Document vyBbGR49gQyjVw4Ld7vORd1nR

A Guidelines for the Diagnosis and Clasaifleatlon of Asbeetos-fteiatad Medical Cun Thit guideline supplements the Guidelines forth* Management of Chronic Occupational Hines***. (See Section 3.2) it a>so cover* those asbastos-related condition* listed below. Use of this classification should be re stricted to those cases m which there is evidence of probable asbestos exposure. Benign Asymptomatic Abnormalities; Pleural thickening and/or plaques and/or calcification with no evidence of parenchymal disease Benign Symptomatic Illnessac Presumptive asbestosis Confirmed asbestosis Exudative pleural thickening Pieurai effusion Malignant (Inessas: i Mesothelioma of the pleura or peritoneum Carcinoma of the lung, larynx, or gastrointestinal tract (stomach, colon) A presumptive diagnosis of asbestosis it one in which there Is good evidence of parenchymal disease due to asDestos exposure even though there is no intarstltiai Ibrosla noted on x-ray. Such a case would in clude pleural x-ray changes, symptoms, abnormal spirometry and/or abnormal blood gases. Accepted medical practica and NIOSH guidelines suggsst that a confirmed diagnosia of asbestosis should be made only with the presence of x-ray changae of interstitial fibrosis, symptoms (dyspnea, cough, ate.), physical findings (ralts, stc.), impaired pulmonary function (abnormal spirometry or blood gases), and a positive exposure history (1, 2). 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 preDuPont occupational exposure and off-the-iob asbestos-related exposure (3). A detailed evaluation of smoking habits should be made. Ail employees who have been exposed to asbestos should be informed oftheir greatly increased risk of developing lung cancer If they continue to smoke. They should be strongly advised to stop smoking. This should be documented in the medical record. 9 % [ 0 9 3 5 17B DU 036887 - Section 4 1 Pi|<2 A suoclemental work history should be orepared by site management listing all penods and/or drcumstancas of possible asbestos exposure. If tha employee was not assigned to a job that involved han dling asbestos-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 deter mining wnen and whether causal exposure could neve occurred, it should be borne m mind that asbestosrelated disorders can result not only from long-term moderate exposure but also from short-term massive exposure. in ail 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 Medi cal Oivision. The site should use an approved medical specialist to carry out the additional tasting or eval uation required to establish a diagnosis. The scope of further testing will normally be determined by the specialist, but should include certain minimum tests. A suggested referral letter indicating these tests is attached. ( Whsra an asbestoe-ralatad lung abnormality of Du Pont causality has been established, the fallow-upshould at a minimum, include a peeterior-antanorchest x-ray, and pulmonary function tests done annual ly. If the pulmonery specietist recommends more frequent examinations, this should be done. If the em ployee refuses, this fact should be documented in the employee's medical record. Those employees with confirmed eibestosia. presumptive esbestosis, exudative pleural thickening, pleural effusion or malignant illnesses should be excluded from teaks with potential torexposure to asbes tos. Those with benign asymptomatic abnormalities need not be excluded. Ail employees with asbestos- related abnormalities should be instructed todiscontinue smoking and this fact should be docu mented in their medical record. References ' (1) Pregar, U at el, "Asbestos-Related Olseaaa*. published Game It Stratton, New York, 1978. (2) NIOSH, "A Guide to the Work-Relatadneea of Disease', Rev. Edtion, January 1979. (3) National Cancer Inatituts, `Asbestos: An Information Resource*, May 1978. o ut N-a DU 036888 DU 036889