John P. Cunha, DO, is a U.S. board-certified Emergency Medicine Physician. Dr. Cunha's educational background includes a BS in Biology from Rutgers, the State University of New Jersey, and a DO from the Kansas City University of Medicine and Biosciences in Kansas City, MO. He completed residency training in Emergency Medicine at Newark Beth Israel Medical Center in Newark, New Jersey.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Asbestosis is a process of lung tissue scarring caused by asbestos fibers. Because many other diseases also lead to lung scarring, other causes must be excluded first when a patient is found to have lung scarring
(pulmonary fibrosis). Patients with particular
X-ray findings or biopsy results must also have a remote history of asbestos exposure and a characteristically delayed development of the condition in considering asbestosis as a diagnosis.
Smoking appears to increase the frequency and/or the rate of progression of asbestosis, possibly by preventing the efficient elimination of inhaled fibers from the airways.
What are symptoms and signs of
asbestosis?
The clinical symptoms usually include slowly progressing
shortness of breath and cough, often 20 to 40 years after
exposure to asbestos. Breathlessness advances throughout
the disease, even without further asbestos inhalation. In
the absence of cigarette smoking, sputum (mucus coughed up
from the lungs) production and wheezing are uncommon. The
exception is workers who have been exposed to very high
concentrations of asbestos fibers. Those workers may also
develop symptoms as soon as 10 years after exposure. Other
indications of asbestosis include abnormal lung sounds on
examination, changes in the ends of the fingers and toes
("clubbing"), a blue tinge to the fingers or lips
("cyanosis"), and failure of the right side of the heart
("cor pulmonale").
What tests and studies are used to evaluate asbestosis?
Breathing abnormalities can be identified with lung function tests (pulmonary function tests or PFTs) or exercise tests that are performed at specialized laboratories. Asbestosis can produce both obstruction of airflow and restriction of lung inflation. In addition, the disease can affect the ability to transfer oxygen into the blood. With advanced disease, patients may have markedly reduced blood oxygen at rest and may need supplementary oxygen.
X-ray abnormalities include thickening of the lining of
the lungs and tiny lines marking the lower portions of the
lungs. However, up to 20% of patients have completely
normal-appearing chest X-rays. These patients may
demonstrate more subtle changes on computerized X-ray
studies (computerized tomography, or CT scans). Up to 30%
of patients with a normal chest X-ray who have been exposed
to asbestos will have an abnormal high resolution (high
definition) CT. The CT scan may be very useful in
separating true asbestosis from other conditions that may
have similar findings. However, even a CT scan may not
identify disease of the lining of the lung (pleural
disease) in patients with asbestosis. The proper role of
CT scanning has not been fully established.
Laboratory testing studies may be abnormal (certain antibodies
and markers of inflammation), but they do not specifically
suggest asbestosis.
Occasionally, a biopsy and microscopic examination of the lung is used to diagnose asbestosis.
Under microscopic examination, certain coated fibers (asbestos bodies) can be seen in association with a pattern of scarring. The amount of both coated and uncoated (transparent) asbestos has been linked to the severity of asbestosis. Because other particles may resemble asbestos, a conclusive identification may require scanning electron microscopy. Currently, detection of asbestos fibers in the lung tissue and fluids (sputum, secretions) can be used to make the diagnosis, along with a history of asbestos exposure and characteristic
X-ray or CT results.
The currently available commercial form of asbestos, chrysotile, does not form asbestos bodies as easily as previously used fibers.
Lung cancer kills more men and women than any other form of cancer. Eight out of 10 lung cancers are due
to tobacco smoke. Lung cancers are classified as either small cell or non-small
cell cancers.
There are several types of kidney cancer, including renal cell cancer (renal adenocarcinoma or hypernephroma), transitional cell carcinoma, and Wilms tumor. Symptoms of kidney cancer include blood in the urine, an abdominal lump or mass, chronic pain in the side, and tiredness. Treatment of kidney cancer--which may include surgery, arterial embolization, radiation therapy, biological therapy or chemotherapy--depends upon the stage of the disease and the patient's overall health.
Esophageal cancer is a disease in which malignant cells form in the esophagus. Risk factors of cancer of the esophagus include smoking, heavy alcohol use, Barrett's esophagus, being male and being over age 60. Severe weight loss, vomiting, hoarseness, coughing up blood, painful swallowing, and pain in the throat or back are symptoms. Treatment depends upon the size, location and staging of the cancer and the health of the patient.
Pleurisy, an inflammation of the lining around the lungs, is associated with sharp chest pain upon breathing in. Cough, chest tenderness, and shortness of breath are other symptoms associated with pleurisy. Pleurisy pain can be managed with pain medication and by external splinting of the chest wall.
Cancer is a disease caused by an abnormal growth of cells, also called malignancy. It is a group of 100 different diseases, and is not contagious. Cancer can be treated through chemotherapy, a treatment of drugs that destroy cancer cells.
Pulmonary fibrosis is scarring throughout the lungs. Pulmonary fibrosis can be caused by many conditions including chronic inflammatory processes, infections, environmental agents, exposure to ionizing radiation, chronic conditions, and certain medications. Symptoms include shortness of breath, coughing, and diminished exercise tolerance. Treatment options are dependent on the type of pulmonary fibrosis; lung transplant and/or medications are optons.
Symptoms of cancer of the larynx, the organ at the front of the neck, include hoarseness, a lump in the neck, sore throat, cough, problems breathing, bad breath, earache, and weight loss. Treatment for larynx cancer depends on the stage (the extent) of the disease. Radiation therapy, surgery, and chemotherapy are all forms of treatment for laryngeal cancer.
Pleural effusion is an excess fluid between the two membranes that envelop the lungs. There are two classifications of causes of pleural effusion; transudate and exudate. The treatment of pleural effusion depends on the cause.
Interstitial lung disease, is a term to describe a certain lung condition. Causes of interstitial lung disease include lung infection, exposure to toxins in the environment (asbestos for example), medications (chemotherapy), radiation therapy, and chronic autoimmune disorders. Common symptoms of interstitial lung disease include a dry cough and shortness of breath. Diagnosis and treatment depend upon the cause of the condition.
Head and neck cancer is cancer of the oral cavity, salivary glands, paranasal sinuses and nasal cavity, pharynx, larynx, or lymph nodes in the upper part of the neck. These cancers account for 3% to 5% of cancers in the U.S. Tobacco and alcohol use are important risk factors. Treatment may involve surgery, radiation therapy, and/or chemotherapy.
Though it's difficult to say why some people develop cancer while others don't, research shows that certain risk factors increase a person's odds of developing cancer. These risk factors include growing older, family history of cancer, diet, alcohol and tobacco use, and exposure to sunlight, ionizing radiation, certain chemicals, and some viruses and bacteria.
Mesothelioma is a form of cancer that forms in the chest lining (pleural mesothelioma), abdomen (peritoneal mesothelioma), and the heart sac (pericardial mesothelioma) in rare cases. Chest pain, shortness of breath, weight loss, and night sweats are symptoms and signs of mesothelioma. Treatment depends upon the stage and type of mesothelioma.
The lungs are primarily responsible for the exchange of oxygen and carbon dioxide between the air we breathe and the blood. Eliminating carbon dioxide from the blood is important, because as it builds up in the blood, headaches, drowsiness, coma, and eventually death may occur. The air we breathe in (inhalation) is warmed, humidified, and cleaned by the nose and the lungs.
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