Asbestosis
| Classification according to ICD-10 | |
|---|---|
| J61 | Pneumoconiosis caused by asbestos and other inorganic fibers - asbestosis |
| ICD-10 online (WHO version 2019) | |
The asbestosis is a disease of the lungs and is one of the so-called pneumoconiosis (black lung disease). It is caused by inhaled asbestos dust , the use of which has been banned in Austria and Switzerland since 1990, in Germany since 1993 and EU-wide since 2005.
Pathophysiology
Fibrosis
Depending on the duration of exposure and the concentration of fine asbestos dusts as well as personal disposition , inhaled asbestos particles lead to fibrosis of the lung parenchyma to a very different extent after a delay of 15 to 20 years . Fibrosis of the lower lobes and the pleuronic lung segments is most common because the asbestos fibers accumulate here .
The inhaled fibers are absorbed by alveolar macrophages (scavenger cells in the alveoli). However, depending on the fiber geometry, the asbestos fibers cannot be completely broken down, so that the alveolar macrophages release messenger substances (interleukin 1 and growth factors). The result is the immigration of T helper cells and granulocytes . Furthermore, fibrocytes (lung tissue cells) are stimulated to produce type III collagen . This ultimately leads to fibrosis of the lung tissue .
Lung cancer
On average, with a latency of 30 years - within a range of 10 to 60 years - asbestosis can lead to the development of lung cancer .
Lung cancer
In addition to asbestosis, inhalation of asbestos dust can also lead to pleural plaques and calcification. The plaques are not precancerous lesions (precursors of cancer) which cannot degenerate into malignant (malignant). It is also possible to develop a mesothelioma . It is a malignant tumor of the pleura , which can also only develop after 20 to 40 years after exposure to asbestos. Typical of pleural mesothelioma is the low exposure to asbestos fibers that is sufficient to trigger it.
Of the types of asbestos used, the carcinogenic properties of crocidolite are higher than those of chrysotile because of its fiber geometry and high bio- resistance .
Symptoms
The lung fibrosis, which occasionally progresses even after the end of exposure, leads to dyspnoea , dry cough, viscous sputum, weight loss and, in an advanced stage, to disability .
Complications
The most important complications include chronic obstructive pulmonary disease , bronchopneumonic processes, cor pulmonale and pleural effusions .
Diagnosis
The diagnosis of asbestosis is essentially based on the clinical examination (especially auscultation of the lungs with a stethoscope ), the lung function test , the x-ray of the lungs and the occupational history. Occupations at risk are: insulators, chemical workers, locksmiths, car mechanics, plumbers, tilers, spinners, tailors, building material manufacturers, bricklayers, roofers, shipbuilders, aircraft builders, smelters, formers, welders. At the moment, people who renovate and refurbish buildings are particularly exposed. The computed tomography (CT), the lung changes earlier and more detailed than the present conventional X-ray technology, especially in high-definition technology.
Pulmonary dysfunction
A so-called restrictive ventilation disorder often shows up in the lung function test. A diffusion disorder (gas exchange) is possible.
ILO classification
The signs of asbestosis in the X-ray are described according to a standardized procedure. This ILO (International Labor Office) classification is valid worldwide and describes the changes in the X-ray image using letter-number codes:
Image quality: 1–4 = good – unacceptable
Pulmonary findings:
- small rounded shadows
- p = diameter ≤ 1.5 mm
- q = diameter> 1.5 to ≤ 3 mm
- r = diameter> 3 to 10 mm
- small irregular shadows
- s = caliber <1.5 mm
- t = caliber> 1.5 to ≤ 3 mm
- u = caliber> 3 to 10 mm.
- big shadows
- A = diameter> 10 to 50 mm
- B = larger or more numerous shadows than A, shadow equivalent <right upper field
- C = shadow sum> upper right field
- distribution
- R (right lung field) and
- L (left lung field) are divided into three fields: upper (O), middle (M) and lower field (U)
- Scattering (estimation of the shadow concentration by comparison with standard films)
- 0 = small shadows are missing
- 1–3 stands for increasing scattering density
Pleural findings:
- width
- a = greatest width <5 mm
- b = 5 to ≤ 10 mm
- c => 10 mm
- expansion
- 1 = total length equivalent to the length of a quarter of the projection of a lateral chest wall
- 2 = total length equivalent of more than a quarter but less than a half of a lateral chest wall
- 3 = total length more than half the projection of a lateral chest wall
Diaphragm involvement Yes (Y), No (N)
Pleural plaques
Typical of asbestosis are calcifying deposits (plaques) on the lung membrane (pleura), which can be visualized in the computer tomography. Pleural plaques usually do not cause symptoms, but are important for diagnosing asbestosis and for proving asbestos-induced lung cancer. Pleural plaques can be detected even better by means of a thoracoscopy ( thoracoscopy ) than with CT .
Asbestos bodies
Samples can be obtained and examined as part of a bronchoalveolar lavage (BAL, lung lavage). Microscopically, so-called asbestos bodies can be found in asbestosis. These are asbestos fibers with an iron-containing protein shell. They arise when alveolar macrophages try to eat up the long asbestos fibers and perish in the process. The protruding asbestos fibers look like a “kebab skewer” under the microscope.
Activities with significant exposure to asbestos
- Asbestos processing
- Manufacture or processing of asbestos textile products
- Manufacture, processing or repair of asbestos products
- Use of asbestos as a filler in the manufacture of various materials, such as E.g .: paints, floor coverings, sealing compounds, rubber tires, thermoplastics, synthetic resin molding compounds ...
- Renovation work on buildings:
- Weakly bound asbestos: sprayed asbestos on large buildings, otherwise in plaster, lightweight panels, electrical appliances, fillers, fire protection and floor coverings.
- Firmly bound asbestos in the form of asbestos cement: roof or corrugated sheets, pipes, flower boxes, especially in the 1960s also in floor coverings (floor-flex sheets). Black-brown bitumen adhesives often contain asbestos: if the adhesive is sanded off during renovation, large amounts of asbestos are released.
- Firmly bound asbestos in plasters, fillers and, above all, tile adhesives, released during demolition work, drilling and grinding. In houses that are only 30 years old, around every fourth house is still affected.
- Other exposures: nurses who powdered their surgical gloves with asbestos-containing talc. Brake lining wear from road and rail vehicles.
- Laundry of asbestos-contaminated work clothes
- Indirect exposure: Carry-over from the workplace to the private area, e.g. B. through work clothes.
Asbestosis as an occupational disease
In the case of occupational asbestos exposure, asbestosis is an occupational disease that is compensated if it causes physical functional damage or cancer. According to the Occupational Diseases Ordinance in the version of September 5, 2002, asbestoses are classified under the
- No. 4103 "Asbestosis or diseases of the pleura caused by asbestos dust" and the
- No. 4104 “Lung Cancer or Larynx Cancer
- - in connection with asbestos dust disease (asbestosis)
- - in connection with disease of the pleura caused by asbestos dust or
- - if evidence of the effect of a cumulative asbestos fiber dust dose at the workplace of at least 25 fiber years (25 × 10 6 ((fibers / m³) × years)) "and
- No. 4105 "Mesothelioma of the pleura, peritoneum or pericardium caused by asbestos"
- No. 4114 "Lung cancer due to the interaction of asbestos fiber dust and polycyclic aromatic hydrocarbons with evidence of the effect of a cumulative dose that has a causal probability of at least 50% of Appendix 2 (Second Ordinance to Amend the BKV, Federal Law Gazette 2009 No. 30, p . 1273–1276) corresponds to “led.
Occupational diseases caused by asbestos - in addition to asbestosis, this also includes mesothelioma and lung cancer caused by exposure to asbestos - are of great importance in Germany. In 2005, the employers' liability insurance association recorded more than 3,700 new occupational diseases caused by asbestos and in 27,000 cases had to provide benefits totaling well over 300 million euros annually. Asbestos tops the list of carcinogenic substances by a large margin. In 2001 there were 1,480 cases or 77.1 percent of all cancers recognized as an occupational disease that were attributed to asbestos. In 2005, 1540 deaths from asbestos-related occupational diseases were recorded. Because of the long time lag between exposure to asbestos and the development of cancer, most annual new cases of asbestos-related lung cancer are not expected until 2015 to 2020.
In Switzerland, the Netherlands and France, domestic asbestos victims who wash their work clothes at home are also compensated. In Germany, these victims are not compensated (as of 2019).
In asbestos dust-associated lung cancer, tobacco smoking represents a significant additional risk factor, but in no way excludes recognition as an occupational disease if occupational exposure to asbestos has been proven and either asbestosis has been present or a plausible “cumulative asbestos fiber dust dose ” is proven.
Demand for a central register
The Federal Association for Asbestosis demands a public asbestos register so that owners, buyers, sellers and builders can find out which properties are contaminated with asbestos fibers.
literature
- Silvia Schön and Hans-Joachim Woitowitz : We are suing. Asbestos and its victims. Kellner-Verlag, Bremen and Boston 2014, ISBN 978-3-95651-002-1 .
Individual evidence
- ↑ https://www.lfu.bayern.de/buerger/doc/uw_9_asbest.pdf
- ^ [1] GBU Federal Health Reporting
- ↑ [2] BaUA Federal Institute for Occupational Safety and Health, National Asbestos Profile Germany , 2015
- ↑ Public Health: From Society's Health Needs to Clinical Implications. Thomas E. Dorner (Ed.). 2013
- ^ [3] , text of the Federal Environment Agency on the subject of asbestos
- ^ [4] , text by the Federal Environment Agency on the subject of asbestos
- ↑ [5] , Baulinks information from June 25, 2015
- ↑ [6] , Die Welt, May 11, 2012, "The camouflaged killer asbestos is omnipresent"
- ↑ [7] , M. Mattenklott, 2007, "Asbestos in talc and soapstone - today's situation"
- ↑ [8] , Mesothelioma Cancer Alliance, 2016, "Asbestos in Talc Powder Products"
- ↑ [9] Der Blaue Engel, press release, "Eco-label for asbestos-free brake and clutch linings"
- ↑ a b c Susanne Donner: Deadly washing. In: riffreporter.de. October 8, 2019, accessed November 21, 2019 .
- ^ German Statutory Accident Insurance (DGUV): Documentation of the occupational diseases in Germany. ( Memento of September 13, 2011 in the Internet Archive ) (PDF; 3.5 MB)
- ↑ DGUV: Asbestos occupational diseases continue to increase. ( Page no longer available , search in web archives ) Info: The link was automatically marked as defective. Please check the link according to the instructions and then remove this notice.
- ↑ DGUV: Asbestos makes you sick - even today. ( Memento from March 28, 2010 in the Internet Archive )
