Symptoms of mesothelioma include shortness of breath and chest pain due to pleural effusion.

Your doctor will diagnose an asbestos-related lung disease based on your past exposure to asbestos, your symptoms, a physical exam, and test results.

Specialists Involved

Your primary care doctor, such as a family doctor or internist, may provide ongoing care if you have an asbestos-related lung disease. Other specialists also may be involved in your care, including a:

• Pulmonologist. This is a doctor who specializes in diagnosing and treating lung diseases.
• Radiologist. This is a doctor who is specially trained to supervise x-ray tests and look at x-ray pictures.
• Surgeon or oncologist. An oncologist is a doctor who specializes in diagnosing and treating cancer. The surgeon or oncologist may take a tissue sample from your lungs to study under a microscope.
• Pathologist. A pathologist is a doctor who specializes in identifying diseases by studying cells and tissues under a microscope. A pathologist may study your tissue sample.

Exposure to Asbestos

Your doctor will want to know about your history of asbestos exposure. He or she may ask about your work history and your spouse's or other family members’ work histories.

Your doctor also may ask about your location and surroundings. For example, he or she may ask about areas of the country where you've lived.

If you know you were exposed to asbestos, your doctor may ask questions to find out:

• How much asbestos you were exposed to. For example, were you surrounded by visible asbestos dust?
• How long you were exposed to asbestos and how often during that time you were in direct contact with it.

Symptoms

Your doctor may ask whether you have any symptoms, such as shortness of breath or coughing. The symptoms of asbestos-related lung diseases vary. They depend on which disease you have and how much it has damaged your lungs.

Your doctor also may ask whether you smoke. Smoking, along with asbestos exposure, raises your risk for lung cancer.

Physical Exam

Your doctor will listen to your breathing with a stethoscope to find out whether your lungs are making any strange sounds.

If you have a pleural effusion with a lot of fluid buildup, your doctor might hear a dull sound when he or she taps on your chest. Or, he or she might have trouble hearing any breathing sounds. If you have asbestosis, your doctor may hear a crackling sound when you breathe in.

Your doctor will check your legs for swelling, which may be a sign of lung-related problems. He or she also will check your fingers and toes for clubbing.

Clubbing is the widening and rounding of the fingertips and toes. Clubbing most often is linked to heart and lung diseases that cause lower-than-normal blood oxygen levels.

Chest X Ray

A chest x ray is the most common test for detecting asbestos-related lung diseases. This painless test creates pictures of the structures inside your chest, such as the lungs.

A chest x ray can’t detect asbestos fibers in the lungs. However, it can show asbestos-related diseases, such as pleural plaque and pleural effusion. Pleural effusion also can be a sign of a more severe disease, such as mesothelioma.

A chest x ray also can show asbestosis. Often the lung tissue will appear very white on the x-ray pictures. The size, shape, location, and degree of whiteness can help your doctor figure out how much lung damage you have. Severe asbestosis may affect the whole lung and have a honeycomb look on the x-ray pictures.

If you have lung cancer, a chest x ray may show masses or abnormal fluid.

If you have mesothelioma, a chest x ray will show thickening of the pleura. The pleura is the tissue around the lungs and diaphragm (the muscle below your lungs). The chest x ray also will usually show signs of pleural effusion in people who have mesothelioma.

Other Diagnostic Tests

To help confirm a chest x-ray finding, or to find out how much lung damage you have, you may have more tests.

Chest Computed Tomography Scan

A chest computed tomography (to-MOG-ra-fee) scan, or chest CT scan, is a painless test that creates precise pictures of the structures inside your chest, such as your lungs. A CT scan is a type of x ray, but its pictures show more detail than standard chest x-ray pictures.

A chest CT scan may be very helpful for finding asbestosis in its earliest stages, before a standard chest x ray can detect it.

Lung Function Tests

Lung function tests measure how much air you can breathe in and out, how fast you can breathe air out, and how well your lungs deliver oxygen to your blood.

These tests can show whether your lung function is impaired. They also can help your doctor track your disease over time.

Biopsy

The only way to confirm a diagnosis of lung cancer or mesothelioma is for a pathologist to check samples of your lung cells or tissues. A pathologist is a doctor who identifies diseases by studying cells and tissues under a microscope.

Doctors have many ways to collect tissue samples. One way is through bronchoscopy (bron-KOS-ko-pee). For this procedure, your doctor will pass a thin, flexible tube through your nose (or sometimes your mouth), down your throat, and into your airways. He or she will then take a sample of tissue from your lungs.

If your doctor thinks you have mesothelioma, you may have a thoracoscopy (thor-ah-KOS-ko-pee). For this procedure, you'll be given medicine so you don't feel any pain.

Your doctor will make a small cut through your chest wall. He or she will put a thin tube with a light on it into your chest between two ribs. This allows your doctor to see inside your chest and get tissue samples.

No treatments can reverse the effects of asbestos on your lungs. However, treatments may help relieve symptoms and prevent or delay complications. If you have lung cancer, treatments may help slow the progress of the disease.

Treatments for Pleural Plaque, Pleural Effusion, and Asbestosis

If you have pleural plaque, pleural effusion, or asbestosis and you smoke, your doctor will advise you to quit smoking. People who have these conditions can lower their risk for lung cancer if they quit smoking.

Talk with your doctor about programs and products that can help you quit smoking. Also, try to avoid secondhand smoke.

If you have trouble quitting smoking on your own, consider joining a support group. Many hospitals, workplaces, and community groups offer classes to help people quit smoking.

For more information about how to quit smoking, go to the Diseases and Conditions Index Smoking and Your Heart article and the National Heart, Lung, and Blood Institute’s “Your Guide to a Healthy Heart.” Although these resources focus on heart health, they include general information about how to quit smoking.

If you have trouble breathing or shortness of breath and a very low blood oxygen level, your doctor may recommend oxygen therapy. For this treatment, you're given oxygen through nasal prongs or a mask. Oxygen therapy may be done at home or in a hospital or other health facility.

If excess fluid around the lungs (pleural effusion) is making it hard for you to breathe, thoracentesis (THOR-ah-sen-TE-sis) may help. For this procedure, your doctor will insert a thin needle or plastic tube into the space between your lungs and chest wall. He or she will then draw out the excess fluid.

Treatments for Lung Cancer and Mesothelioma

If you have lung cancer or mesothelioma, your treatment may include surgery, chemotherapy, radiation therapy, and/or targeted therapy. (Targeted therapy uses medicines or other substances to find and attack specific lung cancer cells without harming normal cells.)

Your doctor may prescribe medicines to prevent fluid buildup, ease pain, or relieve other complications of your disease.

If you have lung cancer or mesothelioma, talk with your doctor about whether you should get flu and pneumonia vaccines. These vaccines can help lower your risk for lung infections.

The outlook for people who have asbestos-related lung diseases varies. It will depend on which disease a person has and how much it has damaged the lungs.

No treatments can reverse the effects of asbestos on your lungs. However, treatments may help relieve symptoms and prevent complications. If you have lung cancer, treatments may help slow the progress of the disease.

Ongoing Care

If you have an asbestos-related lung disease, you'll need routine followup care for the rest of your life. This may include chest x rays and lung function tests every 3 to 5 years.

Follow your treatment plan as your doctor prescribes. Call your doctor if you notice new or worsening symptoms.

Talk with your doctor about whether you should get flu and pneumonia vaccines. These vaccines can help lower your risk for lung infections. Avoiding lung infections can help prevent other, more serious complications.

If you smoke, quit. Smoking raises your risk for lung cancer if you have pleural plaque, pleural effusion, or asbestosis. Talk with your doctor about programs and products that can help you quit smoking. Also, try to avoid secondhand smoke.

If you have trouble quitting smoking on your own, consider joining a support group. Many hospitals, workplaces, and community groups offer classes to help people quit smoking.

For more information about how to quit smoking, go to the Diseases and Conditions Index Smoking and Your Heart article and the National Heart, Lung, and Blood Institute’s “Your Guide to a Healthy Heart.” Although these resources focus on heart health, they include general information about how to quit smoking.

Emotional Issues and Support

Living with an asbestos-related lung disease may cause fear, anxiety, depression, and stress. Talk about how you feel with your health care team. Talking to a professional counselor also can help. If you’re very depressed, your doctor may recommend medicines or other treatments that can improve your quality of life.

Joining a patient support group may help you adjust to living with an asbestos-related lung disease. You can see how other people who have the same symptoms have coped with them. Talk with your doctor about local support groups or check with an area medical center.

Support from family and friends also can help relieve stress and anxiety. Let your loved ones know how you feel and what they can do to help you.