Pleural Effusion and Asbestos

Pleural effusion, a build-up of large amounts of fluid in the pleural cavity, is among one of the many conditions that affects people with mesothelioma and other asbestos-related diseases. Pleural effusions alone are not life-threatening, yet it’s the underlying condition that brought about the effusions to begin with that’s typically the most detrimental. In addition, pleural effusions may continue to surface periodically and can lead to a host of complications, including pleural thickening, a type of lung disease caused by considerable scarring to the lung’s linings.

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 Pleural Effusion Symptoms

Sometimes people with pleural effusion exhibit none or one to two symptoms, whereas another person may have multiple symptoms. The signs and symptoms will vary according to each individual:

•          Chest pain that increases when inhaling

•          Dry, hacking cough

•          General feeling of uneasiness and discomfort

•          Frequent hiccups

•          Rapid, short breaths

•          Orthopnia: the inability to breathe normally unless sitting upright

Remember, even if someone exhibits all of the aforementioned symptoms,the only true way to determine pleural effusion is through a physician’s diagnosis.

Pleural Effusion Causes

One of the primary ways that pleural effusion develops is after someone develops an asbestos-related disease, such as mesothelioma or asbestosis. When asbestos fibers are inhaled, they reach the pleural lining of the lungs, and while some fibers excrete from the body naturally, it’s impossible to get rid of every asbestos fiber that enters the body. In time, the lodged fibers create havoc around the pleural area of the body, causing pain, swelling, and inflammation. As a result, pleural effusion may occur.

Pleural effusion can be transudative (a watery fluid build-up) or exudative (protein fluid build-up). Aside from asbestos exposure, other common reasons that pleural effusion develops include:

Exudative:

•          Pneumonia

•          Kidney diseases

•          Pulmonary diseases

Transudative:

•          Open-heart surgery

•          Pulmonary diseases

•          Cirrhosis

•          Heart failure

In some instances, pleural effusion may be caused by certain medications, radiation therapy, and stomach surgery. Other causes, although rare, include tuberculosis, autoimmune diseases such as rheumatoid arthritis, and chest bleeding due to trauma.

 Pleural Effusion Diagnosis

The starting point when determining pleural effusion usually consists of X-ray imaging that allows physicians to view the fluid accumulation in the pleura. Other ways of viewing the fluid build-up may include:

•          CT scan

•          Chest ultrasound

If there isn’t enough fluid for a proper diagnosis via imaging, a thoracoscopy is performed. A thoracoscopy is a procedure that involves inserting a thin tube, known as a thoracoscope, into the chest via a small incision. The thoracoscope allows doctors a more in-depth view of the lungs, pleura, and surrounding areas. In most cases, a sample of the fluid is taken in order to analyze it for cancer cells and/or bacterial infections.

Doctors will also look for physical signs when making a diagnosis, such as abnormal breathing sounds, reduced chest movement, and diminished vocal resonance.

Pleural Effusion Treatment

The type of treatment for pleural effusion depends on what caused the condition in the first place. For example:

•          People with heart failure may require diuretics, heart medication, and in severe cases, a combination of radiation therapy and chemotherapy

•          For patients with a respiratory illness, the fluid is normally drained via therapeutic thoracentesis

•          Uncontrollable fluid build-up after drainage may require thoracentesis as well as scelorsing-type drug, which helps to reduce and heal scarring

For those with mesothelioma and other asbestos-related illnesses, there is chance that along with repeated thoracentesis treatments, patients may also need surgery if the fluid fails to drain on its on or returns continuously:

Pleurodesis

Pleurodesis is a form of therapeutic surgery reserved for those with lung cancer and other similar conditions, including mesothelioma. Although it doesn’t cure pleural effusions, it helps to ease symptoms and reduce pain.

A pleurodesis procedure involves draining the excessive fluid build-up from the pleura areas. The fluid should be drained as much as possible for the best results. Afterwards, either a chemical or mechanical pleurodesis is administered, depending upon which method the physician feels will work best.

A mechanical pleurodesis is the most invasive of the two, which involves fusing the linings of both lungs together to prevent additional buildup. Chemical pleurodesis is much more common and less invasive. It involves inserting a talc chalk into the chest via a tube and small incision. Once the talc is in the patient’s chest, they lie down for several hours, allowing the chalk to evenly distribute. The talc is removed after it’s been distributed, allowing the affected pleural areas to seal up.

Pleural Effusion Prognosis

Pleural effusion is almost always the result of another, usually more serious, underlying condition, such as mesothelioma. Although mesothelioma is treatable, it’s important to remember that there is currently no cure, and if it has progressed to the point of pleural effusion, the disease is usually in an advanced stage. Consequently, the prognosis is typically poor. The treatments for pleural effusion are palliative rather than curative, meaning the main goal is to help reduce inflammation, pain, and help the patient live more comfortably.

According to John E. Heffner, MD,FCCP, the average survival rate for patients with malignant pleural effusions involved in research on the disease was around 4 months. In a study of over 417 patients, only 13% survived a year after treatment.

Studies are still ongoing regarding minimal pleural effusion (less than 10 mm of fluid build-up), yet the Journal of Clinical Oncology suggests that it’s an early phase of the inevitable malignant pleural effusion.