Introduction

Asbestos-associated diseases such as asbestosis and pleural plaques are not curable. Some complications of asbestos-related disease like acute pleuritis are self-limited. Management focuses on prevention and amelioration of symptoms in the patient with asbestos-related disease. Therefore, the primary actions are to

• Avoiding further exposure to asbestos if that is currently occurring,
• If currently employed in a job that entails asbestos exposure, the patient should be referred to an occupational specialist who can advise the patient on avoiding further exposures through the use of personal protective equipment (PPE) and well ventilated work spaces, and can provide important advice regarding the legal and occupational issues that work with asbestos entails, and
• Monitor the patient to facilitate early diagnosis and treatment of any treatable respiratory conditions associated with asbestos.

Patients who are symptomatic may need documentation of impairments caused by asbestos-associated disease for the purpose of filing for workers compensation, social security disability, or other claims. Explanation of the specific statute of limitations for filing of workers compensations should be explained; the different states will have differing laws regarding workers compensation claims. Degree of disability should be stated in the terms required by the program to which the patient is applying. Recording these impairments and advising on legal issues associated with occupational asbestos-related disease is an important task and may require the assistance of a specialist such as an occupational physician. To locate such a specialist, please refer to the Web resources listed under "Sources of Additional Information" at the end of this CSEM.

The remainder of this section focuses on patient care.

All Exposed Patients

Care of patients who have been exposed to asbestos, whether or not they are symptomatic, involves routine follow up to facilitate early diagnosis and intervention. This includes

• Exposure and medical histories and regular physical examinations,
• Periodic chest radiographs and pulmonary function tests to look for early signs of asbestos-associated disease,
• Encouraging smoking cessation for patients who smoke, and
• Educating patients regarding the possible consequences of asbestos exposure.

Asbestosis

Asbestosis is irreversible, and the rate of disease progression varies [American Thoracic Society 2004]. Currently, there is no specific effective treatment.

Patients with advanced disease and hypoxemia at rest, during exercise, or during sleep may benefit from continuous home oxygen therapy, which can prevent or attenuate cor pulmonale. However, primary management strategies for asbestosis are listed below.

• Remove the patient from the source of exposure if there is any ongoing exposure. If occupational exposure is currently ongoing, refer the patient to an occupational physician for advice on achieving cessation or amelioriation of this occupation related issue.
• Assess the patient's level of disability.
• Treat chest infections aggressively.
• Provide pneumococcal vaccine and annual influenza vaccines as recommended by Centers for Disease Control and Prevention.
• Provide respiratory therapies and pulmonary rehabilitation as needed.
• Counsel smokers to quit.
• Counsel patients to call you if they notice any changes in their health such as weight loss, change in cough or coughing up blood.
• Notify the appropriate health authorities in states where asbestosis is reportable.
• Follow the general strategies listed for all patients.

Patients should be monitored periodically (per doctor-patient consultation) for disease progression and closely observed for asbestos-associated malignancies such as lung cancer, mesothelioma, and other cancers [American Thoracic Society 2004; IARC 2012]. Colon cancer screening should begin at age 50 and follow standard guidelines [Levin et al. 2008]

Pleural Abnormalities

Pleural plaques are generally benign, but can occasionally result in pulmonary impairment. As mentioned previously, when severe pleuritic pain accompanies asbestos-related pleural disease, it requires appropriate management [Harbut et al. 2009]. In addition, patients with asbestos-related pleural abnormalities may have or eventually get asbestosis or asbestos-related cancers. Therefore, management of asbestos-related pleural abnormalities involves monitoring for asbestosis and all known related malignancies and the general strategies listed for all patients.

Mesothelioma

Diffuse malignant mesothelioma is almost always fatal. Median life expectancy following diagnosis ranges from 8 to 14 months in various studies [British Thoracic Society 2001].

For more information about the diagnosis and treatment of mesothelioma, see

• British Thoracic Society Standards of Care Committee, Statement on malignant mesothelioma in the United Kingdom [British Thoracic Society 2001].
• The National Cancer Institute's latest news on the treatment of mesothelioma at https://www.cancer.gov/types/mesothelioma/.

Lung Cancer

The treatment and management of asbestos-associated lung cancer is the same as that of lung cancer from other causes.

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