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STO|75775 PLAINTIFF'S EXHIBIT MEDICAL QUESTIONS AND ANSWERS ON ASBESTOS (JAMA, NOVEMBER 9, 1984) Q. Does Asbestosls develop In all who are heavily exposed for extended periods? A. No. Humans differ markedly in their response to asbestos fibers. (The same can be said of most other substances.) Immunology may be a factor. Q. What is the treatment of Asbestosls? A. There Is no treatment other than symptomatic. Prevention Is the only way to control the disease. Q. Is It advisable to change jobs when evidence of Asbestosls develops? A. Further exposure should be eliminated. Q. What changes in the pleura are observed after exposure? A. Asbestos produces isolated lesions In the pleura. Including effusion, fibrosis, plagues, and mesothelioma. Pleural plaques are localized flbrotlc lesions that originate just below the surface of the parietal pleura. Calcification is often found. Pleural plaques seldom cause lesions. Pleural mesothelioma Invariably produces pain, usually before other symptoms appear. Fibrosis Is often not present. Pleural plaques do not develop Into mesothelioma (not a premallgnant 1eslon). Q. Can mesothellomas develop after either transient or casual exposure to asbestos? A. Mesotheliomas are rare. Reported In household contact - people with limited exposure Not associated with smoking Reported 11 - 16% of cases - no history of exposure 9LLSLI01S MEDICAL QUESTIONS AND ANSWERS ON ASBESTOS (JAMA, NOVEMBER 9, 1984) Q. Does cigarette smoking Influence the develoment of asbestosrelated diseases? A. There Is no evidence that cigarette smoking predisposes a person to pulmonary fibrosis or mesothelioma. However, smoking can decrease pulmonary function and compromise overall health. The synergistic effect of cigarette smoke and asbestos exposure greatly Increases the risk of bronchogenic carcinoma. Lung cancer rate for non-smoking asbestos workers Is five times the rate of controls. The asbestos worker who smokes is 53 times more ltkely to develop bronchogenic carcinoma. Q. What is the likelihood that bronchogenic carcinoma will develop In a patient with Asbestosls? A. There Is no specific relationship. Q. What risks are associated with drinking water containing asbestos? A. There Is no evidence to Indicate that Ingested fibers cause disease In man. Q. Do the commonly used asbestos substitutes cause diseases? A. To date, there Is no reason to believe fibers of glass or mineral wool cause chronic pulmonary disease. sn 5/85 STO175777 MEDICAL QUESTIONS AND ANSWERS ON ASBESTOS (JAMA, NOVEMBER 9, 1984) Q. What are the major pathologic responses to asbestos exposure? A. Pulmonary fibrosis (Asbestosls) Malignant mesotheliomas Bronchogenic carcinoma Other malignancies Pleural plaques Q. What are the clinical features of Asbestosls? A, Early stages asymptomatic As it progresses - cough, shortness of breath, fatigue, weight loss, chest pain Advanced stages - restriction of chest expansion, clubbing and blueness of fingers Chest x-ray - fibrosis (strands) particularly In bases Pulmonary function - primarily restrictive Poor gas exchanges Q. What exposure Is required for develoment of Asbestosls? A. Brief exposure to a high concentratlon may occasionally result in Asbestosls; however, generally one must inhale relatively large amounts for an extended period. Lesions are not usually apparent for at least five years after exposure. Casual and sporadic exposures do not generally produce fibrosis. Q. Is there a relation between fiber size and development of disease? A. Long fibers (8 micrometers or more) play an Important role. Most fibers (95%) are relatively short. Current techniques Ignore fibers less than 5 micrometers.