Verursacht langjährige Asbestexposition eine obstruktive Ventilationsstörung?

Zusammenfassung

Die Literaturübersicht zeigt, dass langjährige Exposition gegenüber asbestfaserhaltigen Stäuben neben der Verminderung der Lungenvolumina zu einer Einschränkung der forcierten Atemflüsse, v. a. der FEF₅₀ und FEF₇₅, aber auch überhäufig der FEV₁/FVC sowie einer Erhöhung des Atemwegswiderstands führt. Es ergeben sich signifikante Dosis-Wirkungsbeziehungen und eine Zunahme der Funktionsstörungen bei langer Latenzzeit. Bemerkenswerterweise weisen bereits Kollektive ohne radiologisch fassbare Pleura- und Lungenparenchymveränderungen weitestgehend konsistent diese Veränderungen auf. Unter Nichtrauchern sind die asbestbedingten Lungenfunktionseinschränkungen im Mittel gering, im Einzelfall können sie aber den pathologischen Bereich und klinische Relevanz erreichen. Unter rauchenden Asbestexponierten sind die Lungenfunktionseinschränkungen in Folge synergistischer Wirkungen vor allem im Bereich der peripheren Atemwege hoch signifikant ausgeprägt. Die Verwendung nicht zeitgemäßer Sollwerte, Healthy-worker-Effekte und die Lungenblähung unterschätzen die asbestbedingten Lungenfunktionsveränderungen. Zwischen den verschiedenen untersuchten Berufsgruppen mit Asbestexposition ist kein eindeutiger Unterschied festzustellen.

Abstract

This review shows that long-term exposure to asbestos-containing dust leads not only to a reduction of lung volume as well as to limitations of forced expiratory flows, such as FEF₅₀ and FEF₇₅, but also to increased frequencies of FEV₁/FVC, and elevated airway resistance. There is evidence for significant dose-response relationships and an increase in functional changes in parallel to an increase due to the latency period. Remarkably, even asbestos workers without radiologically detectable pleural or parenchymal changes already show these functional impairments. In non-smokers, asbestos-induced lung function impairment is usually small on average, although some of these subjects show functional impairment of clinical relevance in the pathological range. In asbestos workers who also smoke, due to synergistic effects, lung function, especially of the peripheral airways, is highly significantly reduced. The use of inappropriate reference values, healthy worker effects, and airway trapping lead to an underestimation of asbestos-induced lung function impairments. There are no differences among the various occupations associated with asbestos exposure.

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