Asbestos Disease and Supplemental Oxygen Therapy

Background to use of asbestos in Australia

Asbestos is a fibrous mineral that was used extensively in the building industry in Australia and other countries during the 20th century. A naturally occurring silicate material made up of fine, fibrous crystals, asbestos was used for its strength and flexibility, as well as its insulation, fire and chemical retardant properties. Used in Australia extensively between 1945 and 1980, it was finally banned in 1989 in building products, and completely prohibited in 2003.

Diseases caused by asbestos

The microscopic straight long asbestos fibres can easily enter the lungs and embed in the tissue. They are very resistant to the regular cleaning processes of the lungs, and can remain deeply sited in the lung tissue.  As a result several diseases can result including:

  • Pleural disease – inflammation and irritation of the outer lining of the lung, where the pleura stiffens and thickens, can fill with fluid and can restrict breathing.
  • Asbestosis where the lungs are permanently scarred and inflamed, so that Oxygen is no longer able to transfer from the lungs into the blood. Because the lungs become stiff and inelastic, breathing becomes progressively difficult.
  • Mesothelioma or cancer of the pleura can be triggered by exposure to asbestos, although only a small percentage of people exposed to asbestos develop mesothelioma. Tragically it is estimated that about 500 men and 100 women develop mesothelioma  in Australia each year,  and this is likely to increase to 900 new cases per year by 2020.
  • People exposed to asbestos have a greater risk of contracting lung cancer.

As there may be as much as a 20 to 40 year time lag between exposure to asbestos and actual onset of symptoms, it is expected that asbestos related diseases in Australia will not peak until the 2020s.1

Asbestosis

Asbestosis is exclusively caused by the inhalation and retention of asbestos dust. The fibres lodge in the lung tissue were the immune system in response to the foreign matter, produces macrophages that attempt to surround and digest the fibres. Hence lung tissue is inflamed.  At the same time the fibres cause the cells of the lungs to produce fibroblast cells which lay down connective or fibrous tissue in an attempt to heal the ‘wounds’ caused by the razor sharp fibres.  The ongoing creation of scar tissue causes the alveolar walls to thicken and lose elasticity, reducing the lung’s ability to take in Oxygen and remove carbon dioxide.

The primary symptoms of asbestosis are reduced ability to tolerate physical exercise and ensuing shortness of breath. Other symptoms include tightness in the chest, dry cough, blood in the sputum, swelling in the neck or face, difficulty in swallowing, loss of appetite, weight loss and a bluish tinge in later stages owing to insufficient Oxygen.

A less common symptom is known as ‘finger clubbing’, where the fingers become swollen, misshapen and red owing to fluid build up in the finger tissues. 2

While there is currently no cure for asbestosis supportive treatments include:

  • Respiratory physiotherapy to assist in the removal of lung secretions
  • Medications to thin lung secretions and for pain management
  •  Use of supplemental Oxygen therapy.  3

Supplemental Oxygen therapy

Many people require supplemental Oxygen as their medical condition worsens. Commonly people are supplied with an in-home concentrator and several Oxygen gas bottles to assist them to live at home and provide them with some mobility out of the home. An in-home concentrator produces continuous flow Oxygen with machines varying in output from 0.5litres per minute (LPM) through to 5 or 10LPM.  Oxygen can be supplied via a nasal cannula – a piece of plastic tubing with two curved nasal prongs that sit in the front of the nostrils or by way of a face mask.

All Oxygen concentrators work by drawing in the surrounding air, passing it through a sieve bed, extracting the Nitrogen and storing the Oxygen under pressure.

Often, as a person adjusts to their changed circumstances where they now require supplemental Oxygen, they start to look for a more versatile and cost effective Oxygen solution – a solution that will enable them to move about more freely and return to a more active lifestyle.

Portable Oxygen concentrators (POCs) are a relatively new means of supplying supplemental Oxygen whilst giving an individual greater personal freedom. As the technology improves, the POCs are reducing in size and weight, whilst increasing in functionality. Weight and size reduction is made possible by supplying pulse Oxygen. This is where your breath triggers the release (pulse) of Oxygen. The use of pulse delivery significantly lessens the demand for Oxygen compared to a continuous flow machine. The majority of people can comfortably use pulse delivery Oxygen whilst out and about, although it is recommended that you check with your Doctor first. Many people will combine a continuous flow machine at home and maybe at night with a pulse delivery POC if out during the day.

The recent arrival in Australia of the LifeChoice ActiVox is a state of the art example of a compact, lightweight unit. Able to produce up to 3LPM, the ActiVox has a battery life from between 12 to 5hours (depending on the setting 1 through to 3LPM) and weighs only 2.2kg! The newer units are also using improved technology in the way the Oxygen is delivered. For example the Auto Mode Technology automatically adjusts Oxygen delivery to meet your Oxygen needs. The ActiVox adjusts to higher respiration rates whilst you are active and will adjust Oxygen delivery to reflect your altered breathing patterns whilst at rest or asleep. The Activox can be used whilst sleeping but it is not suitable for use by mouth breathers or users of a CPAP machine.

The unique Pulse Wave Technology of the ActiVox delivers Oxygen continuously during the first 30% of each inspiration, to ensure maximum intake of Oxygen. This mode of delivery also reduces the side effects of retrograde flow (as experienced with continuous flow delivery) minimising potential side effects such as dry/irritable nasal passages.

As a general rule increased output is reflected in an increase in size and consequently weight of a POC.  For example, the Philips Simply Go weighs 4.5kg but has a maximum pulse delivery capacity of 6LPM. In addition, the Simply Go can produce continuous flow Oxygen up to 2LPM. It also has a Sleep mode (also pulse), which adjusts Oxygen delivery to reflect the changed inspiration pattern while at rest.

There is a range of POCs available in the marketplace.  We recommend that you only purchase good quality units and wherever possible arrange to have a trial of the unit/s pre-purchase. An extremely important consideration is the type of ongoing support offered by the company.  EasyOxygen will supply an equivalent unit if at any stage your POC requires maintenance during the warranty period. Warranty periods do vary anywhere from 2 to 5 years depending on the manufacturer, the supplier and the unit.

Oxygen concentrators produce medical grade Oxygen broadly from between 87 to 96% +/- 3%. The in-home units have wheels allowing easy movement throughout the home as needed. The POCs generally feature at least two ways of carrying the unit usually by handle or shoulder strap, with some models allowing for a backpack. The heavier units generally are supplied with a trolley. With a little ingenuity a POC can be used with a walker, wheelchair/power chair or a mobility scooter.

Most of the good quality POCs are able to be used whilst flying, although the airlines do require you to complete a form in advance of travel. It is always advisable to check if the POC is approved for travel by the respective airline before booking.

Units can be charged from either mains electricity or from a car charger.  Suitable for travelling in trains, planes, cruise ships and caravans – there will be a POC that will meet your specific Oxygen and lifestyle needs.

A POC will revolutionise your lifestyle. You’ll be able to get out and about, meet with friends and family and travel.

REFERENCES                                                                                          

1 National Health and Medical Research Council at: http://www.nhmrc.gov.au/your-health/asbestos-related-diseases    Accessed 28 October 2013

2 Asbestos.com at: http://www.asbestos.com/asbestosis          Accessed 26 October 2013

(Information provided by The Mesothelioma Center:   http://www.maacenter.org)

3 Asbestos.com at: http://www.asbestos.com/asbestosis         Accessed 26 October 2013

 

FURTHER INFORMATION

Asbestos Diseases Society of Australia Inc, (ADSA) – www.asbestosdiseases.org.au

Asbestos Related Disease Support Society Qld Inc (ARDSSQ) – www.asbestos-disease.com.au

Dust Diseases Board, NSW – www.ddb.nsw.gov.au

NHS Inform – www.nhsinform.co.uk/Health-Library/Articles/A/asbestosis

National Health Service, UK – www.nhs.uk/Conditions/Asbestosis

Industry Contacts

Worksafe Queensland – www.worksafe.qld.gov.au

Safework Australia – www.safeworkaustralia.gov.au

Queensland Health – www.health.qld.gov.au

Asbestos Industry Association – www.asbestosindustry.asn.au

National Association of Testing Authorities – www.nata.asn.au

Allens Industrial Products Pty Ltd – www.allensindustrial.com.au

Demolishers, Recyclers & Asbestos Contractors Association of Qld (DRACAQ) – www.demolishersassocqld.com.au

Asbestos Support and Advocacy Groups

NSW – www.adfa.org.au

SA – www.avasa.asn.au

SA – www.adssa-inc.com.au

Gippsland Victoria – www.gards.org

Mesothelioma Cancer Centre (USA) – www.asbestos.com

VIC – www.berniebanton.com.au

VIC – www.asbestoswise.com.au

DISCLAIMER

The information contained in this article aims to assist the public to be better informed. No content should be taken as medical advice, or used for self diagnosis, treatment etc. Independent medical advice should always be sought.

EasyOxygen does not accept any liability for any injury, loss or damage incurred by use of or reliance on the information contained in this article.

29 October 2013

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