FIOH / Tampere Asbestos and asbestosis Tööga seotud kopsuhaigused Tartu, 8.-9. oktoober 2003 ASBEST JA ASBESTOOS Panu Oksa Soome Töötervishoiu Instituut

FIOH / Tampere Asbestos and asbestosis

Tööga seotud kopsuhaigusedTartu, 8.-9. oktoober 2003

ASBEST JA ASBESTOOS

Panu OksaSoome Töötervishoiu Instituut

Tampere, Soome


What is asbestos?

• asbestos is the name of a group of different naturally occurring minerals

• asbestos is fibrous silicate. Fibers are very strong and resistent to heat and chemicals

• serpentines – chrysotile (white asbestos)

• amphiboles – crocidolite (blue), amosite (brown), anthophyllite, tremolite, actinolite.


Asbestos materials

• spray coating of steel work, concrete walls and ceiling for fire protection and insulation

• insulation lagging in buildings, on pipework, for boilers and ducts

• asbestos cement products: walls, roofs, tiles

• asbestos used also in bitumen, paints, plastic, resin, rubber products


ACM, serpetine and amphiboles

• any material containing more than 1% asbestos is called "asbestos-containing material" (ACM)

• all asbestos types are equally dangerous and confirmed human carcinogens

• in organism only chrysotile breaks into shorter fibers, all amphiboles split to thinner fibers


Effects of asbestos exposure

• pleural plaques (pleura parietale)

• pleuritis

• fibrosis of visceral pleura

• asbestosis

• lung cancer and mesothelioma

• retroperitoneal fibrosis


Pleural plaques• benign hyaline plaques of parietal pleura • latency time 20-40 years• no effect on respiration• already little exposure is enough, even

purely environmental exposure• high prevalence in Finland• differential diagnosis subpleural fat,

muscular insertions, technical fault and tumors


Asbestosis

• diffuse fibrosis of lungs caused by asbestos dust. HRCT is most sensitive in showing it.

• moderate or heavy exposure is needed

• average latency period is 20-30 years

• symptoms: shortness of breath and cough

• lung functions: restriction and lowered diffusing capacity


Fibrosis of visceral pleura

• not so specific to asbestos exposure

• acute pleuritis or pleural effusion precedes the pelural fibrosis, latency can be even under 10 years

• typical complications are adhesions and rounded atelectasis

• differential diagnosis: other pleurites


WORK HISTORYMowe et al 1985, Tuomi et al 1991, Zitting et al 1996,

Wilkinson et al 1995, Pairon et al 1994, Sakai et al 1994)

Definite exposure: Manufacture of asbestos products, asbestos spraying, insulation, demolition of old buildings

Probable exposure: Construction, shipbuilding, heating trades, pipefitting, sheet metal work

Possible exposure: Transport, railways, ship engine crew, firefighting, mining and quarrying, oil refining, chemical, paper and metal industries, car repair, general maintenance jobs

Unlikely exposure: Office work, agriculture and forestry, health care and education, telecommunication, textile industry


Work history

• life long cumulative work history

• exposure to asebstos asked about for all work tasks

• quantification of cumulative asbestos exposure as none, slight, moderate, heavy

• fiber years = exposure time (years) x exposure level (fibers/cm3)


HELSINKI CRITERIA 1997ERS TASK FORCE 1998 1/2

For clinical purposes, the following guidelines are recommended for identifying people who have highly probably been exposed to asbestos dust at work:

- over 0.1 million amphibole fibers (>5 m)/g dry lung tissue or

- over 1 million asbestos fibers (>1 m)/g dry lung tissue or

- over 1000 asbestos bodies/g dry tissue (100 asbestos bodies/g wet tissue) or

- over 1 asbestos body/ml in bronchoalveolar lavage fluid


HELSINKI CRITERIA 1997ERS TASK FORCE 1998 2/2

- An increased risk of mesothelioma and pleural plaques may occur below, at or above (1/2) the mentioned concentrations.

- A twofold risk of lung cancer is related to retained fiber levels of 2 million amphibole fibers (>5 m)/g dry lung tissue or 5 million asbestos fibers (>1 m)/g dry lung tissue.


Diagnosing asbestos disease

• anamnesis (work history, smoking, resp. symptoms, lung diseases, thoracic traumas)

• status, auscultation of lungs

• thorax X-ray, high resolution computed tomography, HRCT

• spirometer, diffusion capacity

• differential dg (bronchoscopia, lavage, etc.)


Guidance of patient

• STOP SMOKING!

• guidance of disease diagnosed (prognosis etc.)

• advisory opinion and statement of occupational disease, if needed

• follow-up


Former asbestos workers in Finland (2003)

• 50 - 60 000 (moderate or heavy exposure)

– about 9 000 of them have an asbestos disease:

7 000 plaques, 2 000 asbestosis

average age about 70 years

• in 2001 the average age of new asbestos patients was 64 years


Asbestos-induced diseases in 1990 - 2001

0

300

600

900

1200

1500

90 91 92 93 94 95 96 97 98 99 00 01

Pleural adhesions andcalcificationsAsbestosis

Cancers

Others

Number of cases

Lea AaltoFinnish Register of Occupational Diseases FIOH


0 5 10 15 20

All industries 579

Transport, storage and communications 42

Chemical and petroleum products manufact. 8

Rubber and plastic products manufact. 7

Basic metals and fabricated metal products manufact. 25

Mining and quarrying 2

Pulp, paper and paper products manufact. 26

Electricity, gas and water supply 21

Non-metallic mineral products manufact. 20

Transport equipment manufact. 33

Construction 234

N

ASBESTOS-INDUCED DISEASES (Cases/10 000 employed persons)

Lea Aalto

Most common industries in 2001

Finnish Register of Occupational Diseases FIOH


0 5 10 15 20 25

All occupations 579

Technical, scientific, juridical, humanistic and artistic work 57

Transport and communication work 16

Service work 45

Packing, warehousing and stevedoring work 8

Chemical prosessing, pulp and paper making work 7

Metal, foundry and engineering work 82

Manufacturing work not elsewhere classified 24

Construction and industrial equipment operation work 25

Electrical, radio and television work 51

Building construction work 225

ASBESTOS-INDUCED DISEASES (Cases/10 000 employed persons)

Lea Aalto

NMost common occupations in 2001

Finnish Register of Occupational Diseases FIOH


EU legislation

• Directive 83/477/EEC on the protection of workers from the risk related to exposure to asbestos at work

• updated and amended by Directives 91/382/EEC and 98/24/EC.

• The ban on the marketing and use of chrysotile asbestos introduced by Council Directive 76/769/EEC, as amended in 1999 by Commission Directive 99/77/EC in effect on 1 January 2005, will lead to a substantial reduction in asbestos exposure among workers.

• SEE http://europa.eu.int/eur-lex

Documents

FIOH / Tampere Asbestos and asbestosis Tööga seotud kopsuhaigused Tartu, 8.-9. oktoober 2003 ASBEST JA ASBESTOOS Panu Oksa Soome Töötervishoiu Instituut