Occupational lung diseases Table 1: Anatomical location of occupational diseases

Size: px
Start display at page:

Download "www.australiandoctor.com.au Occupational lung diseases Table 1: Anatomical location of occupational diseases"

Transcription

1 How to Treat PULL-OUT SECTION Complete How to Treat quizzes online (www.australiandoctor.com.au/cpd) to earn CPD or PDP points. inside Asbestos-related lung conditions Other occupational lung diseases Assessment Investigations Management The authors Dr Subash Srikantha respiratory and sleep specialist in private practice, St Leonards, Liverpool and the Woolcock Clinic, Glebe, NSW; and conjoint lecturer, school of medicine, University of NSW. Dr Background IN this industrialised era, workers are exposed to hundreds of potentially hazardous materials, with the associated risk of developing occupational-related health conditions. Increasingly, environmental exposures are being recognised as an important cause of pulmonary disease. Occupational lung disease is one of the leading causes of work-related death and disability in Australia. Causal factors include the inhalation of irritant chemical vapours and gases, organic and inorganic dusts, sensitising agents and toxic fumes, which adversely affect both the upper and lower respiratory tracts. Australia was the world s largest Table 1: Anatomical location of occupational diseases Anatomical location Examples of occupational diseases Upper airways Rhinitis, laryngitis, nasal ulceration, cancer of the nasopharynx Conducting airways Occupational asthma, bronchitis, bronchiolitis, COPD, bronchial cancer Lung parenchyma Pneumoconiosis (silicosis, asbestosis), lung cancer Pleura plaques, diffuse pleural thickening, pleural effusions, mesothelioma asbestos user per capita in the world during the 20th century. This resulted in a significant health burden to the workers who were mining, processing or using asbestos products. Due to the long latency from exposure to disease, the number of cases of asbestos-related mesothelioma is increasing despite the fact that asbestos production ended in 1987 and the importation of asbestos products was completely banned in Recent decades have seen a marked increase in awareness about the adverse health effects of hazardous exposures in the workplace. This has resulted in tighter workplace regulations and industrial legislation to safeguard the health of workers. Each state government now has a WorkCover Authority focused on workplace safety. Among other things, these authorities assist with compensation of workers with occupational lung diseases. can be categorised into groups according to: Anatomical location (table 1). cont d next page Michael Hibbert senior respiratory and sleep specialist, department of respiratory and sleep medicine, Royal North Shore Hospital, St Leonards; and lecturer, Northern Clinical School, University of Sydney, NSW. Copyright 2013 Australian Doctor All rights reserved. No part of this publication may be reproduced, distributed, or transmitted in any form or by any means without the prior written permission of the publisher. For permission requests, 8 March 2013 Australian Doctor 23

2 How To TREAT from previous page Inhaled substances (table 2). Reaction type. Pathophysiological responses. Occupational lung disease needs to be considered in any current or retired worker, particularly when the worker is involved in an industry with exposure to a known hazardous material. It is important to be aware of the latency between exposure and onset of symptoms, especially in the case of asbestos and silica exposure, where there may be a delay of decades before the onset of symptoms. Similarly in occupational asthma, the onset of symptoms may be delayed for months to years after the initial exposure to the allergen. On the other hand, we should not assume the origins of respiratory symptoms are caused by an occupational exposure without a clear causal relationship. Early cessation of exposure to a toxic agent is of paramount importance. Because respiratory symptoms caused by toxic exposures are nonspecific, recognising their potential relationship to a toxic agent or agents is essential to proper diagnosis. Continued exposure may result in irreversible functional decline and even fatal respiratory disease. Knowledge about and familiarity with these diseases is critically important for the primary care physician, who is often the first healthcare provider to see the affected individuals. Table 2: Agents responsible for occupational lung diseases Agent Industry/occupations Lung condition Asbestos Mining and milling, building and construction, transport equipment manufacturing (shipbuilding, railway locomotive building and maintenance), asbestos product manufacture, power generation, carpenters and joiners, metal fitters, boilermakers plaques, pleural thickening, pulmonary fibrosis (asbestosis), mesothelioma Beryllium Aerospace, nuclear power, computer, automotive electronics Pulmonary fibrosis (berylliosis), emphysema, lung cancer Barium Petroleum industry Pulmonary fibrosis Coal Coal mining Pulmonary fibrosis Centrilobular emphysema Cadmium Electronics, metal plating and batteries Emphysema, lung cancer Cotton dust Cotton, flax and hemp workers Bronchitis, byssinosis, hypersensitivity pneumonitis Isocyanates Spray painting Asthma, hypersensitivity pneumonitis Irritant gases (ammonia, Chemical industry, agriculture, fertilisers Bronchitis, asthma sulphur dioxide, chlorine) Ionising radiation Radiology, nuclear industry Pneumonitis, pulmonary fibrosis, lung cancer Mouldy hay (thermophilic Agriculture (farmers) Bronchitis, hypersensitivity pneumonitis actinomycetes) Silica Sandblasters, miners, tunnelers, millers, potters, glassmakers, foundry and quarry Simple silicosis, silicoproteinosis, progressive massive fibrosis, COPD workers Talc Paint, ceramics, leather, paper Pulmonary fibrosis Wood dust Milling, construction Hypersensitivity pneumonitis, asthma Asbestos-related lung conditions ASBESTOS is a naturally occurring mineral used since ancient times for its strength and fire-resistant properties. Due to these properties, asbestos has been widely used in building materials, fire resistant products and insulation (lagging). The most common types of asbestos fibres are serpentine fibres (chrysotile or white asbestos ) and amphiboles (amosite brown asbestos and crocidolite blue asbestos ). Asbestos exposure can result in a number of lung conditions particularly in the occupational setting (see the box below). Exposure to amphibole fibres (crocidolite) confers a greater risk of developing lung disease than the serpentine fibres of chrysotile. This relates to the persistence of amphiboles in the lung for many years after the exposure has stopped, in comparison with chrysotile fibres, which generally disappear within 10 years. Asbestos was mined and processed in Australia for more than 100 years. Until 2003, there was extensive local use and subsequent exposure in many industries. The occupations with high incidence of asbestos exposure are summarised in table 2. As in other industrialised countries, the ill-effects from past exposure are expected to peak later this decade in Australia, due to the long lag time between exposure and disease presentation, particularly in the case of mesothelioma. Exposure to asbestos is quantified in terms of the concentration of inhaled fibres (fibres/ml) with the highest exposure seen in people who worked in asbestos mining (up to 100 f/ml) and background community exposure generally measured at less than 0.01f/mL. The recommended exposure standards for asbestos in air in Australia are 0.1f/mL. Cumulative exposure is expressed in fibre/ml/years, similar to the packyear measurement for smoking. Asbestiform fibres also occur naturally in areas where other minerals, Figure 1: plaques as seen on chest X-ray. plaques Figure 2: Rounded atelectasis. All radiology images courtesy of Dr Greg Briggs and Dr Anne Miller. Lung conditions related to asbestos exposure plaques Benign pleural effusion Rounded atelectasis Diffuse pleural thickening Asbestosis Mesothelioma Lung cancer such as gold and iron ore, have been exploited, with a consequent risk of significant lung disease to miners. Currently, the main sources of exposure to asbestos fibres are old buildings undergoing renovation or demolition where building maintenance and demolition workers are employed. Home owners renovating their own homes are also at risk of exposure to asbestos fibres. Benign pleural disease Exposure to asbestos can cause benign pleural plaques, benign pleural effusions, diffuse pleural thickening or rounded atelectasis in the sub-pleural lung parenchyma. Benign pleural plaques Plaques are deposits of hyalinised collagen fibres on the parietal pleura. They are usually found on the parietal pleura adjacent to the 6th-9th ribs and along the diaphragm. Plaques are rarely seen in the lung apices or costophrenic angles. It usually takes about 20 years after exposure to asbestos for plaques to be evident, and they are often calcified. Up to half of those exposed to asbestos develop plaques. They rarely occur bilaterally without asbestos exposure (figure 1). Benign pleural plaques are merely the markers of asbestos exposure and in isolation do not cause any symptoms. They have no effect on lung volumes and do not impair exercise tolerance or gas exchange. Regular follow-up of pleural plaques with imaging is not required due to their lack of disease potential and such follow-up has not been shown to impact on the survival from mesothelioma or lung cancer. Benign asbestos-related pleural effusion (BAPE) Benign asbestos-related pleural effusion (BAPE) is usually an exudative unilateral effusion with occasionally eosinophilic predominance on cell counts. The interval between the exposure and the presentation of effusion may vary from 5-30 years and early onset is correlated with higher exposures. It usually resolves spontaneously or may be followed by diffuse pleural thickening (see below). Rounded atelectasis adhesions caused by asbestos-related pleural inflammation result in atelectasis of a part of the sub-pleural lung parenchyma and appear as a rounded lung mass on imaging (figure 2). In many instances when they are large or not classical in radiological appearance, biopsy is required to exclude malignancy. Diffuse pleural thickening This generally begins as fibrosis of the visceral pleura with secondary thickening of the parietal pleura. Both visceral and parietal pleura become inseparable, leading to obliteration of the costophrenic sulci (figures 3 and 4). Although commonly a precursor to diffuse plural thickening, pleural effusion is not a prerequisite for diffuse thickening. Diffuse plural thickening may result in dyspnoea as a result of a reduction in lung volumes and diffusion capacity. 24 Australian Doctor 8 March 2013

3 Asbestosis Diffuse interstitial pulmonary fibrosis caused by asbestos exposure is called asbestosis. It is indistinguishable from idiopathic pulmonary fibrosis except for the presence of other radiological features of asbestos exposure such as calcified pleural plaques or identification of asbestos fibres or ferruginous bodies (asbestos fibres coated by iron) in the lung tissue. Although the term asbestosis is often used to describe any asbestos-related disease affecting the lung and the pleura, it should be confined to pulmonary fibrosis caused by asbestos exposure. The development of asbestosis follows high-level asbestos exposure usually seen only in those with occupational exposure. Many patients who develop asbestosis are asymptomatic for at least years after the initial exposure and a high level of exposure results in a shorter latency period. Patients present with an insidious onset of exertional dyspnoea. Productive cough and wheeze are rare and, if present, are usually caused by concomitant smoking-related lung disease. Bilateral fine-end inspiratory crackles and clubbing are seen in about 40-60% cases. Pulmonary function testing demonstrates restricted lung volumes with reduced gas transfer. Laboratory tests such as sputum and basic blood tests are unhelpful. High-resolution CT scanning is much more sensitive than X-ray for assessment, with interstitial changes seen in the lower zones early in the course and progression to honeycombing and upper lobe involvement as the disease advances. Concurrent smoking accelerates the progression of fibrosis. Asbestosis is in general a slowly progressive disease but occasionally follows a more accelerated course, leading to respiratory failure. Malignant mesothelioma Malignant mesothelioma is an insidious, aggressive and fatal cancer of the parietal pleura with a median survival of 12 months from diagnosis. Occasionally it may involve the mesothelial surfaces of the peritoneal cavity, pericardium and tunica vaginalis. Eighty-five per cent of cases are caused by asbestos exposure in an occupational setting. It may also occur with very lowlevel asbestos exposure occasioned by activities such as washing the clothes of someone working in an asbestos-related work environment. The lifetime risk of mesothelioma in a population exposed to asbestos is in the range of 5-10%. Crocidolite fibre exposure causes the greatest risk for the development of malignant mesothelioma. The latency between first exposure and the development of malignant mesothelioma varies from years, with patients most commonly presenting in their 50s, 60s or 70s. The most frequent presenting symptoms of pleural mesothelioma are dyspnoea, often related to a pleural effusion, and non-pleuritic chest pain. Occasionally it may present as an asymptomatic unilateral pleural effusion on routine imaging. The initial chest X-ray findings often show the presence of a pleural effusion or pleural thickening. Figure 3: Chest X-ray of the thorax demonstrating asbestos-related diffuse pleural thickening. Note the overall reduction in right lung volume. thickening thickening are pleural thickening (92%), pleural effusion (74%) (figure 5) and contraction of a hemithorax. Only one-fifth of patients will have radiological evidence of asbestosis. It is also rare for there to be bilateral involvement with malignancy. A PET scan may help to differentiate malignant mesothelioma from diffuse pleural thickening. A definitive histological diagnosis is essential, given the medicolegal consequences of the diagnosis and prognostic implications of particular histological subtypes. Epithelioid and mixed-type malignant mesothelioma denote a better prognosis than sarcomatoid mesothelioma. Closed pleural biopsy or thoracocentesis may produce false-negative results. Surgical intervention in the form of open thoracotomy or video-assisted thoracoscopic surgery has a higher diagnostic yield and is recommended for the tissue sampling. After the pleural biopsy via thoracoscopy or thoracotomy, the surgeons may, if indicated, perform a pleurodesis procedure by mechanically irritating the parietal pleura to cause adhesion of parietal and visceral pleura to prevent any recurrent pleural effusions Although no clear diagnostic role has been established for serum tumour markers, both mesothelin and osteopontin have been used in the research setting to aid in the non-invasive diagnosis of mesothelioma. Mesothelin is a glycoprotein that is expressed on the surface of the normal mesothelial cells and is over-expressed in malignant mes- The most common CT findings othelioma. Soluble mesothelin- Figure 4: CT thorax of the same patient, demonstrating encasement of the right hemithorax by the diffuse pleural thickening with overall reduction in lung volume. related peptides are measured in serum and pleural fluid and their sensitivity in detecting malignancy varies from 16-68% and is limited to epithelioid types. Osteopontin is overexpressed in mesothelioma but has a lower diagnostic yield than mesothelin. Currently, there is no serum, pleural fluid or urine marker that can be used in isolation to diagnose or exclude mesothelioma. Asbestos-related lung cancer Lung cancer can occur as a result of asbestos exposure even in the absence of pulmonary fibrosis. The risk is related to the degree of exposure and the presence of asbestosis. However, it is worth noting that not everyone who develops lung cancer in the asbestos exposure setting has asbestosis. While smoking remains the most important causative agent for lung cancer, the combined effect of asbestos and smoking appears to be more than additive and approaches a multiplicative effect. The relative risk of cancer is increased by up to 60-fold in smokers with asbestos exposure. There is a dose response relationship between asbestos exposure and risk of lung cancer. The quantitative risk of lung cancer varies according to fibre type and cumulative exposure. Crocidolite fibres are three times more likely than chrysolite fibres to cause lung cancer with the same level of exposure. Estimates for excess deaths from lung cancer (ie, compared with the background rate of deaths from lung cancer) at very heavy exposures of 100 f/ml years are of the order Figure 5: Imaging findings in pleural mesothelioma. A: Chest X-ray demonstrating the four classic findings: pleural thickening, pleural effusion, decreased thoracic volume, and no shift of the mediastinum to the affected side. B and C: CT scans demonstrating pleural thickening, loculated pleural effusion, and pleural nodularity. A B thickening with nodularity C effusions of per 100,000 for chrysotile and for crocidolite. Overall, it appears that asbestos-related lung cancer is under-diagnosed and under-compensated mainly because of doctors attributing lung cancer to smoking without considering the contribution of asbestos in patients, most of whom are heavy smokers. cont d page March 2013 Australian Doctor 25

4 How To TREAT Other occupational lung diseases Silicosis SILICOSIS is a fibrotic lung disease caused by inhalation of free crystalline silica. Given that silica is the most abundant mineral in the world, occupational exposure to respirable crystalline silica dust particles occurs in a vast number of industries including mining, quarrying, stone cutting, polishing and sandblasting. Phagocytosis of crystalline silica in the lung triggers an inflammatory cascade with subsequent fibrosis. Impairment of lung function increases with disease progression, even after the patient is no longer being exposed. The cumulative dose of silica is the most important factor that predicts the development of silicosis. On X-ray in simple silicosis, there are small round opacities, often symmetrically distributed with upper-zone predominance and associated calcification of lymph nodes. Lung function abnormalities are uncommon in early disease. In progressive massive fibrosis (figure 6), opacities larger than 1cm develop due to coalescing of small nodules with development of fibrosis and worsening lung function. Mycobacterial diseases, COPD, Kaplan s syndrome (silica nodules with fibrosis in rheumatoid arthritis patients) and lung cancer are associated with silica dust exposure. Meta-analyses of cancer risk in silicosis sufferers show a significant increase, but the effect of silica exposure on lung cancer is weak and variable in workers who do not have silicosis. Silicosis is becoming less common in industrialised nations through aggressive measures to control airborne dust in the workplace, but is still a major problem in many developing nations. Figure 6: Progressive massive fibrosis in silicosis. High-resolution CT showing bilateral upper lobe predominant large irregular rounded opacities, interlobular septal thickening with fibrous parenchymal bands and ground glass pattern. It also shows mediastinal and hilar lymphadenopathy with associated eggshell calcification. Coal workers pneumoconiosis An occupational lung disease caused by exposure to coal dust, coal workers pneumoconiosis is also known as black lung disease with deposition of coal in the lung parenchyma. Simple coal workers pneumoconiosis is characterised by the presence of upper lobe nodular opacities that can develop into progressive massive fibrosis with restrictive impairment of lung function. The onset of disease is related to the length and severity of exposure. Silica contamination increases the pneumoconiosis risk and consequently in some coalminers, pneumoconiosis may represent a mixed picture of coal pneumoconiosis and silicosis. Coal workers pneumoconiosis can also result in airway obstruction with focal emphysema due to small airway inflammation. The prevalence and mortality rates from coal workers pneumoconiosis are declining in most industrialised countries including Australia as a result of tightened industrial regulations. Hypersensitivity pneumonitis Hypersensitivity pneumonitis (extrinsic allergic alveolitis) is a granulomatous disease of the lungs caused by an immunological response to chronic inhalation of organic dusts or chemicals, with more than 300 aetiological agents reported to date. Only a small proportion of those exposed develop clinically significant hypersensitivity pneumonitis, although it may progress to disabling or even fatal end-stage lung disease. While oral corticosteroids can improve the symptoms and radiological appearance in the short term, the definitive treatment is early recognition and control of exposure. Farmer s lung is one of the most common forms of hypersensitivity pneumonitis. Cattle farming, bird and poultry handling (bird fancier s lung), grain and flour processing and lumber milling are some of the occupations that are associated with a risk of developing hypersensitivity pneumonitis. While many causative agents have been recognised in occupational dusts, most current new cases arise from residential exposure to pet birds (pigeons and parakeets), contaminated humidifiers, and indoor moulds. Occupational lung cancer At least 12 substances found in the workplace are classified as human lung carcinogens. These include asbestos, radon, diesel exhaust fumes and certain metals such as arsenic, cadmium, chromium, beryllium and nickel (table 2, page 24). Occupational exposure is estimated to account for about 5% of lung cancer in Australia, with most of them being caused by asbestos. Occupations and industries that tend to be associated with an increased risk of lung cancer include mining and quarrying, asbestos production, metal industries, shipbuilding, railroad equipment manufacturing, gas production and some areas of construction. Occupational asthma Occupational asthma is defined as asthma caused by exposure to agents encountered in the working environment in those without pre-existing asthma. In developed countries, occupational asthma is the leading form of occupational lung disease, having supplanted lung disease related to dust. An estimated 15% of newly diagnosed cases of asthma in working adults are the consequence of occupational exposures. Occupational asthma can occur as a new onset of asthma caused by repeated low-level sensitising exposure (asthma with latency, sensitiser-induced asthma) or asthma that results from a single heavy exposure to a potent respiratory irritant such as chlorine or ammonia (asthma without latency, irritant asthma, or the reactive airways dysfunction syndrome). Spray painters (diisocyanatebased paints), bakers (flour), lumber industry workers (red cedar dust) and cleaners work in some of the highest risk occupations for developing occupational asthma. Most occupational asthma is associated with a latency period of hours to months. Occupational asthma should be considered in every case of adult-onset asthma. Occupational asthma symptoms are identical to patients with asthma without an occupational exposure. Another type of work-related asthma is aggravation of pre-existing asthma by the work environment (work-aggravated asthma). In this situation, an individual with pre-existing asthma who is exposed to factors in the workplace such as non-specific gases or fumes, smoke or cold dry air may have an asthmatic attack precipitated by these factors. The detailed work history should include all types of prior occupations and the specific duties that were performed, the relationship between the symptoms and the workplace and any improvement in symptoms when away from work, particularly for extended periods of time. The confirmation of occupational asthma should begin with spirometry and peak expiratory flow recordings to assess airflow obstruction, its reversibility and variability. Reversible airflow obstruction is a key feature in establishing the diagnosis of asthma, but many asthmatic patients may have normal or near-normal pulmonary function, especially during non-exacerbation periods or due to treatment. In this instance, a methacholine challenge test or comparable measure of nonspecific airway hyper-responsiveness (such as a Mannitol challenge test) during a period of work exposure may help to establish the diagnosis of asthma. The relationship of exposure to work is usually confirmed by serial peak flow measurements performed at least four times a day for a period of at least three weeks at work and three weeks away from work. Other tests that can be performed in the assessment of sensitiser-induced occupational asthma include allergen skin-prick testing and serum-specific IgE testing. Specific challenge testing with the suspected agent is not usually performed in Australia but remains the gold standard of diagnosis. The patients should not be asked to leave work or change their work practices until assessed by a specialist respiratory physician and the diagnosis of occupational asthma is confirmed, as the outcome has important medical, public health, legal and financial implications. Workers with occupational asthma should avoid all future exposure to the sensitising agent. This usually requires a change of job, ideally within the same organisation to minimise hardship to the worker. While occupational asthma can resolve after these measures in about 50% of cases, this is more likely with earlier diagnosis and removal from exposure. Workers with irritant-induced asthma caused by a single heavy exposure, who are not sensitised, can continue working with the agent at low-level exposure. Treatment of occupational asthma is similar to that for usual asthma with inhaled steroids and bronchodilators but significant improvement can result with mere avoidance of the respiratory irritant. Assessment History A THOROUGH occupational and environmental history is the key in the assessment of potential occupational lung disease. The occupational history should be documented in detail in chronological order for every job the patient has ever held, irrespective of duration. The history for each job should include Job title. Tasks undertaken/job processes. Exposures type (chemical, gas, fumes, dust) and level (mild, moderate, high), duration of exposure (per day, per year). Availability and use of respiratory protection and ventilation methods used. Any environmental and domestic exposures associated with demolition or renovation should also be inquired about along with the smoking history. A thorough history is not only essential for an accurate diagnosis but also plays an important role in the possible subsequent litigation process. Occupational hygienists can help with accurate assessment of the degree of exposure (see Online resources, page 28). A history of progressive shortness of breath, chronic cough and other constitutional symptoms usually accompanies the clinical presentation of occupational lung disease. The transient presence of symptoms in relation to the work environment is typical in occupational asthma. Examination The physical signs related to occupational disease are minimal and generally unrevealing about specific causes. The clinical findings include clubbing, inspiratory crackles and wheeze at times. Occasionally pleural effusion is detected clinically. A comprehensive general physical examination, particularly involving the cardiac system, remains important, looking for evidence of advanced signs such as pulmonary hypertension and related cor pulmonale as well as evidence of alternative differential diagnoses and assessment of impairment (see Investigations, page 28). cont d page Australian Doctor 8 March 2013

5 Investigations Serum TAKING an FBC and biochemistry to exclude non-respiratory causes of presenting symptoms should form an early part of the investigative process. Allergen-specific IgE can be useful in some forms of occupational asthma (eg, animal house workers). Precipitants to avian proteins, fungus and thermophilic actinomycetes may be present in patients exposed to organic dusts (eg, mouldy hay exposure leading to hypersensitivity pneumonitis) and should be requested in the pathology. The diagnostic value of soluble mesothelin-related peptide is debatable. Currently it is more useful as a marker for monitoring disease progression in mesothelioma at specialised clinical centres. Radiology Chest X-ray is a good screening test, but provides insufficient detail for Management Author s case studies complete assessment. High-resolution CT scan of the chest provides excellent identification of fibrosis, nodules and ground glass opacities associated with various occupational lung diseases. Images taken in the prone position are important to exclude innocent dependent changes at the lung bases, which may masquerade as pulmonary fibrosis. A CT scan of the chest is also important in identifying pleural plaques one of the markers of asbestos exposure, even when they are not calcified. Pulmonary function tests Spirometry is useful as a screening test, particularly for the diagnosis of early airway obstruction when FEV 1 / forced vital capacity (FVC) is less than 70%. Serial measurements may be a simple method for monitoring progression in fibrotic lung disease generally with normal or increased FEV 1 /FVC ratio. THERE is no specific management currently available for most of the occupational lung diseases. Steroid therapy for occupational asthma and hypersensitivity pneumonitis; and surgical intervention in early occupational lung cancer are some of the specific therapies available. Supportive care with the emphasis on primary and secondary prevention is the current treatment goal. Informing the patient of the likely work-related nature of the illness and the options for compensation will form part of the initial management with formal assessment of functional impairment. For current workers, further avoidance of the exposure is paramount. Patients with benign asbestosrelated conditions such as pleural plaques can be reassured that no regular follow-up required. The management of patients with asbestosis and other pneumoconioses should focus on secondary preventive measures including: Smoking cessation. Withdrawal from further exposure. Immunisation with pneumococcal and influenza vaccines. Optimal management of concurrent respiratory and other diseases. Supplemental oxygen when resting hypoxaemia or exerciseinduced oxygen desaturations occurs. Regular monitoring with respiratory function tests and imaging every 2-3 years or earlier is recommended with development of a patient-specific management plan for symptomatic patients. Management of malignant mesothelioma is controversial, with no standard approach currently available. The treatment may vary from symptom control with pleurodesis Case study 1: Mesothelioma Mr MH was an 89-year-old retired man, living with his wife. He presented with a three-month history of increasing shortness of breath, rightsided pleuritic chest pain and a 10kg weight loss. A CT chest showed a small right-sided pleural effusion with pleural plaques. He was a lifelong non-smoker. Mr MH had had a variety of occupations in the past but spent over 30 years working in a power station and had at least moderate asbestos exposure. Given the clinical symptoms and the latency of asbestos exposure, his presentation was very suspicious for a malignant mesothelioma. aspiration revealed an exudate with no evidence of infection or malignant cells. While other diagnoses such as primary lung cancer, metastatic malignancy, infective or an inflammatory effusion were possibilities, the most likely diagnosis remained mesothelioma due to the clinical presentation and radiology. The possibility of a thoracoscopic procedure (eg, videoassisted thoracoscopic surgery) with a pleural biopsy to obtain tissue for definitive diagnosis and to perform a pleurodesis to prevent recurrent pleural effusions was discussed at length with the patient. Given the small amount of the fluid and the marked frailty of the patient, it was decided that he should be managed conservatively, with symptom control, with a presumptive diagnosis of malignant mesothelioma. He was started on regular paracetamol and an opiate for pain relief and was also started on a small dose of prednisolone to improve his appetite and wellbeing. He was referred to community palliative care services for pain management and regular follow-up. Mr MH s family also sought legal representation with the view to seeking compensation. He continued to deteriorate with weight loss and generalised weakness accompanied by increasing right-sided chest pain and worsening short of breath. A few months Reduced lung volume measurements, both residual volume and total lung capacity, in association with a lowered carbon monoxide diffusing capacity (DLCO) strongly suggest a restrictive defect such as the pulmonary fibrosis seen in asbestosis. Serial peak flow measurements provide evidence for variability in airflow measurements as seen in occupational asthma, particularly when performed at home and at work. Bronchial provocation testing with mannitol or methacholine may be helpful in diagnosing occupational asthma. It is important that this is performed while the patient is exposed to the irritant. Other tests TB screening with Mantoux skin testing in patients with silicosis is recommended as there is strong evidence for an association between silicosis and mycobacterial infection. for recurrent malignant pleural effusion and pain relief to radical surgery or combined approaches. No randomised control trials have demonstrated a survival benefit with surgical resection. A recent pilot study in the UK (the MARS trial), showed no survival benefits but increased morbidity with surgery compared with non-surgical approach. 1 A palliative approach with drainage of pleural effusions and systemic chemotherapy with a cisplatin pemetrexate combination could be considered. Molecularly targeted agents have been trialled in mesothelioma although additional clinical trials are required to establish whether these approaches will have a role in patient management. Management of lung cancer and asthma related to occupational exposure is identical to the management in general population. later, he was admitted to hospital because of significant clinical deterioration. He was managed palliatively and died five days later. A post-mortem, requested by his family and performed for the purposes of compensation, confirmed the diagnosis of mesothelioma. Cardiopulmonary exercise testing provides an objective measure of the overall degree of functional impairment. An assessment of cardiac function including pulmonary pressures with an echocardiogram may be useful in advanced interstitial lung diseases (asbestosis or silicosis). Bronchoscopy with bronchioalveloar lavage is rarely useful in occupational lung diseases other than in situations where an alternative diagnosis such as infection needs to be excluded. Histopathological confirmation of the clinical diagnosis may occasionally be necessary in some cases of occupational interstitial lung disease. In general, fine-needle aspiration biopsy or transbronchial lung biopsy is insufficient for definitive diagnosis and a larger tissue sample, which can be achieved thoracoscopically, is required. Medicolegal aspects of occupational lung disease The medicolegal aspects of occupational lung diseases are complex. Workers compensation is available through the state-based WorkCover authorities, as in all occupational diseases. Diagnosis is usually based on physician assessment, and income support and retraining are usually available to patients. NSW has a specific scheme for asbestos- and silica-related diseases administered by the Workers Compensation Dust Diseases Board. Common law claims can also be pursued, especially with asbestos-related conditions, and require referral to an appropriate legal representative. The fact that an employer may no longer exist does not preclude compensation, as insurers can usually be located. Discussion points A unilateral pleural effusion with pleuritic pain and constitutional symptoms in a patient with previous asbestos exposure is highly suspicious of mesothelioma, even with negative cytology. Since surgical and other multimodality therapy in mesothelioma has no clear survival advantage with an overall median survival of only 12 months, the pros and cons of aggressive therapy vs comfort care should be discussed with the patient and next of kin at diagnosis. Adequate analgesia with good symptom control, early palliative care referral and a claim for compensation are some of the key factors in mesothelioma management. Case study 2: Occupational asthma A 30-year-old male with no past history of asthma began working several years ago as a glazier in a firm manufacturing windows and doors. His work took place in a single shared open-plan factory. Wood machining, wood joinery and glazing were carried out in adjoining areas. His job involved cutting glass and placing glass in windows and doors. Almost all the wood used in the factory was Western red cedar. Within 12 months of starting work he developed rhinitis and dermatitis. Eight years later, he noticed the gradual onset of cough and chest tightness. His GP diagnosed asthma and started him on beclomethasone and salbutamol. He left his job as he felt his asthma was work-related and worked as a courier for a few years. During this time, he was able to stop all asthma medications owing to a lack of asthma symptoms. cont d page 30 Online resources US National Institute of Occupational Safety and Health Occupational Respiratory Disease and Surveillance (information on various occupational lung diseases, its spread and its impact) surveillance/ords/ Workers Compensation Dust Diseases Board of NSW Provides a system of no-fault compensation to people (and their dependants) who have developed a dust disease from occupational exposure to dust as a worker in NSW Asbestos Diseases Research Institute Aims to improve the prevention, the diagnosis and treatment of asbestos-related diseases Asbestos Diseases Society of SA Provides counselling, support and information to asbestos disease victims in SA Australian Mesothelioma Registry Monitors all new cases of mesothelioma diagnosed from 1 July 2010 in Australia Asbestos Awareness Describes why asbestos is dangerous, where it can be found in the home, how to remove it safely, how to deal with it and how to dispose of it Safework Australia Provides national codes of practice and guidance notes and reports by the Australian Safety and Compensation Council on mesothelioma Australian Institute of Occupational Hygienists Information about occupational hygiene and the profession of occupational hygienist Reference 1. Treasure T, et al. Extra-pleural pneumonectomy versus no extra-pleural pneumonectomy for patients with malignant pleural mesothelioma: clinical outcomes of the Mesothelioma and Radical Surgery (MARS) randomised feasibility study. Lancet Oncology 2011; 12: Further reading Available on request from 28 Australian Doctor 8 March 2013

6 How To TREAT from page 28 Some years later, he recommenced work as a glazier in the same factory as before. Within one month it became necessary for him to start taking his asthma medications again because of symptom recurrence. His asthma has persisted since and has become worse in the past year. He has had two exacerbations of asthma in the past 12 months requiring courses of prednisolone. There have been no spills or accidents at work to suggest irritant asthma. He is an exsmoker with five pack-year history. His examination was unremarkable and his baseline spirometry was normal. He had evidence of nonspecific bronchial hyper-responsiveness with a positive methacholine challenge. He monitored his serial peak flows and the results are shown in figure 7. There was a significant deterioration in his peak flows at the start of the working week, with an improvement on weekends. A diagnosis of occupational asthma due to Western red cedar was made. He was moved to another Figure 7: Serial peak flow readings of 30-year-old male working in a window and door factory. PEFR /01/ /01/ /01/ /01/2008 part of the factory with no exposure to Western red cedar and now has no asthma symptoms, is on no medications and has a normal methacholine challenge. SERIAL PEFR 4/02/2008 Date 11/02/2008 Maximum Minimum 18/02/ /02/2008 Mean Working 1/03/2008 Discussion points New asthma in a working person requires documentation of a careful occupational history. Occupational exposure to a known cause of occupational asthma, such as Western red cedar, increases the likelihood of the diagnosis of occupational asthma. Work-related symptoms including rhinitis and dermatitis followed by asthma symptoms are suggestive of occupational sensitisation. It may take months to several years before the onset of asthma symptoms. Evidence of a relationship between lung function and attendance at work, with documentation of peak flow measurements, confirms the diagnosis of occupational asthma and should be performed before advising a worker to stop exposure. Evidence of reversible airway obstruction on spirometry is very specific for a diagnosis of occupational asthma while nonspecific bronchial hyper-responsiveness may be helpful when spirometry is normal with high clinical suspicion. Further exposure to the sensitising agent needs to be avoided. Summary Occupation-related lung diseases are common despite workplace regulations and increased awareness A thorough occupational history is crucial in identifying any workrelated lung conditions Finding a clear temporal relationship between symptoms and exposure is useful, but be aware that current exposures do not always lead to immediate symptoms An occupational agent is a common culprit in adult-onset asthma and is under-diagnosed as a result of the failure to associate symptoms and work. Early referral to a respiratory physician is recommended if there are ongoing respiratory symptoms in a patient with occupational exposure. Avoidance of exposure to the causative agent is the main management strategy to reduce further lung impairment. How to Treat Quiz 8 March 2013 Instructions Complete this quiz online and fill in the GP evaluation form to earn 2 CPD or PDP points. We no longer accept quizzes by post or fax. The mark required to obtain points is 80%. Please note that some questions have more than one correct answer. GO ONLINE TO COMPLETE THE QUIZ 1. Which THREE statements are correct regarding occupational lung disease? a) It is important to consider occupational lung disease in any current or retired worker with respiratory symptoms b) The upper airways are never affected by occupational exposure to inhaled irritants c) Awareness of the latency between exposure and onset of symptoms is extremely important in consideration of occupational lung disease d) A clear causal relationship needs to be established before attributing the cause of a patient s respiratory symptoms to occupational exposure 2. Which TWO statements are correct regarding asbestos fibres? a) Asbestos is a man-made fibre that has been in use only since the early 1950s b) Asbestos production ended in Australia in 1987 and the importation of asbestos products was completely banned in 2003 c) Serpentine fibres are known as chrysotile or white asbestos, while amosite ( brown asbestos ) and crocidolite ( blue asbestos ), are both amphiboles d) Blue asbestos, or crocidolite, is a benign form of asbestos fibre, in contrast to white asbestos, or chrysotile 3. Which THREE statements regarding asbestos exposure are correct? a) Occupational exposure to asbestos is limited to those involved in asbestos product manufacture b) Exposure to asbestos is quantified in terms of the concentration of inhaled fibres (fibres/ml). Cumulative exposure is expressed in fibre/ml/ years, similar to the pack-year measurement for smoking c) Asbestiform fibres also occur naturally in areas where other minerals, such as gold and iron ore, have been exploited, with a consequent risk of significant lung disease to miners d) Currently, the main sources of exposure to asbestos fibres are old buildings undergoing renovation or demolition 4. Which THREE statements regarding benign pleural disease are correct? a) Benign plural plaques are deposits of hyalinised collagen fibres on the parietal pleura b) Benign pleural plaques require regular followup with imaging c) adhesions due to asbestos-related pleural inflammation appear as a rounded lung mass on imaging and often require a biopsy to exclude malignancy d) Diffuse pleural thickening generally begins as fibrosis of the visceral pleura with secondary thickening of the parietal pleura 5. Which TWO statements regarding asbestosis are correct? a) Asbestosis is the correct term to describe all asbestos-related disease affecting the lung and pleura b) Many patients who develop asbestosis are asymptomatic for at least years after the initial exposure c) Productive cough and wheeze are rare in patients suffering from asbestosis d) Chest X-ray is the gold standard for detection of asbestosis 6. Which TWO statements are correct regarding mesothelioma? a) Malignant mesothelioma has a median survival of three years from diagnosis b) Mesothelioma may occur with very-lowlevel asbestos exposure occasioned by activities such as washing the clothes of someone working in an asbestos-related work environment c) The most common CT findings are pleural thickening (92%), pleural effusion (74%) and contraction of a hemithorax d) Diagnosis of mesothelioma can be definitively established using the serum tumour markers mesothelin and osteopontin 7. Which THREE statements regarding silicosis and hypersensitivity pneumonitis are correct? a) The mechanism causing silicosis from inhalation of free crystalline silica is phagocytosis of the crystalline silica in the lung, which triggers an inflammatory cascade, with subsequent fibrosis b) Short-term occupational exposure to silica can cause silicosis c) Hypersensitivity pneumonitis (extrinsic allergic alveoli) is a granulomatous disease of the lungs caused by an immunological response to chronic inhalation of organic dusts or chemicals d) Cattle farming, bird and poultry handling (bird fancier s lung), grain and flour processing and lumber milling are some of the occupations that are associated with a risk of developing hypersensitivity pneumonitis 8. Which TWO statements are correct regarding occupational asthma? a) Occupational asthma is defined as asthma caused by exposure to agents encountered in the working environment in workers without pre-existing asthma b) An estimated 2% of newly diagnosed cases of asthma in working adults are the consequence of occupational exposures c) The relationship of exposure at work is usually confirmed by serial peak flow measurements performed at least four times a day for a period of at least three weeks at work and three weeks away from work d) Frequent doses of oral corticosteroids is the standard treatment for occupational asthma 9. Which TWO statements regarding assessment of patients with occupational lung disease are correct? a) Identification of the multitude of clinical signs that develop as a result of occupational lung disease is essential to diagnosis b) Industrial hygienists can help with accurate assessment of the degree of exposure c) Soluble mesothelin-related peptide is currently useful as a marker for monitoring disease progression in mesothelioma at specialised clinical centres d) Bronchoscopy with bronchioalveloar lavage is an important investigation in the diagnosis of occupational lung disease 10. Which TWO statements regarding treatment and compensation of occupational lung disease are correct? a) Secondary preventive measures for patients with asbestosis and pneumoconiosis include smoking cessation, withdrawal from exposure, and immunisation with pneumococcal and influenza vaccines b) Surgical treatment of mesothelioma has demonstrated survival benefits c) NSW has a specific compensation scheme for asbestos- and silica-related diseases administered by the Workers Compensation Dust Diseases Board d) Compensation for occupational lung disease is impossible to obtain if the employer no longer exists CPD QUIZ UPDATE The RACGP requires that a brief GP evaluation form be completed with every quiz to obtain category 2 CPD or PDP points for the triennium. You can complete this online along with the quiz at Because this is a requirement, we are no longer able to accept the quiz by post or fax. However, we have included the quiz questions here for those who like to prepare the answers before completing the quiz online. how to treat Editor: Dr Barbara Tink Next week Non-alcoholic fatty liver disease is emerging as the most common cause of liver disease worldwide, despite its being hard to diagnose and having only an estimated true incidence. It is physiologically linked to insulin resistance and is the hepatic manifestation of the metabolic syndrome. The next How to Treat aims to build awareness of this condition, focusing on its pathogenesis, diagnosis and management. The author is Dr Leah Gellert, consultant gastroenterologist and hepatologist, Bondi Junction, NSW. 30 Australian Doctor 8 March 2013

HEALTH CARE FOR EXPOSURE TO ASBESTOS. 2010 The SafetyNet Centre for Occupational Health and Safety Research Memorial University www.safetynet.mun.

HEALTH CARE FOR EXPOSURE TO ASBESTOS. 2010 The SafetyNet Centre for Occupational Health and Safety Research Memorial University www.safetynet.mun. HEALTH CARE FOR PATIENTS WITH EXPOSURE TO ASBESTOS 2010 The SafetyNet Centre for Occupational Health and Safety Research Memorial University www.safetynet.mun.ca HEALTH CARE FOR PATIENTS WITH EXPOSURE

More information

PARTICLE SIZE AND CHEMISTRY:

PARTICLE SIZE AND CHEMISTRY: Pneumoconioses LW/Please note: This information is additional to Davidson s Principles and Practice of Medicine. /Hierdie inligting is aanvullend tot Davidson s Principles and Practice of Medicine. Pneumoconioses

More information

Asbestos Disease: An Overview for Clinicians Asbestos Exposure

Asbestos Disease: An Overview for Clinicians Asbestos Exposure Asbestos Asbestos Disease: An Overview for Clinicians Asbestos Exposure Asbestos: A health hazard Exposure to asbestos was a major occupational health hazard in the United States. The first large-scale

More information

Asbestos and your lungs

Asbestos and your lungs This information describes what asbestos is and the lung conditions that are caused by exposure to it. It also includes information about what to do if you have been exposed to asbestos, and the benefits

More information

Circular Instructions related to occupational lung diseases

Circular Instructions related to occupational lung diseases Circular Instructions related to occupational lung diseases Compensation Fund Dr Monge Lekalakala OCCUPATIONAL DISEASES According to Section 65(1) of the COID ACT: a) An Occupational disease disease arising

More information

Asbestos Related Diseases

Asbestos Related Diseases Asbestos Related Diseases Asbestosis Mesothelioma Lung Cancer Pleural Disease Asbestosis and Mesothelioma (LUNG CANCER) Support Group 1800 017 758 www.amsg.com.au ii Helping you and your family through

More information

Francine Lortie-Monette, MD, MSc, CSPQ, MBA Department of Epidemiology and Biostatistics University of Western Ontario 2003

Francine Lortie-Monette, MD, MSc, CSPQ, MBA Department of Epidemiology and Biostatistics University of Western Ontario 2003 ASBESTOS Francine Lortie-Monette, MD, MSc, CSPQ, MBA Department of Epidemiology and Biostatistics University of Western Ontario 2003 Asbestosis Asbestosis is a model for other dust diseases as well as

More information

Defending the Rest Basics on Lung Cancer, Other Cancers and Asbestosis: Review of the B-Read and Pulmonary Function Testing

Defending the Rest Basics on Lung Cancer, Other Cancers and Asbestosis: Review of the B-Read and Pulmonary Function Testing Defending the Rest Basics on Lung Cancer, Other Cancers and Asbestosis: Review of the B-Read and Pulmonary Function Testing ASBESTOSIS November 2013 Bruce T. Bishop Lucy L. Brandon Willcox & Savage 440

More information

FREQUENTLY ASKED QUESTIONS about asbestos related diseases

FREQUENTLY ASKED QUESTIONS about asbestos related diseases FREQUENTLY ASKED QUESTIONS about asbestos related diseases 1. What are the main types of asbestos lung disease? In the human body, asbestos affects the lungs most of all. It can affect both the spongy

More information

Pulmonary interstitium. Interstitial Lung Disease. Interstitial lung disease. Interstitial lung disease. Causes.

Pulmonary interstitium. Interstitial Lung Disease. Interstitial lung disease. Interstitial lung disease. Causes. Pulmonary interstitium Interstitial Lung Disease Alveolar lining cells (types 1 and 2) Thin elastin-rich connective component containing capillary blood vessels Interstitial lung disease Increase in interstitial

More information

NISG Asbestos. Caroline Kirton

NISG Asbestos. Caroline Kirton NISG Asbestos Caroline Kirton 1 The Control of Asbestos Regulations 2012, Regulation 10 requires every employer to ensure that adequate information, instruction and training is given to their employees

More information

Asbestos Diseases. What Is Asbestos?

Asbestos Diseases. What Is Asbestos? 1 Asbestos Diseases What Is Asbestos? Asbestos is a term applied to a group of minerals formed into rock and mined in a similar way to coal. In this form, asbestos is made up of strong, fine and flexible

More information

Occupational Lung Disease. SS Visser Internal Medicine UP

Occupational Lung Disease. SS Visser Internal Medicine UP Occupational Lung Disease SS Visser Internal Medicine UP Classification Anorganic ( mineral ) dust/pneumoconiosis Fibrogenic - silica, asbestos, talc, silicates Non-fibrogenic - Fe, barium, tin Immunologic/Pharmcologic

More information

Report of Working Groups

Report of Working Groups BD5.3 Report of Working Groups Elimination of Asbestos-related Diseases ICOH 2012 March 18, 2012 Cancun Report of WG Elimination of Asbestos-related Diseases Dr. Sherson mail to ICOH President of 7 December

More information

Asbestos Related Diseases. Asbestosis Mesothelioma Lung Cancer Pleural Disease. connecting raising awareness supporting advocating

Asbestos Related Diseases. Asbestosis Mesothelioma Lung Cancer Pleural Disease. connecting raising awareness supporting advocating Asbestos Related Diseases Asbestosis Mesothelioma Lung Cancer Pleural Disease connecting raising awareness supporting advocating 1800 017 758 www.asbestosassociation.com.au Asbestos lagging was widely

More information

Disease/Illness GUIDE TO ASBESTOS LUNG CANCER. What Is Asbestos Lung Cancer? www.simpsonmillar.co.uk Telephone 0844 858 3200

Disease/Illness GUIDE TO ASBESTOS LUNG CANCER. What Is Asbestos Lung Cancer? www.simpsonmillar.co.uk Telephone 0844 858 3200 GUIDE TO ASBESTOS LUNG CANCER What Is Asbestos Lung Cancer? Like tobacco smoking, exposure to asbestos can result in the development of lung cancer. Similarly, the risk of developing asbestos induced lung

More information

Malignant Mesothelioma

Malignant Mesothelioma Malignant Malignant mesothelioma is a tumour originating from mesothelial cells. 85 95% of mesotheliomas are caused by asbestos exposure. It occurs much more commonly in the chest (malignant pleural mesothelioma)

More information

Malignant Mesothelioma

Malignant Mesothelioma Malignant mesothelioma is a tumour originating from mesothelial cells. 85 95% of mesotheliomas are caused by asbestos exposure. It occurs much more commonly in the chest (malignant pleural mesothelioma)

More information

FIBROGENIC DUST EXPOSURE

FIBROGENIC DUST EXPOSURE FIBROGENIC DUST EXPOSURE (ASBESTOS & SILICA) WORKER S MEDICAL SCREENING GUIDELINE Prepared By Dr. T. D. Redekop Chief Occupational Medical Officer Workplace Safety & Health Division Manitoba Labour & Immigration

More information

Occupational Disease Fatalities Accepted by the Workers Compensation Board

Occupational Disease Fatalities Accepted by the Workers Compensation Board Occupational Disease Fatalities Accepted by the Workers Compensation Board Year to date, numbers as of January 1, 2008 to December 31, 2008 Occupational disease fatalities are usually gradual in onset

More information

NHS Barking and Dagenham Briefing on disease linked to Asbestos in Barking & Dagenham

NHS Barking and Dagenham Briefing on disease linked to Asbestos in Barking & Dagenham APPENDIX 1 NHS Barking and Dagenham Briefing on disease linked to Asbestos in Barking & Dagenham 1. Background 1.1. Asbestos Asbestos is a general name given to several naturally occurring fibrous minerals

More information

Transcript for Asbestos Information for the Community

Transcript for Asbestos Information for the Community Welcome to the lecture on asbestos and its health effects for the community. My name is Dr. Vik Kapil and I come to you from the Centers for Disease Control and Prevention, Agency for Toxic Substances

More information

Environmental Lung Disease (Pneumoconiosis) AGAINDRA K. BEWTRA M.D.

Environmental Lung Disease (Pneumoconiosis) AGAINDRA K. BEWTRA M.D. Environmental Lung Disease (Pneumoconiosis) AGAINDRA K. BEWTRA M.D. Pneumoconiosis Originally pneumoconiosis (gr: Pneumo = lung; konis = dust). So it was those diseases caused by dust inhalation, but in

More information

Restrictive lung diseases

Restrictive lung diseases Restrictive lung diseases Characterized by reduced compliance of the lung. Prominent changes in the interstitium (interstitial lung disease). Important signs and symptoms: - Dyspnea. - Hypoxia. - With

More information

Service Specification

Service Specification Service Specification Spirometry in Primary Care Date: February 2011 Document Reference: Service Specification (V4.0) Contents: Section Page 1 Definition of service 3 2 Training 4 3 Reporting / Monitoring

More information

ASBESTOS DISEASES. Dr Alastair Robertson

ASBESTOS DISEASES. Dr Alastair Robertson ASBESTOS DISEASES Dr Alastair Robertson Occupational Health Department University Hospital Birmingham Birmingham B29 6JF 01216278285 Alastair.robertson@uhb.nhs.uk Occupational Lung Disease Unit Birmingham

More information

Frequently Asked Questions

Frequently Asked Questions This fact sheet was written by the Agency for Toxic Substances and Disease Registry (ATSDR), a federal public health agency. ATSDR s mission is to serve the public by using the best science, taking responsive

More information

HEALTH EFFECTS. Inhalation

HEALTH EFFECTS. Inhalation Health Effects HEALTH EFFECTS Asbestos can kill you. You must take extra precautions when you work with asbestos. Just because you do not notice any problems while you are working with asbestos, it still

More information

Exploring the Role of Vitamins in Achieving a Healthy Heart

Exploring the Role of Vitamins in Achieving a Healthy Heart Exploring the Role of Vitamins in Achieving a Healthy Heart There are many avenues you can take to keep your heart healthy. The first step you should take is to have a medical professional evaluate the

More information

Asbestos Health Risks. Dr Andrew Pengilley Acting Chief Health Officer

Asbestos Health Risks. Dr Andrew Pengilley Acting Chief Health Officer Asbestos Health Risks Dr Andrew Pengilley Acting Chief Health Officer Asbestos Asbestos is a name given to several different fibrous minerals Three main commercial types are Chrysotile (white asbestos)

More information

by Lee S. Newman, M.D., and Cecile S. Rose, M.D., M.P.H.

by Lee S. Newman, M.D., and Cecile S. Rose, M.D., M.P.H. OCCUPATIONAL ASBESTOSIS AND RELATED DISEASES by Lee S. Newman, M.D., and Cecile S. Rose, M.D., M.P.H. A 63-year-old man consulted an internist complaining of dyspnea on exertion. He reported the following:

More information

Occupational Disease Fatalities Accepted by the Workers Compensation Board

Occupational Disease Fatalities Accepted by the Workers Compensation Board Occupational Disease Fatalities Accepted by the Workers Compensation Board Year to date, numbers as of Occupational disease fatalities are usually gradual in onset and result from exposure to work-related

More information

Occupational Lung Diseases

Occupational Lung Diseases Occupational Lung Diseases OCCUPATIONAL HEALTH AND SAFETY OCCUPATIONAL LUNG DISEASES The Major Types of Occupational Lung Diseases: Pneumoconioses, diseases caused by dust in the lungs Hypersensitivity

More information

P L E U R A L M E S O T H E L I O M A

P L E U R A L M E S O T H E L I O M A For media outside the US, UK and Canada only P L E U R A L M E S O T H E L I O M A 1. Overview 2. What is pleural mesothelioma? 3. How common is pleural mesothelioma? 4. What are the risk factors for pleural

More information

Asbestos and the diseases it causes

Asbestos and the diseases it causes Asbestos and the diseases it causes October 2013 Liz Darlison Mesothelioma UK University Hospitals of Leicester Contents What is asbestos Why is it such an issue in the UK Disease Statistics Asbestos Related

More information

Occupational lung diseases an overview 22:07:2013

Occupational lung diseases an overview 22:07:2013 Occupational lung diseases an overview 22:07:2013 IIT MUMBAI 52/M Non smoker Worked in a bakery for > 30 years C/O Productive cough and exertional breathlessness since 2 years Treated with AKT on multiple

More information

education Occupational lung disease CME Obstructive occupational airway disease PA Reid, 2 PT Reid

education Occupational lung disease CME Obstructive occupational airway disease PA Reid, 2 PT Reid CME http://dx.doi.org/10.4997/jrcpe.2013.111 2013 Royal College of Physicians of Edinburgh Occupational lung 1 PA Reid, 2 PT Reid 1 Specialist Registrar in Respiratory Medicine, Department of Respiratory

More information

Asbestos: health effects and risk. Peter Franklin Senior Scientific Officer, EHD Senior Research Fellow, UWA

Asbestos: health effects and risk. Peter Franklin Senior Scientific Officer, EHD Senior Research Fellow, UWA Asbestos: health effects and risk Peter Franklin Senior Scientific Officer, EHD Senior Research Fellow, UWA What is asbestos Naturally occurring mineral that has crystallised to form long thin fibres and

More information

Employees Compensation Appeals Board

Employees Compensation Appeals Board U. S. DEPARTMENT OF LABOR Employees Compensation Appeals Board In the Matter of MICHAEL NOMURA, JR. and DEPARTMENT OF THE NAVY, SEA SYSTEMS COMMAND, Vallejo, CA Docket No. 01-1761; Oral Argument Held July

More information

Uses and Abuses of Pathology in Asbestos-exposed Populations

Uses and Abuses of Pathology in Asbestos-exposed Populations Uses and Abuses of Pathology in Asbestos-exposed Populations Jerrold L. Abraham, MD Department of Pathology State University of New York Upstate Medical University Syracuse, NY, 13210 USA The term: Asbestosis,

More information

Occupational respiratory diseases due to Asbestos. Dirk Dahmann, IGF, Bochum

Occupational respiratory diseases due to Asbestos. Dirk Dahmann, IGF, Bochum Occupational respiratory diseases due to Asbestos Dirk Dahmann, IGF, Bochum Contents Introduction Diseases Further Effects Preventive Strategies Conclusion Asbestos minerals Woitowitz, 2003 Imports (+

More information

WA Asbestos Review Program

WA Asbestos Review Program WA Asbestos Review Program Dr Fraser Brims Consultant Respiratory Physician, SCGH, Head of Occupational and Respiratory Health Unit, LIWA Asbestos awareness week seminar, 2014 Introduction Asbestos and

More information

Mesothelioma: Questions and Answers

Mesothelioma: Questions and Answers CANCER FACTS N a t i o n a l C a n c e r I n s t i t u t e N a t i o n a l I n s t i t u t e s o f H e a l t h D e p a r t m e n t o f H e a l t h a n d H u m a n S e r v i c e s Mesothelioma: Questions

More information

Occupational Disease Fatalities Accepted by the Workers Compensation Board

Occupational Disease Fatalities Accepted by the Workers Compensation Board Occupational Disease Fatalities Accepted by the Workers Compensation Board Year to date, numbers as of December 31, 2014 Occupational disease fatalities are usually gradual in onset and result from exposure

More information

Occupational Health III.

Occupational Health III. Occupational Health III. Asbestosis SU Department of Public Health Occupational respiratory diseases Dust Toxic Gases Silica dust SO 2 Asbestos dust NO x Coal dust Biologic reaction Inflammatory reaction

More information

Surgeons Role in Symptom Management. A/Prof Cliff K. C. Choong Consultant Thoracic Surgeon Latrobe Regional Hospital GIPPSLAND

Surgeons Role in Symptom Management. A/Prof Cliff K. C. Choong Consultant Thoracic Surgeon Latrobe Regional Hospital GIPPSLAND Surgeons Role in Symptom Management A/Prof Cliff K. C. Choong Consultant Thoracic Surgeon Latrobe Regional Hospital GIPPSLAND Conditions PLEURAL Pleural effusion Pneumothorax ENDOBRONCHIAL Haemoptysis

More information

International Journal of Case Reports in Medicine

International Journal of Case Reports in Medicine International Journal of Case Reports in Medicine Vol. 2013 (2013), Article ID 409830, 15 minipages. DOI:10.5171/2013.409830 www.ibimapublishing.com Copyright 2013 Andrew Thomas Low, Iain Smith and Simon

More information

LECTURES IN OCCUPATIONAL DISEASES

LECTURES IN OCCUPATIONAL DISEASES LECTURES IN OCCUPATIONAL DISEASES الدكتورة سجال فاضل فرھود الجبوري M.B.Ch.B.(Babylon University) M.Sc.(Community Medicine-Al Nahrain) Asbestosis Asbestosis is a chronic inflammatory medical condition affecting

More information

Primary -Benign - Malignant Secondary

Primary -Benign - Malignant Secondary TUMOURS OF THE LUNG Primary -Benign - Malignant Secondary The incidence of lung cancer has been increasing almost logarithmically and is now reaching epidemic levels. The overall cure rate is very low

More information

Influenza (Flu) Influenza is a viral infection that may affect both the upper and lower respiratory tracts. There are three types of flu virus:

Influenza (Flu) Influenza is a viral infection that may affect both the upper and lower respiratory tracts. There are three types of flu virus: Respiratory Disorders Bio 375 Pathophysiology General Manifestations of Respiratory Disease Sneezing is a reflex response to irritation in the upper respiratory tract and is associated with inflammation

More information

WORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 1894/06

WORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 1894/06 WORKPLACE SAFETY AND INSURANCE APPEALS TRIBUNAL DECISION NO. 1894/06 BEFORE: R. Nairn : Vice-Chair HEARING: September 25, 2006 at Windsor Oral DATE OF DECISION: October 16, 2006 NEUTRAL CITATION: 2006

More information

Leanne M Poulos Patricia K Correll Brett G Toelle Helen K Reddel Guy B Marks Woolcock Institute of Medical Research, University of Sydney, NSW

Leanne M Poulos Patricia K Correll Brett G Toelle Helen K Reddel Guy B Marks Woolcock Institute of Medical Research, University of Sydney, NSW Lung disease in Australia Leanne M Poulos Patricia K Correll Brett G Toelle Helen K Reddel Guy B Marks Woolcock Institute of Medical Research, University of Sydney, NSW Prepared for Lung Foundation Australia

More information

Asbestos and Mesothelioma a briefing document for the Metropolitan Police

Asbestos and Mesothelioma a briefing document for the Metropolitan Police Asbestos and Mesothelioma a briefing document for the Metropolitan Police Prepared by Professor John Cherrie, Heriot Watt University, Edinburgh, UK. Introduction The purpose of this document is to provide

More information

MWR Solicitors A legal guide HEALTH & SAFETY: Industrial diseases. Lawyers for life

MWR Solicitors A legal guide HEALTH & SAFETY: Industrial diseases. Lawyers for life MWR Solicitors A legal guide HEALTH & SAFETY: Industrial diseases Lawyers for life CONTENTS Time Limits 4 Foreseeable Risk of Injury 4 Asbestos-Related Disease 4 - A Brief Insight 4 - Overview 5 - Pleural

More information

Health effects of occupational exposure to asbestos dust

Health effects of occupational exposure to asbestos dust Health effects of occupational exposure to asbestos dust Authors: N.Szeszenia-Dąbrowska, U.Wilczyńska The major health effects of workers' exposure to asbestos dust include asbestosis, lung cancer and

More information

GUIDE FOR PEOPLE EXPOSED TO ASBESTOS AND THOSE SUFFERING FROM THE RELATED DISEASES

GUIDE FOR PEOPLE EXPOSED TO ASBESTOS AND THOSE SUFFERING FROM THE RELATED DISEASES GUIDE FOR PEOPLE EXPOSED TO ASBESTOS AND THOSE SUFFERING FROM THE RELATED DISEASES The Organisation for Respiratory Health in Finland seeks to promote respiratory health and the quality of life among people

More information

Non-Small Cell Lung Cancer

Non-Small Cell Lung Cancer Non-Small Cell Lung Cancer About Your Lungs and Lung Cancer How do your lungs work? To understand lung cancer it is helpful to understand your lungs. Your lungs put oxygen into the blood, which the heart

More information

BOHRF BOHRF. Occupational Asthma. A guide for Employers, Workers and their Representatives BOHRF. Occupational Health Research Foundation

BOHRF BOHRF. Occupational Asthma. A guide for Employers, Workers and their Representatives BOHRF. Occupational Health Research Foundation Occupational Asthma A guide for Employers, Workers and their Representatives March 2010 British O Occupational Health Research Foundation This leaflet summarises the key evidence based advice for policy

More information

UKRC 2015 Dr Michael Sproule Glasgow

UKRC 2015 Dr Michael Sproule Glasgow UKRC 2015 Dr Michael Sproule Glasgow Radiology of Asbestos Related Lung Disease General term given to a group of fibrous minerals containing silica and a variety of other elements. Asbestos: Derived

More information

Occupational Lung Diseases

Occupational Lung Diseases What are occupational lung diseases? Occupational lung disease is the number one cause of workrelated illness in the United States in terms of frequency, severity and preventability. Many occupational

More information

GCE AS/A level 1661/01A APPLIED SCIENCE UNIT 1. Pre-release Article for Examination in January 2010 JD*(A09-1661-01A)

GCE AS/A level 1661/01A APPLIED SCIENCE UNIT 1. Pre-release Article for Examination in January 2010 JD*(A09-1661-01A) GCE AS/A level 1661/01A APPLIED SCIENCE UNIT 1 Pre-release Article for Examination in January 2010 JD*(A09-1661-01A) 2 BLANK PAGE 3 Information for Teachers The attached article on asthma is based on some

More information

Mesothelioma. 1995-2013, The Patient Education Institute, Inc. www.x-plain.com ocft0101 Last reviewed: 03/21/2013 1

Mesothelioma. 1995-2013, The Patient Education Institute, Inc. www.x-plain.com ocft0101 Last reviewed: 03/21/2013 1 Mesothelioma Introduction Mesothelioma is a type of cancer. It starts in the tissue that lines your lungs, stomach, heart, and other organs. This tissue is called mesothelium. Most people who get this

More information

Pharmacology of the Respiratory Tract: COPD and Steroids

Pharmacology of the Respiratory Tract: COPD and Steroids Pharmacology of the Respiratory Tract: COPD and Steroids Dr. Tillie-Louise Hackett Department of Anesthesiology, Pharmacology and Therapeutics University of British Columbia Associate Head, Centre of Heart

More information

SUMMARY OF S.B. 15 ASBESTOS/SILICA LITIGATION REFORM BILL

SUMMARY OF S.B. 15 ASBESTOS/SILICA LITIGATION REFORM BILL SUMMARY OF S.B. 15 ASBESTOS/SILICA LITIGATION REFORM BILL S.B. 15, the asbestos/silica litigation reform bill, distinguishes between the claims of people who are physically impaired or sick due to exposure

More information

Understanding Pleural Mesothelioma

Understanding Pleural Mesothelioma Understanding Pleural Mesothelioma UHN Information for patients and families Read this booklet to learn about: What is pleural mesothelioma? What causes it? What are the symptoms? What tests are done to

More information

An introduction to claiming compensation: Industrial diseases Deafness, Dermatitis, HAVS, Silicosis, Latex allergies and Dermatitis

An introduction to claiming compensation: Industrial diseases Deafness, Dermatitis, HAVS, Silicosis, Latex allergies and Dermatitis An introduction to claiming compensation: Industrial diseases Deafness, Dermatitis, HAVS, Silicosis, Latex allergies and Dermatitis www.thompsons.law.co.uk Our pledge to you Thompsons Solicitors has been

More information

Tina Mosaferi, Harvard Medical School Year III Gillian Lieberman, MD

Tina Mosaferi, Harvard Medical School Year III Gillian Lieberman, MD July 2014 Tina Mosaferi, Harvard Medical School Year III 1. Our Patient-Introduction 2. Asbestos Basics 3. Pulmonary Findings Manifestations demonstrated by companion patients 4. Our patient-conclusion

More information

MONTH OF ISSUE: October 2011 TO: MANAGERS, SUPERVISORS, GENERAL FOREMEN & CREWS SUBJECT: Asbestos Alert

MONTH OF ISSUE: October 2011 TO: MANAGERS, SUPERVISORS, GENERAL FOREMEN & CREWS SUBJECT: Asbestos Alert MONTH OF ISSUE: October 2011 TO: MANAGERS, SUPERVISORS, GENERAL FOREMEN & CREWS SUBJECT: Asbestos Alert On the 21/09/2011 at approximately 10.30 am one of our worksites was inspected by a NSW Workcover

More information

Objectives. Mylene T. Truong, MD. Malignant Pleural Mesothelioma Background

Objectives. Mylene T. Truong, MD. Malignant Pleural Mesothelioma Background Imaging of Pleural Tumors Mylene T. Truong, MD Imaging of Pleural Tumours Mylene T. Truong, M. D. University of Texas M.D. Anderson Cancer Center, Houston, TX Objectives To review tumors involving the

More information

Clinical cases in Malignant Pleural Mesothelioma: Adherence to the ESMO Clinical Practice Guidelines

Clinical cases in Malignant Pleural Mesothelioma: Adherence to the ESMO Clinical Practice Guidelines Clinical cases in Malignant Pleural Mesothelioma: Adherence to the ESMO Clinical Practice Guidelines Wieneke Buikhuisen The Netherlands Cancer Institute Amsterdam The Netherlands Case (1) Male, 56 year

More information

Interstitial lung disease in a rheumatic electrician

Interstitial lung disease in a rheumatic electrician Interstitial lung disease in a rheumatic electrician Case history The case presented here concerns a male, born in 1931, who was an electrician for 34 years. He had frequent and close contact with asbestos,

More information

Diseases. Inflammations Non-inflammatory pleural effusions Pneumothorax Tumours

Diseases. Inflammations Non-inflammatory pleural effusions Pneumothorax Tumours Pleura Visceral pleura covers lungs and extends into fissures Parietal pleura limits mediastinum and covers dome of diaphragm and inner aspect of chest wall. Two layers between them (pleural cavity) contains

More information

Asbestos Diseases Uncovered

Asbestos Diseases Uncovered Asbestos Diseases Uncovered Your complete download & keep guide to asbestos-related diseases. Their symptoms, causes and potential compensation payable Contents What is Asbestos? What diseases are caused

More information

ASBESTOS DISEASE COMPENSATION WESTERN AUSTRALIA

ASBESTOS DISEASE COMPENSATION WESTERN AUSTRALIA ASBESTOS DISEASE COMPENSATION WESTERN AUSTRALIA KACEY WUELFERT Partner Tel: 08 9325 6920 www.turnerfreemanwa.com.au Level 8, 16 St Georges Terrace, Perth WA 6000 PO Box 5755, St Georges Terrace, Perth

More information

ASBESTOS DISEASE COMPENSATION WESTERN AUSTRALIA 2015

ASBESTOS DISEASE COMPENSATION WESTERN AUSTRALIA 2015 ASBESTOS DISEASE COMPENSATION WESTERN AUSTRALIA 2015 KACEY WUELFERT Partner Great People. Great Results. Great Value. Tel: 08 9325 0900 www.turnerfreeman.com.au Level 6, 580 Hay Street, Perth WA 6000 PO

More information

Occupational Disease Fatalities Accepted by the Workers Compensation Board

Occupational Disease Fatalities Accepted by the Workers Compensation Board Occupational Disease Fatalities Accepted by the Workers Compensation Board Year to date, numbers as of 30, Occupational disease fatalities are usually gradual in onset and result from exposure to work-related

More information

Asbestos at the Work Site

Asbestos at the Work Site Asbestos at the Work Site Asbestos is a naturally occurring mineral. The most commonly used types of asbestos are named chrysotile, amosite and crocidolite. Asbestos has been and continues to be used in

More information

ASBESTOS RELATED LUNG DISEASE

ASBESTOS RELATED LUNG DISEASE ASBESTOS RELATED LUNG DISEASE Version 2 Final Page 1 Document control Version history Version Date Comments 2 Final 19 January 2007 Signed off by MSCMT 2e (draft) 21 November 2006 Comments from MSCMT incorporated

More information

What is Mesothelioma?

What is Mesothelioma? What is Mesothelioma? Mesothelioma is a rare type of cancer that develops in the mesothelial cells found in one s body. These cells form membranous linings that surround and protect the body s organs and

More information

Occupational Disease Fatalities. January 1, 2006 to December 31 2006

Occupational Disease Fatalities. January 1, 2006 to December 31 2006 Occupational Disease Fatalities Occupational Disease Fatalities January 1, 2006 to December 31 2006 Occupational disease fatalities consist mostly of recognized occupational disease, meaning disease known

More information

Asbestos: Medical guidance note

Asbestos: Medical guidance note Asbestos: Medical guidance note Guidance Note MS 13 This guidance is issued by the Health and Safety Executive. Following the guidance is not compulsory and you are free to take other action. But if you

More information

Lung Cancer. This reference summary will help you better understand lung cancer and the treatment options that are available.

Lung Cancer. This reference summary will help you better understand lung cancer and the treatment options that are available. Lung Cancer Introduction Lung cancer is the number one cancer killer of men and women. Over 165,000 people die of lung cancer every year in the United States. Most cases of lung cancer are related to cigarette

More information

بسم هللا الرحمن الرحيم

بسم هللا الرحمن الرحيم بسم هللا الرحمن الرحيم Updates in Mesothelioma By Samieh Amer, MD Professor of Cardiothoracic Surgery Faculty of Medicine, Cairo University History Wagner and his colleagues (1960) 33 cases of mesothelioma

More information

Asbestos Disease Awareness. help

Asbestos Disease Awareness. help Asbestos Disease Awareness help Asbestos: Contents Asbestos Disease Awareness Contents What have I got Page 2 The five main types of asbestos How did I get it? Page 3 Can I get compensation? Pages 4/5

More information

Asbestos. Part 1. Overview. What is asbestos? Prepared by: Penny Digby Principal Adviser (Occupational Health) Workplace Health and Safety Queensland

Asbestos. Part 1. Overview. What is asbestos? Prepared by: Penny Digby Principal Adviser (Occupational Health) Workplace Health and Safety Queensland Asbestos Prepared by: Penny Digby Principal Adviser (Occupational Health) Workplace Health and Safety Queensland Part 1. Overview types history respiratory system and defence mechanisms asbestos related

More information

Mesothelioma. 1. Introduction. 1.1 General Information and Aetiology

Mesothelioma. 1. Introduction. 1.1 General Information and Aetiology Mesothelioma 1. Introduction 1.1 General Information and Aetiology Mesotheliomas are tumours that arise from the mesothelial cells of the pleura, peritoneum, pericardium or tunica vaginalis [1]. Most are

More information

Mesothelioma and Asbestos

Mesothelioma and Asbestos CANCER INFORMATION FACTSHEET Mesothelioma and Asbestos The information in this factsheet will help you to understand more about mesothelioma. It is an agreed view on this cancer by medical experts. We

More information

IMPOR 'ANT NOTICE NOT TO BE PUBLISHED OPINION

IMPOR 'ANT NOTICE NOT TO BE PUBLISHED OPINION IMPOR 'ANT NOTICE NOT TO BE PUBLISHED OPINION THIS OPINIONIS DESIGNA TED "NOT TO BE PUBLISHED. " PURSUANT TO THE RULES OF CIVIL PROCEDUREPROMULGATEDBY THE SUPREME COURT, CR 76.28 (4) (c), THIS OPINION

More information

SMALL CELL LUNG CANCER

SMALL CELL LUNG CANCER Protocol for Planning and Treatment The process to be followed in the management of: SMALL CELL LUNG CANCER Patient information given at each stage following agreed information pathway 1. DIAGNOSIS New

More information

Asbestos Review Program Update

Asbestos Review Program Update Asbestos Review Program Update Fraser Brims Respiratory Physician, SCGH Head of Occupational and Respiratory Health Unit, Institute for Lung Health, WA CCWA Lung Cancer: an update for 2015 Introduction

More information

INJURY & NEGLIGENCE SPECIALISTS Illnesses. Asbestos Illnesses

INJURY & NEGLIGENCE SPECIALISTS Illnesses. Asbestos Illnesses Asbestos Illnesses INJURY & NEGLIGENCE Asbestos SPECIALISTS Illnesses Injury & Negligence I was totally satisfied with my solicitors service, it was First Class. Quote about Pannone part of Slater & Gordon,

More information

Asbestos is a naturally occurring mineral, with many physical forms, of which the three most important are:

Asbestos is a naturally occurring mineral, with many physical forms, of which the three most important are: Asbestos Awareness 1. Introduction This presentation contains: The properties of asbestos Its effects on health Its interaction with smoking The types of product and materials likely to contain asbestos

More information

Occupational Lung Disease. David Perlman, MD

Occupational Lung Disease. David Perlman, MD Occupational Lung Disease David Perlman, MD What causes occupational lung diseases? Breathing bad stuff into your lung Mechanism of particle deposition Large particles (>0.5μM) Impaction Gravitational

More information

WATCH COMMITTEE. Health significance of occupationally-induced declines in FEV 1

WATCH COMMITTEE. Health significance of occupationally-induced declines in FEV 1 WATCH COMMITTEE PAPER Meeting date: 10 June 2004 Open Govt. Status: Type of paper: Paper File Ref: Exemptions: WATCH/2004/11 Fully Open WATCH COMMITTEE Health significance of occupationally-induced declines

More information

Round Table with Drs. Anne Tsao and Alex Farivar, Case 2: Mesothelioma

Round Table with Drs. Anne Tsao and Alex Farivar, Case 2: Mesothelioma Round Table with Drs. Anne Tsao and Alex Farivar, Case 2: Mesothelioma I d like to welcome everyone, thanks for coming out to our lunch with experts. The faculty today are great people in the thoracic

More information

ASTHMA IN INFANTS AND YOUNG CHILDREN

ASTHMA IN INFANTS AND YOUNG CHILDREN ASTHMA IN INFANTS AND YOUNG CHILDREN What is Asthma? Asthma is a chronic inflammatory disease of the airways. Symptoms of asthma are variable. That means that they can be mild to severe, intermittent to

More information

ASBESTOS AWARENESS. For workers and building occupants

ASBESTOS AWARENESS. For workers and building occupants ASBESTOS AWARENESS For workers and building occupants Asbestos Awareness Asbestos is a serious health hazard commonly found in our environment today. This module is designed to provide an overview of asbestos

More information

This factsheet aims to outline the characteristics of some rare lung cancers, and highlight where each type of lung cancer may be different.

This factsheet aims to outline the characteristics of some rare lung cancers, and highlight where each type of lung cancer may be different. There are several different kinds of lung cancer, often referred to as lung cancer subtypes. Some of these occur more often than others. In this factsheet we will specifically look at the subtypes of cancers

More information