Our cells (including those in the lung) are subject to damage from infections and other abnormal materials (including asbestos). When the repair process is upset or altered in some way this can lead to a change in the structure of the tissue, which we call “fibrosis”.
How asbestosis affects patients
Some people with asbestosis develop only minor lung scarring without any symptoms. Others progress to more established scarring called fibrosis. It is not known why some people develop severe scarring and others do not.
At the more severe end of the spectrum, the scarring pattern in asbestosis (which in the letters you receive from your doctor is termed “usual interstitial pneumonia”) looks identical to that seen in idiopathic pulmonary fibrosis (abbreviated to “IPF”).
How antifibrotic drugs can sometimes help
IPF is a condition for which there have been licensed treatments for some time. These drugs are called “antifibrotics”. They include a drug called Nintedanib (see below). They act to slow down the process of fibrosis by helping your lung repair more normally. It has long been frustrating for doctors that it has not been possible to offer such treatments to patients with asbestosis. The process leading to the lung damage is the same, even if the cause is not.
Medical research called The INBUILD study (Cottin et al. 2019) has demonstrated that the rate of lung function decline in patients with a wide range of progressive fibrotic lung conditions (including asbestosis) can be slowed with the use of the antifibrotic drug Nintedanib. This is already widely used and well tolerated in IPF.
How your doctor will decide if NIntedanib could help you
The criteria used to determine decline include falling breathing test values, worsening lung CT scans appearances or progressive symptoms. The National Institute for Health and Care Excellence (NICE) recently published guidance, based on a review of available evidence, allowing specialist doctors to prescribe this medication for patients with progressive fibrotic lung diseases other than IPF. This guidance takes effect from the end of February 2022.
What you can do about it
It may be that you are, or may become in the future, eligible for consideration of Nintedanib. This will depend on whether there is demonstrable progressive fibrosis. You can discuss this with your chest doctor. If you are no longer under the care of a specialist, it may be appropriate to discuss referral with your GP.
Dr. Anjali Crawshaw DPhil, FHEA, FRCP
Editors Note: If you decide to talk to your GP about Nintedanib, but don’t know what to say, you may like to show them this article.