Enfermedades respiratorias relacionadas con la asbestosis (català)
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Causas y efectos del amianto en la Salud, diferentes enfermedades respiratorias relacionadas y la fibrosis pulmonar provocada por asbestosis. Presentación efectuada en la Jornada " El amianto y su impacto en la Salud", realizada en Parc Científic de Barcelona, 15-N-2019
Enfermedades respiratorias relacionadas con la asbestosis (català)
- 1. Malalties respiratòries vinculades amb l'asbestosi Josep Morera Novembre 2019 JORNADA L'AMIANT I EL SEU IMPACTE EN LA SALUT Malalties respiratòries vinculades amb l'asbestosi Dr. Josep Morera Prat – Co-director del Servei Respiratori Centre Mèdic Teknon PATOLOGIA MALIGNA EN UNA POBLACIÓ EXPOSADA A L'AMIANT Dr. Josep Tarrés Olivella - Coordinador de l’Equip Mèdic Observatori per l’estudi de las Patologies Relacionades amb l’Amiant en el Vallès Occidental Actualització en diagnòstic del mesotelioma pleural maligne Dr. Ernest Nadal Alforja -Cap de Secció de Tumors Toràcics i de Cap i Coll. Oncologia Mèdica. Institut Català d'Oncologia. L'Hospitalet. Projecte Bermes: Desenvolupament d'un nou fàrmac pel mesotelioma maligne Dra.Carme Plasencia Castillo - Directora Científica d’AROMICS Confirmar assistència a bermesproject@gmail.com o info@aromics.es
- 2. GUIÓ 1.- Introducció 2.- Tipus d’exposició 2.- Mètodes diagnòstics 2.- Patologia benigna asbestósica 3.- Fibrosi pulmonar asbestósica 4.- Conclusions
- 4. ո鰿ٱ -El 1890 es relaciona per primera vegada la inhalació de fibres d’amiant amb malaltia pulmonar -El 1907 s’atribueixen les primeres morts a l'exposició al amiant. El primer cas descrit va ser a Londres a una treballadora de 33 anys d’una fabrica tèxtil. -1931 es fa al Regne Unit la primera Legislació de control d’exposició al amiant -Els anys 40 es confirma que el asbest és un carcinogen -Els anys 60 es relaciona el mesotelioma amb l'exposició a l’amiant - A partir del 2002 està prohibit al Espanya l'ús d’amiant
- 6. Tipus d’amiant 1.- Blanc Crisotilo. Fibres corbades 2.- Blau. Crocidolita. Fibres rectes. 6.- Marró Amosita. Fibres rectes
- 7. •Ocupacional, en els treballs directes amb asbest •Domèstica, per aïllaments d’edificis a altres elements contaminants o per el rentat de robes de treball •Ambiental por l'ús d’asbest en espais públics, per l’enderrocament d’edificis o per la proximitat a factories contaminants. Tipus d’exposició
- 8. Tipus d’exposició Asbestos bodies in normal lung of western Mediterranean populations with no occupational exposure to inorganic dust. Monsó E, Texidó A, Lopez D, Aguilar X, Fiz J, Ruiz J, Rosell A, Vaqueró M, Morera J. Arch Environ Health. 1995 Jul-Aug;50(4):305-11. We concluded that, in west-ern Mediterranean populations, normal lung asbestos body counts were higher in urban industrial inhabitants than in rural inhabitants; however, in both populations, there was a low prevalence of asbestos bodies.
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- 11. Mètodes diagnòstics 1.- Historia laboral (tipus exposició, tipus d’asbest, anys i intensitat exposició) 2.- Radiologia: La radiografia de tòrax és la principal eina de detecció de lesions per asbest. Però el TAC alta resolució (TACAR) es més sensible en la detecció estadis precoços 3.- Funció Pulmonar: Patró restrictiu / DLCO 4.- Broncoscòpia i Rentat broncoalveolar 5.- Anatomia patològica/ cossos d’asbest 6.- Anàlisis mineralògic i anàlisis de fibres
- 12. Patologia per amiant 1.- Patologia pleural - Plaques pleurals, sense o amb calcificació - Engruiximent pleural difús - Vessament pleural - Mesotelioma 2.- Patologia pulmonar - Fibrosis pulmonar per Asbest - Atelèctasi rodona - Càncer de pulmó
- 13. Altres patologies relacionades amb amiant Small airways disease and mineral dust exposure. Churg A, Wright JL. Pathol Annu. 1983;18 Pt 2:233-51 www.drjospmorera.com
- 15. Vessament pleural and 2. CT images from a patient with history of asbestos exposure demonstrating large right pleural effusions. Although not typical, the effusions in asbe C. Norbet et al. / Current Problems in Diagnostic Radiology 44 (2015) 371–382 vessanent placa
- 18. Plaques pleurals
- 19. Plaques pleurals Figure 4. Axial high-resolution CT scan ob- tained with lung windows shows uncalcified ante- Figure 5. (a) Photograph (original magnificatio pearly plaques that arise from the parietal pleura. ( approximately ϫ250; hematoxylin-eosin stain) sho a basket-weave pattern and focal lymphocytic aggr
- 21. Fibrosi pleural difusa Consisteix en una fibrosis difusa de la pleura visceral, de entre 1 mm y 1 cm de gruix, que es pot estendre uns mil·límetres al pulmó. Es pot associar a les plaques pleurals. La seva freqüència augmenta amb el temps i la intensitat de l'exposició i en pacients amb vessament pleural previ. Apareix després de més de 20 anys des de l'exposició. Alguns poden presentar dispnea.
- 22. Fibrosis pleural difusa exposure. However, any entity that leads to the formation of organized pleural exudate, such as tuberculosis, histoplasmosis, Dressler syndrome following cardiac surgery, and hemothorax, may produce the same radiographic appearance. It is most commonly seen in the lingula, followed by the right middle lobe and then the lower lobes, but any lobe may be affected.13 Conventional CT is most helpful in making the diagnosis, and 3 major features have been described: (1) rounded or oval mass (2.5-7 cm abutting a peripheral pleural surface); (2) the curving “comet tail” of bronchovascular structures passing into the mass, resulting in a blurred central margin; and (3) thickening of the adjacent pleura or hypertrophy of the subpleural fat with or without calcification, which is usually but not always thickest adjacent to the mass.13 Lynch et al16 included the additional feature of volume loss in the adjacent lung (Figs 12-15). represent the scarred invaginated visceral pleura.17 In e a positron emission tomography (PET)/CT would be pr Fibrotic Bands Abundant inhalation of asbestos fibers can cause the visceral pleura with single or multiple fine or c parenchymal fibrous bands radiating from a single pleura. This creates an image that can be likened t ance of crow’s feet or chicken’s feet (Figs 19 and 2 usually seen in connection with diffuse pleural thic has been suggested that “crow’s feet,” pleural tag chymal fibrotic bands are predominantly related to the visceral pleura and should be differentiated features more suggestive of diffuse interstitial fibro Figs 10 and 11. CT images demonstrating bilateral pleural thickening and its usual continuous nature. The pleural thickening can be up to 3 cm in thickness exposure. However, any entity that leads to the formation of organized pleural exudate, such as tuberculosis, histoplasmosis, Dressler syndrome following cardiac surgery, and hemothorax, may produce the same radiographic appearance. It is most commonly seen in the lingula, followed by the right middle lobe and then the lower lobes, but any lobe may be affected.13 Conventional CT is most helpful in making the diagnosis, and 3 major features have been described: (1) rounded or oval mass (2.5-7 cm abutting a peripheral pleural surface); (2) the curving “comet tail” of bronchovascular structures passing into the mass, resulting in a blurred central margin; and (3) thickening of the adjacent pleura or hypertrophy of the subpleural fat with or without calcification, which is usually but not always thickest adjacent to the mass.13 Lynch et al16 included the additional feature of volume loss in the adjacent lung (Figs 12-15). represent the scarred invaginated visc a positron emission tomography (PET Fibrotic Bands Abundant inhalation of asbestos the visceral pleura with single or m parenchymal fibrous bands radiatin pleura. This creates an image that ance of crow’s feet or chicken’s fee usually seen in connection with dif has been suggested that “crow’s f chymal fibrotic bands are predomin the visceral pleura and should b features more suggestive of diffuse Figs 10 and 11. CT images demonstrating bilateral pleural thickening and its usual continuous nature. The pleural thickening can be up
- 23. Ateléctasi rodona És una forma de col·lapse pulmonar no segmentari i perifèric que simula una neoplàsia pulmonar o pleural. És produeix com a conseqüència del plegament sobre sí mateix d`una part del pulmó, secundari a una afectació pleural. Qualsevol pleuritis d’altres etiologies poden també provocar-la. El diagnòstic es fa amb el TAC, ja que a la radiografia de tòrax simula una massa pulmonar. El TAC mostra una opacitat rodona de base pleural. Hi ha també curvatura dels vasos pulmonars i dels bronquis adjacents (“signe de la cometa”). Sol ser unilateral i als lòbuls inferiors, i el diagnòstic diferencial més freqüents es amb càncer de pulmó́.
- 24. 1.- Atelèctasi rodona 2002 RG f Volume 22 ● Special Issue
- 25. Fibrosis pulmonar per asbestosis Es una pneumopatia intersticial difusa, amb fibrosis, provocada por la inhalació de fibres d’amiant. S’associa amb períodes de llarga exposició, entre 10 i 20 anys Però s’han descrit casos amb exposicions molt intenses de poc temps (entre1 mes i1any) que l’han provocat. Els símptomes son inespecífics, como tos seca i dispnea d’esforç i en la exploració hi ha crepitants tipo “velcro” a bases pulmonars i acropaquia. En fases avançades: insuficiència respiratòria i corpulmonale Les manifestacions funcionals i radiològiques son similars a la fibrosis pulmonar per altres causes
- 27. Fibrosis pulmonar per asbestosis Lung dust content in idiopathic pulmonary fibrosis: a study with scanning electron microscopy and energy dispersive x ray analysis. Monsó, Tura, Pujadas, Morell ,Ruiz, Morera J. Br J Ind Med. 1991 May;48(5):327-31. Figure 1 Asbestosfibres in a sample with a previous diagnosis of idiopathic pulmonaryfibrosis (scanning electron microscopy 1250 x ). Results One sample of normal lung tissue and one sample of tissue from a patient with IPF were discarded from mineralogical analysis due to poor quality of the SEM imaging that impeded recognition of the inor- ganic particles. These samples were not considered in the results. Most of the samples from patients diagnosed as having IPF contained only occasional inorganic particles (< 10 particles in the area studied), but two (8 3%) showed innumerable asbestos fibres (> 100 asbestos fibres in the area). One ofthese patients had an antecedent of a brief occupational exposure to asbestos. No relevant antecedent was found in the second patient (table 2; figures 1, 2). The twenty four samples of normal lung analysed Figure 2 Energy dispersive x ray analysis ofan asbestos fibre. all others in the normal group, had no relevant inhalatory antecedents (table 3). Discussion Our results provide evidence that an examination using optical microscopy and polarised light over- diagnoses IPF. We found 2/24 cases with a previous diagnosis of IPF (8-3%) that contained innumerable asbestos fibres in the area studied, with no asbestos Table 3 Patient 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 Inorganic particles in normal lung types No of Particles Type 7 Silicate (4) Fe (3) 6 Silicate (3) Fe (3) 6 Silicate (1) Silica (2) Fe (2) ZnCu (1) 5 Silicate (4) Silica (1) 5 Silicate (4) ZnCu (1) 27 Silicate (11) Asbestos (1) Pb (15) 3 Silicate (1) Al (1) Ag (1) 0 _ 8 Silicate (8) 0 _ 4 Silicate (4) 4 Silicate (4) 5 Silicate (2) Fe (3) 3 Silicate (3) 2 Silicate (2) 0 - 0 _ 5 Silicate (5) 9 Silicate (7) Fe (2) 1 Silicate (1) 7 Silicate (3) Al (1) Cu (1) Fe (2) 1 Fe (1) 0 _ 1 Fe(1) Lung dust content in idiopathicpulmonaryfibrosis Figure 1 Asbestosfibres in a sample with a previous diagnosis of idiopathic pulmonaryfibrosis (scanning electron microscopy 1250 x ). Results One sample of normal lung tissue and one sample of showed only occasi cases (<10 particl composition of the prevalence of non-f 614%) and partic particles; 34 9%). particles in the area was the only asbesto (1/109 particles; 0 all others in the inhalatory antecede Discussion Our results provid using optical micro diagnoses IPF. We diagnosis of IPF (8 asbestos fibres in t Amb aquestes tècniques de 25 biòpsies pulmonars diagnosticades de fibrosis pulmonar idiopàtica es comprova que dues eren fibrosis asbestósica
- 29. Fibrosis Asbestosica phage eventually dies, thus releasing cytokines and attracting further lung macrophages and fibroblastic cells to lay down fibrous tissue. This eventually forms a fibrous mass, resulting in interstitial fibrosis.30,31 It usually takes 20 years or more to see asbestosis develop after exposure. The distortion of pulmonary architecture, namely, the laying down of collagen in an interstitial location, is similar to many of the features seen in usual interstitial pneumonia. Lung tissue becomes scarred around the terminal bronchioles and alveolar ducts. The fibrotic scar tissue causes alveolar walls to thicken, which reduces elasticity and gas diffusion, leading to reduced oxygen transfer to blood and removal of carbon dioxide. Moreover, asbestos, particularly amphibole in the form of crocidolite and amosite, includes iron and is considered responsible for the production of reactive oxygen and nitrogen species. These reactive oxygen and nitrogen species may further promote local chronic inflammation.30,31 Because of these cellular and molecular events, cleaved asbes- tos fibers accumulate in regional lymph nodes, the distal end of developing malignancy, which is discussed further in the section on neoplastic disease. Neoplastic Disease Malignant Mesothelioma Malignant mesothelioma is known to be highly associated with asbestos exposure and occurs primarily in the pleura and the peritoneum, but it can also arise in the pericardium, tunica vaginalis testis, larynx, and kidney. Asbestos exposure has also been suggested as a contributor to nodular pulmonary amyloidosis.4 Malignant Pleural Mesothelioma Epidemiology Malignant pleural mesothelioma (MPM) is the most common primary neoplasm of the pleura32,33 but still a rare tumor. Pleural Round atelectasis does show enhancement at trast-enhanced CT (31), and it has been sug- ed that a uniform pattern of enhancement ors round atelectasis. However, contrast en- cement is not thought to be a reliable charac- stic for differentiating benign asbestos-related ase from malignancy (1,32). Stability or nkage of the mass with the passage of time ngly suggests benignancy (32), but biopsy y be required. Magnetic resonance (MR) imaging has been orted to show round atelectasis as a mass with signal intensity characteristics similar to those verity of fibrosis (12,36). The lag between expo- sure and onset of symptoms is usually 20 years or longer (36) (sometimes more than 40 years) but can be as little as 3 years in cases with constant heavy exposure (36). The pathogenesis of asbestosis, as with so much of asbestos-related disease, is incompletely understood. Tissue damage is caused by che- motactic factors and fibrogenic mediators re- leased from alveolar neutrophils or macrophages after they attempt to ingest and clear the fibers. Chronic fiber deposition stimulates persistent mediator release and leads to fibrosis that spreads ures 12, 13. (12) Photomicrograph (original magnification, ϫ400; hematoxylin-eosin stain) of a bronchoalveo- avage specimen shows a classic asbestos body with a segmental dumbbell-shaped configuration (arrow). (13) Pho- aph shows macroscopic appearance of “honeycomb” lung with subpleural accentuation typical of asbestosis (ar- s). No pleural thickening is present on this section. f Volume 22 ● Special Issue Roach et al S175
- 31. Tractament Fibrosi pulmonar BMC Pulm Med. 2019 Sep 5;19(1):170. Casillo V1, Cerri S2, Ciervo A3, Stendardo M1, Manzoli L1, Flacco ME1, Manno M3, Bocchino M4, Luppi F2,5, Boschetto Antifibrotic treatment response and prognostic predictors in patients with idiopathic pulmonary fibrosis and exposed to occupational dust
- 32. Conclusions 1.- Al menys fins el 2040 s’haurà de mantenir la sospita clínica de malaltia per amiant 2.- El TAC toràcic de la pleura és la forma més sensible no invasiva de sospita/diagnóstic de malaltia asbestósica 3.- El 80% de les atelèctasis rodones actualment estan relacionades amb amiant 4.- La fibrosi asbestósica s’ha de “estreure” per la combinació d'existència de TAC amb fibrosi i anamnesi d’exposició
- 34. ո鰿ٱ • Trabajadores del vidrio • Mineros de ganga de hierro • Aisladores • Peones • Productores de maquinaria • Trabajadores de mantenimiento (electricistas, carpinteros, fontaneros) • Extracción y refinería de petróleo y gas • Trabajadores de la industria primaria • Tuberías y conducciones de agua • Trabajadores de centrales eléctricas • Trabajadores del caucho • Trabajadores y usuarios de plásticos reforzados • Techados • Trabajadores del metal • Astilleros • Trabajadores de la piedra • Mineros del talco
- 35. ո鰿ٱ • Manufactura de productos de amianto • Mezcladores de asfalto • Mecánicos de automóviles • Instaladores de productos acústicos • Trabajadores y usuarios del amianto-cemento • Trabajadores del cartón y papel de amianto • Molineros y mineros de amianto • Caldereros • Químicos • Trabajadores de la construcción (albañiles, demolición, paramentos, trabajadores y usuarios de azulejos, arcilla) • Bomberos • Trabajadores y usuarios de juntas • Trabajadores del vidrio • Mineros de ganga de hierro • Aisladores • Peones Guía para los trabajadores del amianto
- 36. ո鰿ٱ • Textiles • Transportistas • Manufacturación de turbinas • Plastoquímicos (aeronáuticos) • Ferroviarios • Otros (administrativos, sanitarios, directivos, esporádicos) 7. MEDIDAS DE PROTECCIÓN Guía para los trabajadores del amianto