O'Reilly Katherine M A, Mclaughlin Anne Marie, Beckett William S, Sime Patricia J
Southampton General Hospital, Southampton, United Kingdom.
Am Fam Physician. 2007 Mar 1;75(5):683-8.
The inhalation of asbestos fibers may lead to a number of respiratory diseases, including lung cancer, asbestosis, pleural plaques, benign pleural effusion, and malignant mesothelioma. Although exposure is now regulated, patients continue to present with these diseases because of the long latent period between exposure and clinical disease. Presenting signs and symptoms tend to be nonspecific; thus, the occupational history helps guide clinical suspicion. High-risk populations include persons in construction trades, boilermakers, shipyard workers, railroad workers, and U.S. Navy veterans. Every effort should be made to minimize ongoing exposure. Patients with a history of significant asbestos exposure may warrant diagnostic testing and follow-up assessment, although it is unclear whether this improves outcomes. Patients with significant exposure and dyspnea should have chest radiography and spirometry. The prognosis depends on the specific disease entity. Asbestosis generally progresses slowly, whereas malignant mesothelioma has an extremely poor prognosis. The treatment of patients with asbestos exposure and lung cancer is identical to that of any patient with lung cancer. Because exposure to cigarette smoke increases the risk of developing lung cancer in patients with a history of asbestos exposure, smoking cessation is essential. Patients with asbestosis or lung cancer should receive influenza and pneumococcal vaccinations.
吸入石棉纤维可能导致多种呼吸系统疾病，包括肺癌、石棉肺、胸膜斑、良性胸腔积液和恶性间皮瘤。尽管现在对接触石棉有了相关规定，但由于接触石棉与临床疾病之间存在较长的潜伏期，仍有患者不断出现这些疾病。出现的体征和症状往往不具有特异性；因此，职业史有助于指导临床怀疑。高危人群包括建筑行业人员、锅炉制造工、造船厂工人、铁路工人和美国海军退伍军人。应尽一切努力尽量减少持续接触。有大量石棉接触史的患者可能需要进行诊断测试和后续评估，尽管尚不清楚这是否能改善预后。有大量接触史且出现呼吸困难的患者应进行胸部X线检查和肺功能测定。预后取决于具体的疾病类型。石棉肺通常进展缓慢，而恶性间皮瘤的预后极差。有石棉接触史且患肺癌的患者的治疗与任何肺癌患者相同。由于接触香烟烟雾会增加有石棉接触史患者患肺癌的风险，因此戒烟至关重要。患有石棉肺或肺癌的患者应接种流感疫苗和肺炎球菌疫苗。
