Asbestos

CAS RN:1332-21-4

Treatment Overview

0.4.3 INHALATION EXPOSURE
  • A) MANAGEMENT OF TOXICITY
    • 1) Since there is no effective therapy for an established case of asbestosis, treatment is aimed at maintaining vital capacity and reducing respiratory work load. Treatment may include the following: vaccination against pneumococcal pneumonia and influenza, bronchodilator administration, adequate nutrition, home oxygen therapy, rebreathing and exercise training, and smoking cessation. Pharmacological agents to limit the progression of fibrosis as yet have not been developed.
  • B) DECONTAMINATION
    • 1) PREHOSPITAL: Most asbestos exposures are of a chronic nature, such that traditional first aid is not appropriate. In the event of a heavy acute exposure, move the patient to fresh air. Monitor for respiratory distress. Administer oxygen and assist ventilation as required.
    • 2) HOSPITAL: Most asbestos exposures are of a chronic nature, such that traditional first aid is not appropriate. In the event of a heavy acute exposure, move the patient to fresh air. Monitor for respiratory distress. Administer oxygen and assist ventilation as required. Treat bronchospasm with inhaled beta-2 agonist and oral or parenteral corticosteroids.
  • C) AIRWAY MANAGEMENT
    • 1) Administer oxygen and assist ventilation as required. Treat bronchospasm with inhaled beta-2 agonist and oral or parenteral corticosteroids.
  • D) ANTIDOTE
    • 1) None
  • E) PATIENT DISPOSITION
    • 1) HOME CRITERIA: There is no role for home management.
    • 2) OBSERVATION CRITERIA: Patients with known asbestos exposure require outpatient monitoring to detect complications.
    • 3) ADMISSION CRITERIA: While there is no specific therapy for asbestos exposure, patients may require inpatient therapy for their poor pulmonary function or cancer treatment.
    • 4) CONSULT CRITERIA: A toxicologist may be consulted to aid in determining if a patient's symptoms or cancer is from a previous exposure to asbestos. Consult a pulmonologist for patients with evidence of asbestos-induced pulmonary complications.
  • F) PITFALLS
    • 1) Failure to recognize a worker is exposed to asbestos and not instituting appropriate industrial hygiene protective measures.
  • G) TOXICOKINETICS
    • 1) Asbestos fibers thicker than 3 micrometers (mcm) in diameter or longer than 100 mcm are either not inhaled or are rapidly cleared from the respiratory tract. On a weight basis, only a very small proportion of inhaled fibers are retained. When inoculated intrapleurally, the majority of asbestos fibers were cleared during the first 10 days. Subsequently, there was very small elimination through the gut.
    • 2) An inverse relationship between intensity of exposure and time of disease development has been suggested. Depending on the level of workplace exposure, the latency period may range from 5 to 6 years to 10 to 20 years.
  • H) DIFFERENTIAL DIAGNOSIS
    • 1) The differential diagnosis of asbestosis includes coal workers, pneumonoconiosis, dermatomyositis, hypersensitivity pneumonitis, idiopathic pulmonary fibrosis, sarcoidosis, and silicosis.
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