Asbestos Exposure

[eilig]

Hello,

Two weeks ago I was in the basement of a 80+ year old apartment building, moving things in and out of a storage area.  When I was done, I happened to look up and noticed some low-hanging pipes.  On one was a placard:  "ACME Asbestos Covering Chicago."  I didn't think much of it, as we all know old buildings contain asbestos in one form or another.  But I did notice that these pipes were all over, in varying stages of decay.

The next day, I woke up with a horrible sore throat, burning lungs and air passage, and feeling very achy.  Almost like a bad cold.  I thought I was coming down with something, and dismissed it as such.

A week passed, and I still was not feeling any better.  Normally when I have a cold or virus, the sore throat passes after a few days, then I have a cough and some drainage, and I'm feeling better by a week or so later.  Not this time.  My lungs and throat continued to burn and felt sore, and I continued to feel like hell.

Now, two weeks later, I STILL have a sore throat and burning lungs and air passage.  I saw a doctor who dismissed it as a virus, and prescribed an antibiotic (Z pack).  

By way of background, I'm a 39 year old male, in perfect health.  I don't smoke, and I don't drink.  I work in the banking industry.  I have run the Chicago Marathon the last 2 years in a row in 3 1/2 hours.  I know my body, and I especially know my lungs.  Every runner does.  My lungs have NEVER burned like this.  And I have never had a sore throat last this long, except when I had mono back when I was in high school.

As I normally do, I continue running during the first few days of this ordeal, thinking it was just a virus that would pass.  I ran outside, where the Chicago air was cold.  But after a few days of this, I discontinued my running, thinking my body really needs the rest.  So I didn't run for about a week.  Wanting badly to feel better and return to normal, I have tried running the last few days on a treadmill, indoors where it's warm, trying to get back into the swing of things.  II didn't run outdoors because the cold air can make lungs burn even more.  I found myself having difficulting breathing with some light asthma with some light weezing.  

The only other thing you should probably know is that I do have allergies.  Specifically, ragweed, pollen, and even dust.  Symptoms to these are as you might expect.

Concerned about the possibility that this could have been caused by asbestos exposure, and still finding myself with no improvement, I have contacted an industrial hygienist who is coming on Monday to perform air testing in the aforementioned basement, to see if there are asbestos fibers present.

I wanted to share this with you.  Depending on the results of the test next week, I will obviously have a better idea of what's going on.  

Knowing all this, do you have any advice or ideas that you can lend?

Many thanks.

-Jay

[Philip D Parks, MD, MPH, MOccH, FACOEM]

Dear wendig,

A couple comments...

1. We cannot be 100% sure that your exposure to asbestos is not contributing to you current symptoms. If you were exposed to asbestos (inhaled fibers), then, just as you mention in your posting and as I have stated above, asbestos fibers and dust, in general, can be irritating to the respiratory tract.

2. I am sure that the length of time that your symptoms have been on-going is frustrating for you. However, the human body does take some time to heal and normalize after an illness, exposure, or sickness. For example, a pneumonia may take up to 3-4 months to completely resolve (based on radiographs or x-rays and a person's symptoms).

3. If you were exposed to asbestos fibers, then inflammation of your respiratory tract could have occurred and mucus production is part of the inflammatory process in the airways and lungs. The chronic inflammatory changes that are typically found in persons with years of asbestos exposure are found in the pleura or lining of the lung. After many years, fibrosis of  lung tissue may occur as I describe in the other posting from cheetahj.

I recommend that you continue your close contact with medical providers and I hope that you feel better.

~*~  Dr. Parks

This answer is not intended as and does not substitute for medical advice. The information presented in this posting is for patients’ education only. As always, I encourage you to see your personal physician for further evaluation of your individual case.

[wendig]

Hi Doc,

Sorry for the change in nickname since my original post... I forgot the password to my "eilig" nickname.

The sore throat and burning of the airway continue, as does the post nasal drip.  It's now been over 2 months.  

I have been on Protonix for the last 7 days, just in case this is related to GERD.  So far, it has had no impact on the symptoms.

Today they did a CAT Scan of my sinuses, and I'll learn the result tomorrow.

My voice is now very hoarse, especially in the mornings.  This is probably from the very significant mucus that I'm constantly swallowing.  Friends don't even recognize my voice on the phone!

There is one thing that I don't understand, so hoping you can explain it to me.  I've read that asbestos is an irritant, and creates a chronic inflammatory response.  One of the symptoms of an inflammatory response in the respiratory system is increase in mucus production, to help carry away the irritant.  How can we be so sure this entire event hasn't been caused by the asbestos?   (I hope to God it's not, but obviously I'm still concerned that it could be.)

Thanks.

[wendig]

Thanks Doc.  Except you'll note that in my initial post, the mention of a cough was in reference to the "typical" course of a virus, which usually would include a cough.  The complete absence of any cough this time around is what makes my condition so hard to figure out.  None of the docs I have seen are able to shed any light on this burning throat, airway, and lungs.  If I did have a cough, it would seem easier to diagnose.

Certainly the long-term health issues that asbestos exposure creates are of concern... but right now I'm quite honestly more concerned about this incessant burning, and to a much lesser extent, the continued post-nasal drip.  I just want to feel better, as it's been 7 weeks now since I have felt healthy.  

Thanks again for taking the time and effort to address this very frustrating problem.  The service provided on this web site is extremely valuable and much appreciated.

[Philip D Parks, MD, MPH, MOccH, FACOEM]

Dear Wendig,

My reference to your cough was based on looking back at your initial posting where you described having a cough (see above).

Nevertheless, it is possible to still be recovering from bronchitis (and have residual inflammation of the airways) after a cough as ceased.

Your concern regarding the asbestos exposure is difficult to definitively comment on--the effects (biologic marker) of asbestos exposure (pleural plaques) may not be present on chest x-ray or CT scan for many years after the exposure. And, the malignant disease associated with asbestos (mesothelioma) that you may have read about on the internet, has a latency of decades. With a single exposure, your risk of mesothelioma is extremely low.

At this time, you are doing the correct things and have received reasonable care and attention.

Remember to remain proactive regarding the management of your asthma.

Take care and feel free to keep this line of communication open.

- Dr. Parks

[wendig]

Thanks Doc.

What you said makes sense, except at no point have I ever had a cough.  The primary, and most troublesome, symptom all along has been the burning in the throat, airway, and lungs.  

That being said, is it possible to have bronchitis without a cough?

My running attempts have taken place indoors, for the reasons you suggest.  Even when I'm feeling healthy, the cold, dry air prompts a bit of asthma.  So I'm staying indoors where it's warm.

The lengthy duration of this illness, in combination with the fact that the timing is associated with an asbestos exposure, has me very concerned.  

Thanks again.  

[Philip D Parks, MD, MPH, MOccH, FACOEM]

Dear wendig,

Well, it is nice to hear that you have seen providers that have been able to assist you and diagnose and treat you.

Regarding your allergies, did the allergist/immunologist recommend that you should take an anti-histamine such as Allegra or Zyrtec to  reduce your symptoms of rhinitis (runny nose) and post-nasal drip? If not, this might be considered.

Regarding the "burning" in your chest and based on our exchange in this forum, this "burning" feeling could be secondary to the fairly long period of time that you had a cough. Having a chronic or lingering cough can result in a bronchitis (inflammation of the upper respiratory tree in the lungs). The on-going drainage can prevent this bronchitis from improving and can cause you to continue to have a cough.

The treatment for a chronic bronchitis is what your pulmonologist has done. Occasionally, oral corticosteroids are used in addition to the inhalers.

How long does a bronchitis take to completely resolve? It can be several weeks to up to a couple months for a bronchitis to completely resolve once the symptoms are controlled (cough, drainage, etc) and the cause is treated (for example, an infection or toxic/irritant exposure).

You might consider running indoors (if you live in an area with a cold climate) because cold air can be particularly irritating to persons/athletes with exercise-induced asthma. And, as your pulmonologist has hopefully already discussed, use your short-acting inhaler prior to exercise to minimize your symptoms that are induced by exercise.

I hope this is helpful to you.

~*~ Dr. Parks ~*~

This answer is not intended as and does not substitute for medical advice. The information presented in this posting is for patients’ education only. As always, I encourage you to see your personal physician for further evaluation of your individual case.

[wendig]

Hey Doc,

I've visited both a pulmonologist and allergist.  The pulmonologist put me on the breathing machine as a baseline, then put me on a treadmill and repeated the test, then put me on an inhaler and repeated the test.  It confirmed that I have exercise induced asthma.  I've since been using two inhalers daily and the asthma and wheezing has gone away.  So that's good news.

The allergiest put me through a test of 44 different substances, of which I was allergic to 38.  The highest rating in the tests, indicating I am extremely allergic, is 4+.  I had a 4+ rating for every single mold tested, every grass tested except for one, cats, and cockroaches.  She said I'm the most allergic person she's seen in several years.

Anyway, my only remaining symptom continues to be the burning lungs and airway.  Neither the pulmonologist nor the allergist can provide an explanation.  The best way I can describe the sensation is as follows:  If you've ever had a bad cold with a deep, productive cough... when you cough deeply and move out a bunch of flem, there's a second or two afterward when you feel a deep burning in your lungs.  That's how it feels.  

I have noticed that the burning is far worse after my attempts to run.  On a scale of 1 to 10, it is 2-3 in the morning when I get up, and 9-10 during and after a run.  

I am still getting some light drainage, mostly just a running nose.

Do you have any idea what could be causing this burning?  Sorry to beat this topic to death, but it's been 6 weeks now, I've seen all the docs, the symptom is not getting any better, and nobody can tell me what's causing it, or what I should do to possibly help make it go away.

Thanks.

[Philip D Parks, MD, MPH, MOccH, FACOEM]

Dear Eilig,

Wow! That does sound frustrating.

I cannot say for sure regarding the ER because I have not seen or evaluated you. However, in your situation, it would probably NOT be foolish for you to go to the Emergency Department. And, remember the Emergency Department exists to take care of very sick and ill people, so you may have to wait several hours to be seen.

~ Dr. Parks

This answer is not intended as and does not substitute for medical advice. The information presented in this posting is for patients’ education only. As always, I encourage you to see your personal physician for further evaluation of your individual case.

[eilig]

Very frustrated.  I had to schedule almost a month ahead to get an appt w/the pulmonologist.  So I called FOUR others.  All of them have 3-4 week waits to get in for an office visit. Unreal.

In the mean time, my symptons persist.  Only three things have changed:  (1) Now have a nearly constant running nose.  It's a very thin liquid running out.  It even runs at night.  (2)  My chest is tight and achey.  (3) My throat and airway isn't as raw and burning as it was previously.  It's still sore and irritated, but not as severly as before.  

I did see an ENT doc today.  After his analysis and workup, he basically said that there's nothing wrong with my ears, nose, or throat, and he had two recommendations:  (1)  "Stay out of that basement."  (2)  "See a pulmonologist.  You are going to need some help with those lungs."  

I'm so frustrated that I have to wait that long to see a pulmonologist!  I've even considered just going to the ER and maybe I'd end up getting someone to evaluate my lungs.  This has been going on over a month now, and needless to say, I'm extremely frustrated, and more than a little worried.

Do you think it would be foolish for me to go to the ER?  Should I another month to see a pulmonologist?

Thanks Doc.  At least I don't have to schedule a month ahead to get your feedback!!  I appreciate it.

[Philip D Parks, MD, MPH, MOccH, FACOEM]

Dr. Eilig,

First, I agree with your proactive approach to investigate your symptoms at this time with a goal to: (1) treat your acute symptoms; and (2) to potential minimize long-term health consequences.

Second, I am glad that you find the forum beneficial.

Answers to your questions in ALL CAPS. You asked:
1.  "Wouldn't it actually be DESIRABLE to allow my lungs to continue producing this fluid, as it's the fluid that will (hopefully) carry away some of the inhaled asbestos?"

MY ANSWER IS 'NO'. THE FLUID (SECRETIONS) THAT COULD BE ACCUMULATING IN YOUR AIRWAYS IS LIKELY THE BODY'S NATURAL RESPONSE TO ORGANIC AND NON-ORGANIC FOREIGN MATERIALS. THE SECRETIONS OF FLUIDS, WHITE BLOOD CELLS, AND INFLAMMATORY MEDIATORS CAN RESULT IN REACTIVE AIRWAYS AND PRODUCE SYMPTOMS SIMILAR TO WHAT YOU ARE EXPERIENCING (WHEEZING, SHORTNESS OF BREATH). UNFORTUNATELY, OUR BODY'S SOMETIMES PRODUCE AN INFLAMMATORY RESPONSE THAT IS OUT OF PROPORTION TO WHAT IS BENEFICIAL--THIS IS RELATED TO OUR BODY'S IMMUNE SYSTEMS BEING SOME WHAT IMPRECISE IN ITS RESPONSE. ALSO IT IS NOT UNCOMMON FOR INFECTIONS (VIRAL OR BATERIAL PNEUMONIA) TO DEVELOP SUBESEQUENTLY TO OR FOLLOWING AN INFLAMMATORY PROCESS THAT OCCURS IN THE LUNGS.

WITH REGARD TO THE ASBESTOS THAT YOU MAY HAVE INHALED, SOME OF THE INHALED FIBERS MAY BE CLEARED IN THE SECRETIONS BY WHAT WE CALL THE "MUCOCILIARY ESCALATOR" -- THIS MECHANISM MORE OR LESS MOVES FOREIGN PARTICLES UP AND OUT OF THE LUNGS AND THEN YOU SWALLOW THIS "STUFF" AND THEN SOME OF THE PARTICLES ARE PASSED IN STOOL.

BEYOND THE IRRITATION THAT OCCURS AFTER INHALING ANY PARTICLES THAT ARE IRRITATING, THE CHRONIC EFFECTS (IF THEY ARE TO OCCUR) MAY TAKE YEARS, EVEN DECADES TO DEVELOP. IN THE CASE OF ASBESTOS, THE CHRONIC EFFECTS TAKE YEARS TO MANIFEST.

2. “Also, is there any harm in swallowing flem that may contain asbestos fibers?”  

IF YOU HAVE INHALED ASBESTOS FIBERS, THEN SOME OF THE FIBERS WILL BE CLEARED AS I MENTION ABOVE AND SOME OF THE FIBERS WILL MIGRATE INTO THE LUNG TISSUE AND TISSUE IN CLOSE PROXIMITY. THERE IS SOME EVIDENCE THAT ASBESTOS FIBERS ARE ABLE TO MIGRATE INTO MULTIPLE ORGAN SYSTEMS IN THE BODY.

3. "Can this material cause any known issues in the GI tract?"

VERY RARE OCCURRENCE.
http://www.atsdr.cdc.gov/asbestos/asbestos/health_effects/

4. "Lastly, why would this bronchial response be causing me to feel so achy and fatigued?"

ALTHOUGH I CANNOT SAY WITH CERTAINTY, YOUR SYMPTOMS MAY BE RELATED TO AN INFLAMMATORY PROCESS THAT IS GOING ON PARTICULARLY IN YOUR PULMONARY SYSTEM (LUNGS). THESE INFLAMMATORY PROCESSES REQUIRE THE BODY TO EXPEND ENERGY TO CARRY OUT AND MAINTAIN AN INFLAMMATORY PROCESS AND MAY ALSO RESULT IN POOR APPETITE AND DEHYDRATION.

Please keep the questions and comments coming my way.

~ Dr. Parks

This answer is not intended as and does not substitute for medical advice. The information presented in this posting is for patients’ education only. As always, I encourage you to see your personal physician for further evaluation of your individual case.

[eilig]

Hey Doc,

My primary care doc told me to wait 2 weeks and call him.  I prefer a bit more proactive approach, so called a buddy who is a doc, and explained the situation.  

Interestingly, his suggested course of action is exactly the same as you have suggested.  And his brother is a pulmanologist, so I've made an appointment to see him.

I forgot to mention that, for the last week, I've been getting sort of a runny flem down the back of my throat.  I don't have a cough, and it's not the sort of thick flem you get during/after a viral infection.  It's just been constantly in the back of my throat, and I've probably been swallowing it (gross I know, but what can I say).  My buddy said it's probably just my lungs responding to the irritant, producing fluid to carry it away.  He further suggested that is likely the cause of my breathing difficulty during my attempts to run, and that I probably do have asthma.  He would like to get the inhalers going to try to reduce my lungs' response, which hopefully will minimize the likelihood of scarring in my lungs.  So I will proceed accordingly.

I didn't think to ask him this question, so I'll ask you:  Wouldn't it actually be DESIRABLE to allow my lungs to continue producing this fluid, as it's the fluid that will (hopefully) carry away some of the inhaled asbestos?  

Also, is there any harm in swallowing flem that may contain asbestos fibers?  Can this material cause any known issues in the GI tract?

Lastly, why would this bronchial response be causing me to feel so achey and fatigued?

Thanks again for your input.  This is an extremely beneficial forum and I find the info that you provide to be very helpful.

[Philip D Parks, MD, MPH, MOccH, FACOEM]

Dear Eilig,

I am sorry to hear that you continue to have symptoms that might be related to your exposure to dust and asbestos.

What are your personal physician's thoughts at this time?

What were the levels of the asbestos fibers?

If you did have a significant exposure to dust and or asbestos, your respiratory tract (oral pharynx, trachea, and lungs) could remain inflammed for several weeks. Your history of allergies could also cause you to have a particularly robust inflammatory response.

Are you being treated with inhalers for your "asthma-like" symptoms? If you are not, you might consider discussing this possibility with your physician. You might consider asking about the temporary use of an inhaled bronchodilator and/or an inhaled corticosteroid. This is a relatively common practice with irritant bronchitis or pneumonitis that is symptomatic.

Also, a pulmonary function test before inhalers are initiated would be important to establish a baseline and would allow you and your physician to better understand whether you are having a positive response to whatever therapy is begun.

It is also important to be mindful of cough symptoms (productive or not productive), fever, and chills following exposures similar to yours. Pneumonia can follow such exposures in the setting of sick contacts and an inflammed bronchopulmonary system.

Please keep the postings coming. I hope you fell better.

~ Dr. Parks

This answer is not intended as and does not substitute for medical advice. The information presented in this posting is for patients’ education only. As always, I encourage you to see your personal physician for further evaluation of your individual case.

[eilig]

UPDATE:  The chest x-ray, blood oxygen, and blood tests all came back normal.  However, the asbestos tests conducted by the Industrial Hygienist came back positive, indicating there are two types of asbestos that are airborne: amosite, and chrysotile.  The levels were higher than the test range, indicating that the concentration is very high.

Most of my body ache is gone now, but my lungs, throat, and airway are still very raw and burn. I have been attempting to resume my running regimen, and continue to experience asthma.  I have no trouble breathing at rest.  But when I exercise, I wheeze quite a bit.  Today, my throat was actually "whistling" when I was trying to run. When I'm done running, my lungs actually ache from trying so hard to get air.

What do you think is happening with my lungs?  Is there anything I can do?  Thanks.    

[eilig]

Thanks Doc.  

You bring up some very points.  I am a person who has some light asthma, and also I've been diagnosed with multiple chemical sensitivity disorder.  I'm not sure how much I believe in the medical validity of the latter, but the stated symptoms do indeed seem to closely parallel some issues I've experienced in the past.

The only times I experience any wheezing from asthma are when I run in cold weather, and when I'm around cats.

And the only times I have issues with the multiple chemical sensitivity are when I'm around mold, new carpet, fresh paint, cigarette smoke, perfume, etc.  I get a burning throat, headache, burning tongue, watery eyes and dizziness.

I'll post the results of the asbestos testing in a couple days.  In the mean time, I'll followup with my local physician.  Thanks again for your insight.

[Philip D Parks, MD, MPH, MOccH, FACOEM]

Dr. eilig,

Regardless of the cause of your symptoms (that is: asbestos fibers, dust, other type of airborne irritant, or infection), you are doing the correct things. Seeing your personal physician is extremely important.

That being said, your symptoms may be consistent with an irritant bronchitis/pneumonitis which could explain the pulmonary (lung) symptoms and the myalgias (body aches).

With irritant or chemical bronchitis/pneumonitis, patients can benefit from being treated as if they have reactive airway disease (similar to asthma). You might consider asking your physician about this. Your history of "allergies" might put you at greater risk of having an adverse reaction to inhalation of a variety of airborne particles.

In the recent medical literature, we rarely see mention of acute asbestos exposure. However, the U.S. Army's website: http://chppm-www.apgea.army.mil/documents/FACT/65-006-0503.pdf, http://chppm-www.apgea.army.mil/documents/FACT/65-007-0503.pdf describes symptoms of acute exposure.

Other link: http://www.fmlink.com/ProfResources/HowTo/article.cgi?BOMI%20Institute:howto010907.html

Please follow the directions of your personal physician and go the hospital or call your physician if the symptoms worsen.

I am happy to keep the dialogue going if you have questions.

- Dr. Parks


This answer is not intended as and does not substitute for medical advice. The information presented in this posting is for patients’ education only. As always, I encourage you to see your personal physician for further evaluation of your individual case.

[eilig]

The industrial hygienist visited this morning and performed the air sampling.  She performed an "aggressive air test" using a fan to move the air for 2 hours, during which the sample collectors were exposed.

Before she conducted the test, she performed a visual inspection of the area.  She pointed out two spots on the piping where the coating that surrounds the asbestos had been damaged over the years, as well as small areas of white dust directly beneath.  She said this is what causes the particles to enter the air.  So the question is not whether she'll find asbestos in the air, the question is HOW MUCH?  We will have the results in 48 hours.

The basement is dry with no noticeable dampness.

My lungs, throat and air passage continue to burn badly, and last night my body ache was so bad that I nearly went to the hospital.  It feels like I have the flu, except that it's been going on now for over 2 weeks.  No drainage, no cough.  Just burning lungs and bad achiness.  I made an appointment to see my doc again tomorrow.  This is just horrible.

[Philip D Parks, MD, MPH, MOccH, FACOEM]

Dear eilig,

Please keep me informed of the results of the industrial hygienist's findings and I'll respond in more detail to your posting.

Was the basement damp?

- Dr. Parks

This answer is not intended as and does not substitute for medical advice. The information presented in this posting is for patients’ education only. As always, I encourage you to see your personal physician for further evaluation of your individual case.