Breathless: Smoking + asbestos = disaster

Smoke makes most of us want to gag. Thank God people can’t smoke in airplanes anymore. In the pre-historic era, there were smoking and nonsmoking sections in planes. Gee, in a closed cabin without an effective air filtering system! Obviously, it didn’t work. I loved once sitting in nonsmoking row 23 with the folks in row 24 smoking like mad for the entire flight.

What happens if you smoke and have asbestos exposure?

Asbestos is a group of natural fibers that are fire-resistant and good insulators. The problem with asbestos is when it's inhaled, the fibers collect the lungs.  The result is inflammation of the lungs and apparently DNA changes that can to lead to cancer. Asbestos tends to hit the lower lungs and damage breathing tubes and lung cells where gases are exchanged with the blood.

Because smokers’ lungs don’t have normal cells in the breathing tubes (like bronchus, bronchioles), they can’t bring up the asbestos. Healthy lungs have cilia– little hairs that push things out. Smokers lose the cilia.

So get this: In asbestos workers, the risk of dying from lung cancer is 9 times higher in those who smoke less than a pack a day, but 16 times higher in those who smoke more than a pack a day, when compared to the nonsmokers. I’m not just blowing smoke up your– ah, lungs.

Three main types of lung disease can result from asbestos: asbestosis, pleural disease, and cancers. The most common cancer is malignant mesothelioma, in which the lining of the lungs becomes cancerous. Symptoms usually don’t start until 20-30 years after exposure, although it can come on sooner with more exposure. The pleura (lining of the lung) is affected usually before the lungs are, so pleural effusions (like a puddle of water in the chest cavity) can be a bad sign.

Little by little, a person will have more difficulty breathing during activities like climbing stairs or walking.  If the person is not a smoker, coughing, wheezing, and hacking up phlegm usually don’t occur.

As the disease progresses, a good number of folks will get clubbing (not going to Studio 54) of the fingers, which means the finger tips and nails get larger and bud-like. If blood flow through the lungs becomes poor because of the fibrosis (scarring and hardening), blood will back up to cause swelling of the legs and even a type of congestive heart failure. But most people do not die of respiratory failure.

Diagnosis is made by radiological studies and examination– preferably by a pulmonologist.

Unfortunately there is no cure and no specific treatment. Cancer is checked on a regular basis. Pneumovax and flu shots are recommended as is treating pulmonary infections in a timely manner.

You don’t have to work around asbestos to get it. Family members who do the laundry of the person who was exposed can pick it up from the clothes littered with asbestos.

Who are these workers normally? Shipbuilders and repairers, insulation workers, pipefitters, plumbers, electricians, carpenters, welders, and many more are at risk.

Mainly not smoking or being around second-hand smoke is important, though hard for many people. But I know we are all doing the asbestos we can.
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Dr. Hook cracks a joke or two, but he's a respected physician with an interesting website, drjohnhong.com. Email him with your questions.