Asbestos-related lung diseases

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The use of asbestos has been banned throughout the European Union since 2005. However the dangerous effects of asbestos on health were known decades ago. Despite the ban, the number of asbestos-related deaths continues to rise as it can take many years after the initial exposure for diseases to develop.

History

Since 1975, the health risks associated with asbestos exposure were widely recognised and its use throughout the world reduced from 5 million tones in 1975 to 3 million tonnes by 1998. Strict methods to protect workers were introduced until asbestos use was restricted and later banned. Industries were advised to replace asbestos with a less dangerous substance.

What is asbestos?

Asbestos is the name used for a group of natural minerals. It has been used in a large number of products because of its unique properties. It will not catch fire even at very high temperatures and it is extremely flexible and hardwearing. There are three main types:

Crocidolite (blue) Amosite (brown) Chrysotile (white)
Needle-like fibres

Strongest of all asbestos fibres

Most lethal of all asbestos types

High resistance to acids

Spiky fibres

Resistant to heat

Curly fibres

Most flexible of all asbestos types

Can withstand the highest heat

95% of all asbestos mined

Most lethal of all asbestos types

 

Damaged asbestos pipe insulation

 

Why is asbestos dangerous?

Asbestos is made up of fibres, which can break down into smaller fibres that cannot be seen with the naked eye. Products that contain asbestos generate fibres when they are damaged. Fibres are released into the air and can be inhaled into the lungs to cause harm. The presence of fibres in the lungs causes scars to form that can stop the lungs from working properly and can cause cancer. All types of asbestos are potentially fatal if they are inhaled. Diseases can take 15–60 years to develop and they have no cure.

Where is asbestos found and who is most at risk?

Asbestos is most usually found in buildings that were built or refurbished before 2000. It was commonly used in insulation, lagging on pipe work and water tanks and cement for walls, ceilings and floors. Anyone who has to work with materials that contain asbestos has a risk of being exposed to asbestos fibres if materials are damaged. Examples of workers who may be at risk are: miners, builders, plumbers, electricians, joiners, plasterers, decorators, heating engineers, gas fitters and demolition contractors. The person or company who is responsible for maintenance and repair of a building is also responsible for managing the risk from asbestos; assessing whether it is present, its condition and whether it poses a risk for workers. Ask to see an asbestos survey if in doubt

Four main groups of people have been put at risk by the production and use of asbestos

  • People mining and milling crude asbestos or making asbestos products.
  • Workers in the building industry using asbestos products (e.g. pipe fitters and construction workers).
  • People who come across asbestos in their daily routine (plumbers, electricians, carpenters, etc.).
  • The families of workers who bring dust home on their clothes.

Asbestos-related lung diseases

Asbestosis is a non-cancerous, irreversible lung disease that occurs when asbestos fibres are inhaled over long periods. The disease progresses even once exposure to asbestos is stopped. Scar tissue forms, which stiffens and distorts the lungs, making it harder to breathe. The blood supply to the lungs is altered so they cannot work as well as normal and this puts the heart under strain. Asbestos fibres cause the air sacs to thicken, which reduces the amount of oxygen taken up and the amount of carbon dioxide removed. Higher exposure increases the chances of developing asbestosis and reduces the time it takes to develop.

Cancers due to asbestos

Mesothelioma is a type of cancer that starts in the lung lining (the pleura). It can develop 20–70 years after exposure to even small amounts of blue or brown asbestos. It is most common in older men and it is likely to become more common in the next few years. It causes chest pain and breathlessness and there may be fluid between the pleura and the chest cavity (this is called pleural effusion). The cause can be found by taking a detailed exposure history. Most patients die within a year of the cancer being found, and treatment is usually to relieve symptoms. Workers exposed to large amounts of asbestos are at risk of lung cancer (bronchial carcinoma). This disease is likely to appear 15–20 years after exposure and has claimed the most lives of all asbestos-related diseases. Asbestos-related cancers are predicted to cause about 500,000 deaths by 2030 in western Europe.

Other lung conditions due to asbestos

Asbestos can also cause a thickening in the membrane lining the lungs and chest cavity (diffuse pleural thickening), which can be painful and make patients feel breathless. It can also cause areas of scar tissue, called pleural plaques, to form. Pleural plaques do not cause symptoms, and they are not cancerous. Smoking accelerates disease progression and increases the risk of lung cancer in people with asbestosis.

Compensation for victims

Countries that have used asbestos in the past are obliged to arrange compensation for disease-affected victims. Either companies will have their own employer’s liability schemes for asbestos claims or it will be down to governments to deal with compensation issues. The amount of compensation received depends on the amount of asbestos used in that country and the choices made to protect workers. All industrialised countries that used asbestos in the second half of the 20th century have experienced an explosive increase in disease claims following asbestos exposure in the 1970s. Victims are advised to take legal action against their employer on the grounds that the employer has not used appropriate protection for workers. The epidemic of asbestos-related disease is a major political and social issue. It places a heavy burden on health systems and causes thousands of deaths every year in Europe. Although figures for the current and eventual death toll are lacking, estimates of the lives that will be lost to asbestos-related diseases in Europe run into the hundreds of thousands. The way each country copes with the after-effects of asbestos exposure will depend upon the country’s history and levels of social, industrial and economic development.

Author
This factsheet was prepared by the ELF office with assistance from Professor P.S. Burge, of the Occupational Lung Disease Unit, Birmingham Heartlands Hospital, UK. The material was reviewed and approved by the ERS Advisory Board.

Information sources
National Institute of Occupational Safety and Health (NIOSH).
Enviromental Protection Agency.
The Health and Safety Executive.
European Environment Agency.

Interesting links
An article entitled ‘Induced sputum in occupational lung diseases’ published in Breathe 2005, E. Fireman, Y. Lerman

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