Document G6BZNpy9wqjj6Qym2MDmvYo1N

FILE NAME DuPont DUP DATE 1979 Oct DOC DUP113 DOCUMENT DESCRIPTION Guidelines for the Diagnosis and Classification of Asbestos Medical Cases - DuPont Medical Division Du Pont Medical Division October 1979 40.067 40.067 GUIDELINES FOR THE DIAGNOSIS AND CLASSIFICATION OF ASBESTOS MEDICAL CASES This guideline supplements the Guidelines for the Management of Chronic Occupational Illnesses 1 This guideline covers those asbestos conditions listed below Use of this classification should be restricted to those cases in which there is evidence of probable asbestos exposure @e Benign Asymptomatic Abnormalities Pleural thickening and plaques and calcification with no evidence of parenchymal disease @ Benign Symptomatic Illnesses Presumptive asbestosis Confirmed asbestosis Exudative pleural thickening Pleural effusion @ Malignant Illnesses Mesothelioma of the pleura or peritoneum Carcinoma of the lung larynx or gastrointestinal tract stomach colon A presumptive diagnosis of asbestosis is one in which there is good evidence of parenchymal disease due to asbestos exposure even though there is no interstitial fibrosis noted on ray Such a case would include pleural ray changes symptoms abnormal spirometry and abnormal blood gases Accepted medical practice and NIOSH guidelines suggest that a confirmed diagnosis of asbestosis should be made only with the presence of ray changes of interstitial fibrosis symptoms dyspnea cough etc. physical U- 1 000854 000854 000854 0 0854 000854 000854 00854 - - . aeas, findings rales etc. impaired pulmonary function abnormal spirometry or blood gases and a positive exposure history 2 3 A comprehensive history of probable exposure to asbestos and other pulmonary irritants should be obtained by the physician from the patient at the time of the examination This history will assist in the determination of causality as well as aiding in , the diagnosis The history should include all possible pre Pont occupational exposure and the asbestos exposure 4 A detailed evaluation of smoking habits should be made A supplemental work history should be prepared by site management listing all periods and circumstances of possible asbestos exposure If the employee was not assigned to a job that involved handling containing materials an attempt should be made to determine whether the employee could have incurred exposure by working near an operation where asbestos dust was released In determining when and whether causal exposure could have occurred it should be borne in mind that asbestos disorders can result not only from term moderate exposure but also from short massive exposure In all cases where the tentative diagnosis is a benign symptomatic illness or a malignant illness and in other cases if the evaluation is inconclusive the tentative diagnosis should be discussed with the Medical Division Where site should use an approved medical specialist appropriate to carry out the the additional testing or evaluation required to establish a diagnosis 000385 000385 000385 000385000385 -3- of further testing will normally be determined by the The scope specialist but referral letter should include certain indicating these tests minimum tests is attached A suggested Where an asbestos lung abnormality of Du Pont causality has been established the follow up should at a minimum include a annual posterior and lateral chest ray and pulmonary function tests If the employee refuses should be documented in the employee's medical record this fact Those employees with confirmed asbestosis exudative pleural thickening pleural effusion or malignant illnesses should be excluded from tasks with potential for exposure to asbestos Those with benign asymptomatic abnormalities need not be excluded Those with presumptive asbestosis should be handled on an individual basis REFERENCES 1. Medical Division Du Pont Employee Relations Department Guidelines for Physicians Section T. 2 Preger L. et al Asbestos Disease publisher Grune & Stratton New York 1978 3 NIOSH A Guide to the Relatedness of Disease Rev. Edicion January 1979 4 National Cancer Institute Asbestos An Information . Resource May 1978 ne, 000380 000380 000380 000380 000380 000380 Dear Dr. Chest ray findings abnormalities , is have , an employee of the Du Pont referred for pulmonary evaluation been interpreted as containing some In your evaluation the following minimums are requested A detailed history of occupational and nonoccupational exposures including smoking history Examination of the lungs Review of recent and left oblique chest rays views that include right Complete ventilatory function testing without and with a bronchodilator Measurement of arterial blood gases at rest and after exercise A statement of your evaluation of the respiratory impairment if any The etiology of the condition Please send your bill for this service testing and rays and the report to me examination If the employee requests that a copy of your report be sent to his or her personal physician please ask that this request be submitted in writing to me A copy of your report will then be sent from our office Please return our rays by certified mail Very truly yours 000387 000387 000387 000387 000387