Asbestos-related pleural thickening is a lung disease in which extensive pleural scarring (pleural fibrosis) thickens the pleural membrane lining the lungs and chest wall which can restrict lung expansion. It is one of the more common asbestos-related diseases referred to as ‘Diffuse Pleural Thickening’ (DPT) and in more common instances as ‘lung scarring’, ‘calcification of the lungs’ and/or ‘thickening of the pleura’. When pleural thickening is found in ‘both lungs the condition is referred to as ‘bilateral pleural thickening’.
When potentially harmful asbestos fibres are inhaled they travel into the lungs where the body’s natural defence mechanism attempts to break them down before they penetrate the lung lining and enter into the bloodstream. These fibres are difficult to deal with and many fibres enter and settle on the pleura or pleural membrane causing them to thicken, calcify and/or scar over a period of many years. This area of the pleura becomes inflamed which causes irritation and often leads to reduced and restricted lung function.
Pleural thickening often occurs due to inflammation in the lungs and other causes of pleural thickening might be due to infection, tuberculosis, bacterial pneumonia, pleural effusion, rheumatoid lung disease and tumours (benign and malignant) including mesothelioma.
Pleural thickening is associated to many industrial workers where asbestos use was commonplace, as;
Common symptoms of pleural thickening include;
If your lungs have been harmed by asbestos it is likely they will produce a crackling sound when you breathe in and this can be detected by your GP who will examine you and listen to your lungs using a stethoscope. Your GP will ask about your work history and general health and it is important you discuss those health concerns which took you to see your GP in the first instance and be clear about your previous work with asbestos materials or working in environments where asbestos was used.
A number of diagnostic investigations can be carried out to confirm pleural thickening which might include,
Pleural thickening is normally found as shadowing in the lung which is often confirmed by further investigation and CT Scan. An x-ray will detect abnormalities in the structure of the lung associated to asbestos exposure and might also confirm the existence of another asbestos scarring condition known as pleural plaques which represents less extensive scarring (focal scarring) also caused by inhalation of asbestos fibres.
CT Scan (computerised tomography)
This is a painless process which produces more detailed 3D images of the lungs and can help identify less obvious abnormalities missed by x-ray such as early stage asbestosis.
Lung function tests (LFT)
Lung function tests include spirometry, lung volumes and gas transfer which are designed to measure the effectiveness of your lungs. The tests can help identify an abnormal or impaired result but can also be used to track and monitor a disease over periods of time. An abnormal result with ‘restrictive lung pattern’ indicating reduced lung volume is indicative of pleural thickening/scarring, asbestosis, trapped lung, pleural effusions and interstitial lung disease.
Spirometry is a test which involves blowing through a mouthpiece into a spirometer to measure how well you can inhale and exhale using maximum effort. Maximum effort is required and the test might need to be repeated a number of times.
Lung volumes can be measured using similar equipment to a spirometer located within in a small glass sided area during which time you will have a small clip placed on your nose. This test is quite painless and a member of staff is always in attendance watching and speaking with you.
Gas transfer test measures the amount of oxygen passing from the lungs into the bloodstream and is undertaken using a mouthpiece through which you will be asked to fill your lungs with a harmless gas for a few seconds before exhaling.
Asbestos fibres found in the lung could indicate the existence of some other asbestos related lung condition such as asbestosis or mesothelioma and it might be necessary to undertake a biopsy to exclude any more serious conditions.
A biopsy of lung tissue, sometimes from a nodule or lesion, will distinguish asbestosis from other similar lung conditions such as idiopathic pulmonary fibrosis (IPF) sometimes referred to as usual interstitial pneumonia, chronic obstructive pulmonary disease (COPD), emphysema or silicosis.
A biopsy can also help to confirm the existence and type of any cancer such as mesothelioma or lung cancer when examined in a laboratory under the microscope by a Pathologist.
Biopsy procedures, include;
In most cases no specific treatment is required because asbestos-related pleural thickening seldom presents severe symptoms. In instances of severe breathing moderately successful surgical procedures are available to remove some or all of the thickened pleura but generally speaking day to day treatment will involve;
Health monitoring – Periodical health checks can help to identify the progression of pleural thickening and development of another asbestos-related condition.
Avoid smoking – Smoking can aggravate symptoms of breathlessness and increase the risk of developing lung cancer. Your GP will help you to give up and there are numerous prescriptions and replacement therapies which can help to achieve this goal. Seek out local support groups for further help.
Keep active and consider pulmonary rehabilitation (PR) – It is important to maintain healthy lungs regardless of age and general health including those who have a lung condition. Regular physical activity and exercise is proven to add quality to your life, reduce stress and will increase the efficiency of your lungs. If you feel able to take gentle exercise such as walking or swimming discuss this with your GP or physiotherapist before embarking upon any exercise regime to ensure you are safe.
Pulmonary Rehabilitation is a programme of exercise designed to help and educate those people suffering from chronic lung conditions including COPD, bronchiectasis and idiopathic pulmonary fibrosis (IPF). Your GP, nurse or respiratory team will refer you to your local programme.
Key benefits of pulmonary rehabilitation (PR) include;