Asbestos Exposure in My Home

[blue04753]

My husband and I moved into our first house this summer, and were told that the house had no asbestos, both by the owner and the home inspector. In August, we proceeded to do renovations on our basement, which involved moving walls around and (we thought) covering some existing asphalt or vinyl floor tile we found underneath an existing carpet with wood and ceramic tile.  The first of January, I called an asbestos inspector to examine (what I believe to be the same) floor tile that is still exposed in our basement utility room.  When the results came back, we learned that the tile contains roughly 20% chrysotile asbestos.  We then contacted the workers who worked on our basement, and learned that they actually ripped the tile up, and broke a great deal in the process of removal.  They said it was difficult to remove, and they hammered it at times to break it into little pieces, and then scraped a great deal of it off.  They said this produced a good amount of dust, which they simply swept up in a dust pan and disposed of.

There were no preventative measures taken during this renovation to seal the area off or turn off air conditioning units. I was present in the house the entire time they were working every day, going down into the workspace at times to answer their questions.  I lived in the house the entire time the renovations were taking place.  I do not work right now, have been in the house roughly 20-22 hrs/day since, exercising and doing housekeeping routinely in the house.  I had a surgery in November and recovered for two weeks in my bed.

We recently performed wipe tests throughout the house in places I don't think I may have cleaned as often in recent months.  While the work was done in the basement, the samples came back positive in our bathrooms and closets on the top (2nd) floor of the house.  

I am now concerned about my health, and my future prospects/risk of developing an asbestos related lung disease from my exposure.  I am a 23/f non-smoker.

[wendig]

Rosedoor,

I too had an asbestos exposure in November.  I've been using the inhaler regularly for a few weeks.  As much as I hate it, as I have the same issues of increased heart rate and feeling "wired" after using it, I do believe it has helped with my breathing.  So it seems like a worthwhile tradeoff.  In addition to some asthma, I have experienced burning airways as a result of my exposure, which has been a horrible thing.  I am a very allergic person with sensitivities to dust, etc. so perhaps that influences or causes the burning airways.

Also, I have never experienced any coughing. Maybe that's because the duration of my exposure was much less than yours.  I experienced a fairly heavy one-time exposure concentrated during a few hours.  Your exposure has probably been a lighter, longer-term exposure.

Anyway, good luck and perhaps you'll at least find some comfort in knowing that you're not the only one who is going through something like this.  Try to keep a positive attitude about it, as I do think that helps as well.

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

Dear rosedoor:

Before I respond, I'd like to ask a couple questions.

1. Are you or your husband having any symptoms? Are the symptoms correlated with the timeline that you describe above?

2. What type of swipe testing did you perform?

3. Do you have central air conditioning? (from your description it sounds like you have  local area air conditioners or window units)

4. You stated that the work was done in the basement. Can you describe the layout or  floor plan for your house and where you were in relation to where the renovation work was being performed?


~*~ 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.

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

Dear Rosedoor:

You are not alone in your concern for the potential hazards related to a possible exposure to asbestos. As we've discussed in previous postings, the pulmonary (lung) effects that may affect some people that have been exposed to asbestos take many, many years to develop. Most people with a single exposure never have any problems while others may have problems many years later. The majority of people do not experience loss of lung function secondary a single exposure to asbestos. However, it is relatively common for person who are exposed to a significant amount of asbestos over their lifetime to have what are called pleural plaques (asbsestos related pleural disease). Pleural plaques do not usually cause symptoms.

That being said, I cannot quantify how concerned you should be. For now, you should focus on living your life, making health lifestyle choices, and staying positive. Your primary care provider is correct in many ways right now--there is no way to exactly quantify your risk for lung problems over your lifetime. Based on the history that you have shared with me, your risk is very low.

The only "test" that you might consider is a pulmonary function test that will serve as a "baseline" in the event that your lung function does change. The result of this test will most likely be completely "normal." However, be aware that everyone's lung function changes slightly as we get older. The pulmonary function test results are usually adjusted (or normalized) for your height, gender, and sometimes ethnicity.

I hope that this is helpful.

~*~ 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.

[blue04753]

I recently expressed my concerns about asbestos exposure to my general practitioner.  

She shrugged me off, and said "yeah, you might have some problems with that later, but there's now way to know right now."

Should I seek out a pulmonary specialist or someone who can talk to me about people who have problems with asbestos related diseases, and how my exposure/experience stacks up relative to those people? Or are all doctors just going to shrug and say, "oh well, good luck?"

I'm still worrying about this asbestos thing.  We have moved out of the house and into an apartment (trying to reduce exposure, or potential further exposure, moving forward), but now I'm weirded out and worrying a lot about contamination in my clothes, or that I may have tracked into the carpets in the new apt on my shoes, in the car where we loaded things up, on furniture we brought, etc.

If you have any information on the nature of asbestos and how contamination dangers might arise, that would be really helpful.  Part of me is assuming it is just sort of dillutional, and that's why people say it's present everywhere... that when I walked from the house to the car to go somewhere (when I was living there) some of the fibers in my clothing or on my shoes would have disseminated into the air around me, on the ground below me, and what not -- and this is why environmental groups are so concerned about improper asbestos removal and handling?  it's dillutional, so it makes the whole world a little more "exposed"?

Really, Dr. Parks, any insight you can offer on how concerned I should be about doing damage to by body/health through this (potential) contamination would be a great help.  When there is little information on a subject, it's easy to get really worked up, and give your imagination liberty to fill in the blanks in the worst possible way...

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

Dear Rosedoor,

You are welcome with regard to the correspondence. It is nice to hear that you are feeling better and are reassured from our dialogue.

As for your questions:

1. “Where else could this Tremolite have come from?”
2. “Is Tremolite as dangerous as some of the websites I have been reading?”  
3. “And, is there any way to gauge from the results of the qualitative wipe tests how much asbestos I may have been exposed to, or what the magnitude of my risk might be?”

For #1 and #2, check out: http://www.scn.org/~bh162/asbestos2.html

With regard to #3, the short answer is "unfortunately, no." As for companies that perform this type of residential environmental monitoring, your experience is a relatively common one--that is, many of these companies do not know how to advise you after they perform the assessment.

OSHA (Occupational Health and Safety Administrations) sets minimal air concentrations that are permissable for workers. However, these permissible exposure levels (PELs) are based on an assumed 8-hour exposure over the course of a shift. The current OSHA PEL for asbestos is 0.1 fiber/cubic centimeter (air concentration). This is not an exposure level that is known to be 100% "safe."

I appreciate your frustrations regarding "the ambiguous minefield" of information that is difficult to interpret. You are welcome to continue the dialogue as more questions come up.

Stay positive and stay well.

Best wishes,

~*~ 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.

[blue04753]

Thank you for the information on the inhaler.  It's nice to be able to put into perspective how something is working in your body.  Your information on the costochondritis and potentially being related to a cough is worthy of note, as the pain first started occurring after a second bout with a bronchitis-type of illness this spring.  I was not living in the house with the asbestos issues at that point, so I feel it is probably safe to conclude (with the information you've given me and my own medical history) that the pain isn't any kind of chest pain associated with the asbestos exposure, and is, after all, just costochondritis.

The results of the air tests all came back negative for dangerous levels of Asbestos.  However, some qualitative wipe samples from a shelf in my closet, our dish cabinet, and on top of my bathroom medicine cabinet (places I didn't think I had cleaned recently) all came back positive for high levels of asbestos.  The medicine cabinet and closet also demonstrated the presence of Tremolite (in addition to the majority of Chrysotile asbestos present in wipe samples throughout the house).  The tiles that we had tested TEM and PCM(?) both showed no Tremolite.  Where else could this Tremolite have come from?

Is Tremolite as dangerous as some of the websites I have been reading?  

And is there any way to gauge from the results of the qualitative wipe tests how much asbestos I may have been exposed to, or what the magnitude of my risk might be?  The testing labs, consulting groups, abatement people, all seem not to know how to explain the results of the testing, or what it reveals about our situation.  Based on what one person, in specific, told me, it seems like the levels revealed in our samples are 10-30 times greater than average/environmental wipe results.

But then again, no one seems to have a uniform conclusion about what environmental or "normal" is.  So we get lots of different opinions on this.

In terms of the inhaler, the last time i used it was when I wrote my last post.  On the whole the cough seems to have mostly disappeared, as has much of the chest tightness.  Perhaps that was just a cold, or (more likely) it has something to do with my having my car washed this past weekend and the removal of some of the dust that you suggested could have been causing my airways to be restricting.  

It certainly didn't feel like a cold, so I believe you to have been right on that one.

I really appreciate your correspondence. It has been really helpful to me, as I feel like this is all kind of an ambiguous minefield of contradictory information, I'm trying to navigate at a really (fairly) young age.

Cheers (and Go Giants, from a fellow former Bostonian)!

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

Dear Rosedoor,

Thank you for responding which such detail to my questions.

My 'short' response is that there is really not a "safe" amount of asbestos and I recommend that you do as much as is reasonable and feasible to reduce your exposure to asbestos to zero.

Your symptoms sound like reactive airway symptoms. If reactive airway symptoms are chronic (and proven to be reversible with special breathing tests), then it may be appropriate to make the diagnosis of asthma.

You mentioned that using the inhaler may have resulted in your cough being more productive. This is fairly common if you have a significant amount of mucous in the air passages of your lungs. The idea is that the inhaler (albuterol) dilates your airways, thus, making it easier for the mucous to move up and out of your lungs.

Your persistent symptoms are probably related to an irritant and allergic response to dust. In addition to the asbestos fibers, there was likely a significant amount of other particulates and dust particles in the air during the renovations.

Have you been referred to a pulmonary specialist (by your primary care physician)? The specialist might consider the use of a steroid inhaler in addition to the albuterol inhaler that you are currently using. The steroid inhaler will decrease the inflammation that is likely present in the air passages in your lungs. Inflammation of the air passages can be present after weeks and months of coughing after dust exposure. The costochondritis, as you know, is a separate problem. Costochondritis often becomes a problem in people that have a chronic and frequent cough. Costochondritis refers to inflammation of the intercostal muscles and soft tissue between the ribs. The best treatment for costochondritis is to determine the cause of the cough and treat the cough (or at least decrease symptoms).

The emergency room is probably not the best place for you to be seen for your type of symptoms unless you are short of breath and feel very ill. A primary care provider will be better equipped to diagnosis and treat a chronic condition and also be able to refer you to a specialist if necessary. Primary care providers can also provide continuity of care. This means that they (or one of their partners) will see you each time you need to be seen. You can also call them or their nursing staff to ask questions.
Have you and your husband had a HVAC (Heating, ventilation, air conditioning) cleaning service clean the ducts and intakes after the renovation? Do you change the air filters frequently?

I hope this is helpful. Please keep your question and comments coming.

~*~ 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.

[blue04753]

I decided to try the inhaler again tonight.  It seems to make deep, deep breathing easier and alleviates some of the pressure.

I hope there is no harm in me using this thing though.  I would hate to be opening myself up to let fibers in in places which can do more harm than good...

[blue04753]

Thank you so much for responding to my post!  I am really worried about all of this, and it will be nice to talk to someone about it.

To answer your questions:
1.  I am the only person having symptoms.  These include a cough (nonproductive -- sometimes it feels like I have to, other times it is like me willingly coughing to try to cough up what feels like tightness or pressure in my chest), the aforementioned pressure, and some chest pain that a doctor diagnosed in july as costochondritis -- which has been getting worse or more constant in the last few months, especially with exercise.  

   I went in to the emergency room two nights ago because I had been feeling like it was particularly difficult to breathe for almost two weeks, costochondritis was bothering me on top of that, I have been having the cough for almost two weeks, and i was getting some blood in mucus I brought up from my sinus cavity or when I blew my nose (not when I cough -- the er was careful to make this distinction).  They did an EKG, a blood test to test for anemia, and listened to my lungs, then told me that I might have some type of asthma and sent me home with an albuterol inhaler.   I am weary of this inhaler as I dont like the way it makes me feel (like my heart is racing, etc) and to be honest, despite my lingering chest discomfort, I haven't used it since they gave it to me in the er. but when I used it the other day it did make my cough more productive a couple of times...

2.  We did qualitative swipe tests that just detect the presence of asbestos fibers.  yesterday, we had someone come out to do quantitative swipe tests to try to gauge a difference in concentration between the fibers we detected in the basement and the fibers we detected on the 3rd floor.  We also did some air testing.  I am not sure how fruitful any of these things will be because, as i stated in the previous post, I have been cleaning (swiffering, dusting, sweeping, vacuuming) fairly (but not always as routinely as one should) often since we had the renovation work done.

3.  Sorry, yes.  We have central air conditioning.  The air conditioning unit and the heater are in the basement utility room (with ventilated doors), where some of the asbestos tile is still exposed and in questionable condition.

4.  When the renovation work was being performed, I was in the house the entire time.  Most of the time I was sitting in our kitchen, dining room, or in our bedroom on the 2nd floor.  (basement, first floor --entry level, second floor).  When you walk in to our house, the stairs going up are on the left wall.  The kitchen is directly ahead of you, with the dining room just to its right.  On the right side, closest to the door, is the living room.  On the left wall, just before the kitchen are the stairs to the basement.  They have a door, which was left open and not sealed off while the work was being done.  The workers were disturbing the asbestos tile in the entire basement below. Spatially, on the second floor, the master bedroom is probably almost directly on top of the living room.

Hope these details are of some help... and thank you again!