Asbestosis : Dr. A.

Sau; MBBS,MD (Gold

10/03/2020 1
Medalist) ; DD(Medical)
 Regional Labour Institute - Kanpur

Directorate General of Factory Advice Services and Labour Institutes

Ministry of Labour & Employment
Govt. of India

10/03/2020 Asbestosis : Dr. A. Sau; MBBS,MD (Gold Medalist) ; DD(Medical) 2/20

 Asbestosis

Presented By

Dr. Arkaprabha Sau

MBBS, MD (Gold Medalist), DPH, Dip. Geriatric Medicine, Ph.D.(Research Fellow)

Deputy Director (Medical), Group-A, Central Civil Services, DGFASLI

Ministry of Labour & Employment
Govt. of India

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 Description of Asbestos
• Asbestos is a generic term for a group of mineral silicates
• Asbestos fibers are (Length: L ≥ 5 μm, Diameter: D < 3 μm) :
 Very strong
 Highly flexible
 Resistant to breakdown by acid, alkali, water, heat, and flame
 Non-biodegradable
 Environmentally persistent

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 Types of Asbestos
Serpentine / Chrysotile Amphibol

99% Actinolite
Amosite
Anthophyllite
Crocidolite
Tremolite

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 Current Use (Maximum)
• Automobile clutches

• Brake pads

• Corrugated sheeting

• Cement pipe

• Roofing materials

• Fireproof materials
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 Past Use / Minimum Current Use
• Boilers and heating vessels • Laboratory furniture
• Cement pipe • Paper products
• Conduits for electrical wire • Pipe covering
• Corrosive chemical containers • Roofing products
• Electric motor components • Sealants and coatings
• Heat-protective pads • Insulation products

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 Occupational Exposure to Asbestos 
• Auto mechanics • Operating engineers
• Boilermakers
• Painters
• Bricklayers
• Pipefitters
• Building Inspectors
• Plasterers
• Carpenters
• Demolition workers • Plumbers
• Electricians • Roofers
• Floor covering workers • Refinery workers
• Furnace workers  • Shipyard workers

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 Epidemiology
• Number of deaths from asbestosis is approx. 1500 per year (USA)
• Hospitalizations per year 10,000 to 20,000 (USA)
• In 2016 in the UK, 1050 new cases of asbestosis identified
• There is a latency period of around 20 years from time of first
exposure to asbestos to development of radiographic changes
• Exposures to workers in Africa, Asia, and South America are
significantly greater than those currently occurring in the USA,
Canada, Australia and Europe

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 Route of Exposure
• Most common exposure pathway:
 Inhalation of fibers
• Minor pathways:
 Ingestion
 Dermal contact

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 Pathogenesis
• Asbestos fibers induce pathogenic changes via:

 Direct interaction with cellular macromolecules

 Generation of reactive oxygen species (ROS)

 Other cell-mediated mechanisms

• lead to cell injury, fibrosis, and possibly cancer

• Asbestos is genotoxic and carcinogenic

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 Asbestos Associated Diseases
• Respiratory diseases:
 Parenchymal asbestosis
 Asbestos-related pleural abnormalities
 Lung carcinoma
 Pleural mesothelioma
• Nonrespiratory diseases:
 Peritoneal mesothelioma
 Possibly, other extrathoracic cancers
 Rarely, cor pulmonale or constrictive pericarditis
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 Parenchymal Asbestosis
• Diffuse interstitial fibrosis with:
 Restrictive pattern of disease on PFT
 Impaired gas exchange
 Progressive exertional dyspnoea
• Radiographic changes: >10 years
• Latency period: 20-40 years

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 Pleural Abnormalities

• Four types of abnormalities:

 Pleural plaques
 Benign asbestos pleural effusions
 Diffuse pleural thickening
 Rounded atelectasis
• Mostly asymptomatic, though some can cause dyspnea or cough
• Latency periods: 10-30 years

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 Mesothelioma
• Risk depends on
 Level, frequency, and duration of exposure
 Time elapsed since exposure
 Age at time of exposure
 Smoking history (synergistic)
 Individual susceptibility factors
• Mostly asymptomatic
• Latency periods: 20-30 years

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 Health Surveillance

• Pre-employment medical examination to detect any pre existing

lung abnormality and to establish a baseline for comparison in
any further evaluation of the worker

• Periodic medical examinations aimed at detecting any early

specific adverse health effects attributable to the asbestosis

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 Monitoring
• Air Sampling
 PEL (NIOSH): TWA 0.1 fiber/cc (8hour shift of a 40
hour workweek)
 Excursion limit (1.0 f/cc over 30-minute period) 
• Environmental Monitoring
 Maximum Contaminant Level (EPA): 7 MFL (million
fibers per liter) > 10 μm in length  

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 Medical Monitoring
• Medical evaluation of all patients should include:
 Assessment of clinical presentation
 Exposure history
 Medical history
 Physical examination
 Chest radiograph and pulmonary function tests
• Radiologic and laboratory testing can include:
 CT or HRCT
 BAL
 Lung biopsy (rarely needed)

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 Management
Asbestos-
associated Disease Treatment Strategy
Parenchymal • Stopping additional exposure
Asbestosis and • Careful monitoring to facilitate early diagnosis
Asbestos-Related • Smoking cessation
Pleural Abnormalities • Regular influenza and pneumococcal vaccines
• Pulmonary rehabilitation as needed
• Disability assessment
• Aggressive treatment of respiratory infections
Lung Cancer and • Early diagnosis
Mesothelioma • Surgery
• Chemotherapy
• Radiation

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 Thank You
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