What is pleural thickening?
Asbestos-related pleural thickening is a lung disease in which extensive pleural scarring (pleural fibrosis) thickens the pleural membrane lining the lungs and chest wall which can restrict lung expansion. It is one of the more common asbestos-related diseases referred to as ‘Diffuse Pleural Thickening’ (DPT) and in more common instances as ‘lung scarring’, ‘calcification of the lungs’ and/or ‘thickening of the pleura’. When pleural thickening is found in ‘both lungs the condition is referred to as ‘bilateral pleural thickening’.
How is pleural thickening caused?
When potentially harmful asbestos fibres are inhaled they travel into the lungs where the body’s natural defence mechanism attempts to break them down before they penetrate the lung lining and enter into the bloodstream. These fibres are difficult to deal with and many fibres enter and settle on the pleura or pleural membrane causing them to thicken, calcify and/or scar over a period of many years. This area of the pleura becomes inflamed which causes irritation and often leads to reduced and restricted lung function.
Pleural thickening often occurs due to inflammation in the lungs and other causes of pleural thickening might be due to infection, tuberculosis, bacterial pneumonia, pleural effusion, rheumatoid lung disease and tumours (benign and malignant) including mesothelioma.
Who is most at risk of developing pleural thickening?
Pleural thickening is associated to many industrial workers where asbestos use was commonplace, as;
- Insulators (‘Laggers’)
- Heating engineers
- Boiler makers
- Metal workers
- Factory workers
- Power stations
- Telephone exchange
Common symptoms of pleural thickening include;
- Breathlessness/tight chest (initially upon exertion)
- Persistent cough
- Chest pain
How is pleural thickening diagnosed?
If your lungs have been harmed by asbestos it is likely they will produce a crackling sound when you breathe in and this can be detected by your GP who will examine you and listen to your lungs using a stethoscope. Your GP will ask about your work history and general health and it is important you discuss those health concerns which took you to see your GP in the first instance and be clear about your previous work with asbestos materials or working in environments where asbestos was used.
A number of diagnostic investigations can be carried out to confirm pleural thickening which might include,
Pleural thickening is normally found as shadowing in the lung which is often confirmed by further investigation and CT Scan. An x-ray will detect abnormalities in the structure of the lung associated to asbestos exposure and might also confirm the existence of another asbestos scarring condition known as pleural plaques which represents less extensive scarring (focal scarring) also caused by inhalation of asbestos fibres.
CT Scan (computerised tomography)
This is a painless process which produces more detailed 3D images of the lungs and can help identify less obvious abnormalities missed by x-ray such as early stage asbestosis.
Lung function tests (LFT)
Lung function tests include spirometry, lung volumes and gas transfer which are designed to measure the effectiveness of your lungs. The tests can help identify an abnormal or impaired result but can also be used to track and monitor a disease over periods of time. An abnormal result with ‘restrictive lung pattern’ indicating reduced lung volume is indicative of pleural thickening/scarring, asbestosis, trapped lung, pleural effusions and interstitial lung disease.
Spirometry is a test which involves blowing through a mouthpiece into a spirometer to measure how well you can inhale and exhale using maximum effort. Maximum effort is required and the test might need to be repeated a number of times.
Lung volumes can be measured using similar equipment to a spirometer located within in a small glass sided area during which time you will have a small clip placed on your nose. This test is quite painless and a member of staff is always in attendance watching and speaking with you.
Gas transfer test measures the amount of oxygen passing from the lungs into the bloodstream and is undertaken using a mouthpiece through which you will be asked to fill your lungs with a harmless gas for a few seconds before exhaling.
Asbestos fibres found in the lung could indicate the existence of some other asbestos related lung condition such as asbestosis or mesothelioma and it might be necessary to undertake a biopsy to exclude any more serious conditions.
A biopsy of lung tissue, sometimes from a nodule or lesion, will distinguish asbestosis from other similar lung conditions such as idiopathic pulmonary fibrosis (IPF) sometimes referred to as usual interstitial pneumonia, chronic obstructive pulmonary disease (COPD), emphysema or silicosis.
A biopsy can also help to confirm the existence and type of any cancer such as mesothelioma or lung cancer when examined in a laboratory under the microscope by a Pathologist.
Biopsy procedures, include;
- Needle aspiration – A thin needle is inserted into the lung to recover sample cells for examination which is normally undertaken during a CT Scan and under local anaesthetic.
- Bronchoscopy – Involves a doctor or trained nurse inserting a thin and flexible tube (fibre-optic bronchoscope with mini camera) through the mouth or nose to enable examination of the main airways and other areas of the lungs. The procedure is performed under mild sedative and/or local anaesthetic and allows for the collection of tissue samples and/or respiratory secretions to help make a diagnosis. The procedure might be uncomfortable and is likely to prompt occasional coughing but should be completed within 20-30 minutes after which you will be observed for a short while until the effects of local anaesthetic have worn off. After 24 hours you should be able to resume normal activities which might include driving, returning to work and drinking alcohol.
What treatments are available for pleural thickening?
In most cases no specific treatment is required because asbestos-related pleural thickening seldom presents severe symptoms. In instances of severe breathing moderately successful surgical procedures are available to remove some or all of the thickened pleura but generally speaking day to day treatment will involve;
Health monitoring – Periodical health checks can help to identify the progression of pleural thickening and development of another asbestos-related condition.
Avoid smoking – Smoking can aggravate symptoms of breathlessness and increase the risk of developing lung cancer. Your GP will help you to give up and there are numerous prescriptions and replacement therapies which can help to achieve this goal. Seek out local support groups for further help.
Keep active and consider pulmonary rehabilitation (PR) – It is important to maintain healthy lungs regardless of age and general health including those who have a lung condition. Regular physical activity and exercise is proven to add quality to your life, reduce stress and will increase the efficiency of your lungs. If you feel able to take gentle exercise such as walking or swimming discuss this with your GP or physiotherapist before embarking upon any exercise regime to ensure you are safe.
Pulmonary Rehabilitation is a programme of exercise designed to help and educate those people suffering from chronic lung conditions including COPD, bronchiectasis and idiopathic pulmonary fibrosis (IPF). Your GP, nurse or respiratory team will refer you to your local programme.
Key benefits of pulmonary rehabilitation (PR) include;
- PR courses are provided on the NHS.
- Education and PR exercises set at safe and correct level can help improve the management of symptoms including breathlessness.
- PR increases muscle strength and can help to increase well-being, confidence and sense of fitness.
- PR courses provide an opportunity to meet and socialise with others in a similar situation
Compensation & Government benefits for pleural thickening
- Compensation is available to sufferers of pleural thickening to reflect potential life changing costs and financial losses which inevitably follow a diagnosis and impact upon many families. Whilst compensation cannot reverse a diagnosis or restore former good health it can help to provide some financial peace of mind to sufferers and their families at a very difficult time in their lives.
- Experienced specialist industrial disease solicitors are waiting to speak to you to discuss all aspects of your case and provide reassurance as to how they would seek to progress your claim.
- Settlement awards for pleural thickening potentially involve high value compensation and wherever appropriate we would seek to obtain an early interim payment to minimise the financial impact your condition whilst settlement is being achieved. Compensation is obtained from those former employers and/or their relevant insurance companies who negligently exposed you to asbestos fibres in the workplace.
- In addition to compensation from an employer, sufferers of pleural thickening are also eligible to seek a non-means tested benefit, Industrial Injuries Disablement Benefit (IIDB) which is assessed according to the level of your disability on a percentage basis ranging from 1% – 100%. The weekly payments range from £33.94 per week to £169.70 per week according to the assessment of disability made by ‘medical advisor’ appointed on behalf of the Department of Work and Pensions. Normally you must be assessed as 14% or more disabled to attract a payment.
- If for any reason it transpires you cannot make a claim against a former employer you might be eligible to seek a further one-off payment under The Pneumoconiosis etc (Workers’ Compensation) Act 1979. We will help you with your benefit application.