Pleural thickening is a condition of the lungs that is most commonly caused by the long term exposure and inhalation of asbestos particles.
The pleura is a 2-layered membrane that lines the inside of the rib cage, completely covering the lungs. Long term exposure to asbestos can result in thickening of the two membranes.
When asbestos fibres are inhaled, they enter the lungs and irritate the lining causing inflammation and then scarring to develop at those spots. Localised scarring or fibrosis is called pleural plaques. Sometimes however, this scarring can be more widespread and cause large areas of the lining to thicken. This is called diffuse pleural thickening.
Symptoms Of Pleural Thickening
Anyone suffering from pleural thickening will likely experience one or all of the following symptoms:
- Shortness of breath
- Feeling of tightness across the chest
- General chest pain that is usually manifested after physical exertion
The most common symptom of pleural thickening is shortness of breath. When the pleura become extensively thickened and scarred, it loses its elasticity and becomes more rigid and constrictive, causing difficulty in breathing and shortness of breath. However because shortness of breath is associated with several other health conditions, very few people who suffer from these symptoms make the connection at first. The thickening is usually discovered incidentally while conducting tests for other conditions or during a routine check up.
Chest pain and tightness in the chest may or may not be present. These symptoms are typically more prominent after any physical activity. Depending on the extent of the scarring, some people may not experience any noticeable symptoms whereas in others the discomfort and pain can be quite debilitating and can adversely affect their quality of life.
What Causes Pleural Thickening
Asbestos fibres are microscopic in size and linger in the atmosphere in and around any place where asbestos is present. You could inhale these particles as well as asbestos dust simply by being in any place where they are present in the atmosphere. You do not necessarily have to enter any factory that works with asbestos. You could be at risk if you live anywhere near a factory or workplace that uses asbestos in any of their processes. Even just hugging a person who has asbestos particles or dust on their clothes can cause the fibres to be inhaled and enter the lungs.
Once the fibres are inhaled, they settle on the pleural membrane and irritate the spot continuously. This persistent irritation causes the area to thicken and scar. Depending on the extent of exposure, this could lead to localised scarring and calcification or the scarring and calcification could be more diffuse and widespread, which is known as pleural thickening.
After a period of time the scar gets progressively more calcified, reducing the elasticity of the lungs and contributing to reduced lung functions, causing classic symptoms such as shortness of breath and chest pains.
In most people who have this condition, symptoms develop within 20 to 30 years after being exposed to asbestos. The longer the exposure, the shorter the latency period. Those who have been exposed to the material for a decade or more tend to develop the symptoms closer to 20 years, whereas those who were exposed to the material for less than a decade may develop the symptoms closer to 30 years.
Diagnosing Pleural Thickening
As with most other conditions related to asbestos exposure, the thickening of the pleura takes a very long time, making it difficult to make an accurate diagnosis soon after the exposure has occurred.
In individuals who are asymptomatic, the pleural thickening may be discovered by accident during a routine check up. In those who are suffering from shortness of breath or pain in the chest, it is discovered while performing various tests to pinpoint the causative factor while discarding other secondary factors.
X-rays and CT scans of the chest are often taken to differentiate between pleural thickening and other asbestos related diseases. The calcification makes the condition easily visible on an X-ray, especially when it is in the advanced stages. In the earlier stages, when the calcification is not as dense, an X-ray may not show the condition as clearly. In order to confirm the presence of pleural thickening, the doctor will recommend getting a CT scan done.
Treatment of Pleural Thickening
The effects of asbestos on the lungs are unfortunately irreversible. There is no known treatment for curing the symptoms or halting its progress. Knowing that the progression of the disease is very slow offers some degree of comfort.
Once the diagnosis has been made and the presence of pleural thickening is confirmed, it is important to schedule regular appointments with the doctor to monitor the progress of the condition so that the symptoms can be managed and the harmful effects minimised.
There are also several lifestyle changes that can be made to help you maintain a decent quality of life after the diagnosis.
The first is to stop smoking right away if you currently smoke. Smoking can potentially decrease lung function even further, putting you at higher risk for lung cancer.
The second is to undertake some form of physical exercise regularly. If you have been leading a fairly sedentary life before the diagnosis, it is important to start off gently and pick up the pace slowly.
Both of these actions – quitting smoking and regular exercise are the two best things you can do to help slow down the thickening of the pleura and keep the remainder of the lungs healthy and functioning.
Prognosis Of The Condition
Pleural thickening is considered to be benign but the possibility that it could go on to cause mesothelioma, which is malignant, has not been ruled out. This uncertainty has been attributed to the longer gestation period of the symptoms combined with its slow progression and the lack of definitive symptoms. Because of this, once a diagnosis of pleural thickening has been made, monitoring the condition regularly is absolutely vital.