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

2. FIOH / Tampere Asbestos and asbestosis 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.

3. FIOH / Tampere Asbestos and asbestosis 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

4. FIOH / Tampere Asbestos and asbestosis 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

5. FIOH / Tampere Asbestos and asbestosis Effects of asbestos exposure pleural plaques (pleura parietale) pleuritis fibrosis of visceral pleura asbestosis lung cancer and mesothelioma retroperitoneal fibrosis

6. FIOH / Tampere Asbestos and asbestosis 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

8. FIOH / Tampere Asbestos and asbestosis 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

10. FIOH / Tampere Asbestos and asbestosis 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

12. FIOH / Tampere Asbestos and asbestosis WORK HISTORY Mowe 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

13. FIOH / Tampere Asbestos and asbestosis 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/cm 3 )

14. FIOH / Tampere Asbestos and asbestosis HELSINKI CRITERIA 1997 ERS 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

15. FIOH / Tampere Asbestos and asbestosis HELSINKI CRITERIA 1997 ERS 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.

16. FIOH / Tampere Asbestos and asbestosis 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.)

17. FIOH / Tampere Asbestos and asbestosis Guidance of patient STOP SMOKING! guidance of disease diagnosed (prognosis etc.) advisory opinion and statement of occupational disease, if needed follow-up

18. FIOH / Tampere Asbestos and asbestosis 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

19. FIOH / Tampere Asbestos and asbestosis

22. 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