Asbestos exposure is a leading cause of pleural disease, characterized by the formation of plaques and effusions in the lining of the lungs.

However, pleural disease is not a single diagnosis.

Instead, it encompasses a range of asbestos-related illnesses, up to and including cáncer. Many of these conditions have unusually long latency periods, often emerging later in life and with little to no warning. But, by the time that symptoms become noticeable, it is typically too late for the pleurae to be repaired.

Although pleural disease has no known cure, some conditions can be managed—especially if they are detected early, before they have a chance to further ravage the body. Even malignant pleural mesothelioma, a rare but life-threatening cancer, can occasionally be mitigated by rapid intervention.

Asbestos and Pleural Disease

Asbestos is a class of naturally-occurring mineral that can be found around the world.

Although there are a half-dozen different types of asbestos, each with its own properties, they all share a set of common characteristics. Every form of asbestos is, for instance, comprised of tightly-packed bundles of fiber. This fiber is strong, flexible, and incredibly durable—it is all but fireproof, and resistant to electricity and corrosion, too.

Since asbestos is both environmentally abundant and easily recombined with other materials, it was once used to reinforce a wide variety of products. In the United States, asbestos became a short-lived hallmark of American industry, with domestic mines producing some 300 million pounds of it each year between the late 1960s and early 1970s.

During its heyday, asbestos was put into almost everything imaginable, from automotive parts to interior insulation and vinyl floor tiles. More recently, asbestos has even been identified as a contaminant in cosmetics and consumer-grade talc powder.

However, for all its apparent utility, asbestos has always had a downside.

The Medical Risks of Asbestos Exposure

If and when asbestos is reduced to either fiber or dust, it can disperse into the atmosphere, clinging to workers’ hair, skin, or clothing. Eventually, some of these fibers may be inadvertently swallowed or inhaled. And, once inside the body, there is little limit to the damage asbestos can inflict.

A significant body of evidence has already established a causal relationship between asbestos exposure and a plethora of illnesses—illnesses that affect many different parts of the body, from the heart to the ovaries and testicles.

But most asbestos-related conditions start in or around the pleurae, the pair of thin membranes that line the thorax and encase the lungs.

The Different Types of Pleural Disease

Pleural disease is not a disease, but a constellation of injuries and symptoms that reflect extensive damage to the pleural lining of the lungs. It has a variety of causes, but is most often prompted by either occupational or secondary asbestos exposure.

De acuerdo a the federal Centers for Disease Control and Prevention, asbestosis—the most common asbestos-related pleural disease, and the illness most closely associated with the term—is a type of “slowly progressive fibrotic lung disease caused by [the] inhalation of asbestos fibers.” In other words, asbestosis’s defining feature is a profound scarring of the lungs and an inflammation of its pleural tissue.

Health problems associated with pleural disease may include:

Efusiones pleurales, or “water on the lungs,” an accumulation of excess fluid between different layers of the pleurae. Effusions do not always cause any noticeable symptoms, but could cause or exacerbate chest pain, a chronic cough, and difficulty breathing.
Placas pleurales, o areas of thickened tissue that form in the pleural lining of the lungs. Plaques are not cancerous, but are often observed in patients at higher risk for malignant mesothelioma and other cancers. Most people who have pleural plaques, but no other diagnosable condition, experience no symptoms.
Diffuse thickening, or tracts of extensive scarring across large tracts of the pleural membrane. If diffuse thickening is not caused by cancer, it may not prompt any symptoms or impede a patient’s quality of life. But, like pleural plaques, thickening does belie a longer-term risk of malignant illness.

Pleural disease can, in many cases, either accompany or forewarn the emergence of much more serious conditions. Malignant pleural mesothelioma, for instance, is a rare and unusually aggressive cancer that begins in the pleurae but often metastasizes—spreads—to other parts of the body. It has no known cure, and long-term survival rates are typically low.

The Symptoms of Pleural Disease

Pleural conditions, from plaques and asbestosis to malignant mesothelioma, all have very long latency periods. If and when symptoms ever emerge, they may not appear until later in life—years, or even decades, after a patient’s last known asbestos exposure.

The most common early-warning signs of pleural diseases include:

Recurring chest pain
Dificultad para respirar
Chronic cough

Pleural cancers can also provoke these symptoms, but may be accompanied by more insidious and generalized complaints. For example, people with early-stage malignant pleural mesothelioma may also suffer from chronic fatigue, recurring fevers, and drastic, unexpected weight loss.

Diagnosing Pleural Disease

Since pleural conditions often have very generalized symptoms, receiving an accurate diagnosis typically requires paying close attention to your body and taking a proactive approach to your physical health—especially if you have a history of occupational asbestos exposure, or believe that you may have otherwise been exposed to asbestos in the past.

Before reaching any conclusion, your doctor may ask questions about your symptoms and conduct a physical examination before ordering further tests. In many cases, simply listening to your lungs can give your physician clues—pleural effusions, for instance, can cause an unusually “dull” sound in response to chest taps.

However, reviewing your history and performing a physical examination is only the first step in identifying a pleural condition.

If you are exhibiting symptoms of asbestosis, or another condition, your physician may need to order other tests to rule out unrelated possibilities and assess your risk of cancer.

You may be asked to undergo:

A blood test, to see whether you have a viral infection or an illness that increases your risk for pleural disorders.
Medical imaging tests, like an X-ray or chest MRI, to look for fluid or air in the pleurae.
Thoracentesis, a procedure that removes a small sample of pleural fluid for testing.
A biopsy, the removal of a small sample of pleural tissue that will be analyzed in a laboratory for signs of cancer or another disease.

Any treatment, if deemed necessary, will most likely depend on your diagnosis.

Treatment for Different Types of Pleural Disease

The treatment of pleural disease is almost entirely dictated by your diagnosis.

Conventional tratamientos for non-malignant conditions could include:

Prescription painkillers and anti-inflammatory medications
The use of a chest tube to evacuate air from the pleural space
The drainage of excess pleural fluid through use of a small needle
The surgical removal of diseased or heavily damaged pleural tissue
Lifestyle changes, such as tobacco cessation

Pleural cancers, like malignant pleural mesothelioma, typically require much more intensive interventions. While mesothelioma has no known cure, a combination of procedures—including surgery, chemotherapy, surgery with heated intraperitoneal chemotherapy (HIPEC), and virotherapy—can significantly extend patients’ life expectancies, while reducing cancer-related pain.

Some emerging treatments have also shown great promise in mitigating malignant pleural mesothelioma.

Immune checkpoint inhibitors, or ICIs, have exhibited “demonstrated superiority over standard chemotherapy” in treating pleural cancer, especially cancers that cannot be surgically removed.

The use of ICI-type medications is a form of immunotherapy. Unlike chemotherapy, which introduces outside agents to kill cancer cells, immunotherapy teaches the body’s own immune system to recognize and eliminate cancerous cellular abnormalities. Both strategies are usually accompanied by efforts to remove infected pleural tissue.

In either case, early detection and early treatment tends to lead to better outcomes. But simply affording effective care can be difficult.

Fortunately, many Americans with asbestos-related illnesses have options for high-quality treatment—options that let them obtain cutting-edge care without breaking the bank or driving themselves into debt.