[A model to diagnose occupational, asbestos-related pneumoconiosis and thickening of the pleura].

Abstract

To correctly diagnose occupational asbestos-related disease, a specialist in occupational health has to answer a set of questions: (A) is the asbestos-related disease diagnosed by a specialist in pulmonology with the help of a radiologist and cardiologist occupational or non-occupational; (B) is the occupational asbestos-related disease caused by more than one source of asbestos dust, and, if it is, to what has of each of these sources contributed to the development of the disease; (C) how many functional disorders and symptoms (pulmonary, cardiac, chest pain, reactive fear from death, reactive psychoneurotic disorder in which fear is not the main symptom) has occupational asbestos-related disease produced and to what degree; (D) have these disorders and symptoms permanently reduced patient's work ability, and, if they have, can we speak of work disability; (E) have these disorders permanently reduced vital activity, and, if they have, can we speak of vital disability; and (F) does the patient suffer mental pain because of reduced vital activity, and if he does, what sort of pain. This approach should assume the form and content of an expert specialist opinion, that is, of a legal medical expertise and should rely on a more extensive medical and non-medical documentation than the one serving for therapeutic purposes. As such methodological approach is rarely met in practice, we have proposed a model that includes evaluation of cumulative exposure to asbestos dust, determination of work and vital disability, and evaluation of mental pain. This method stems from our long-time practice and experience with patients suffering from asbestos-related diseases, including the experience acquired since 2002 from cooperation with the Reference Centre for Asbestosis and Other Asbestos-Related Diseases of the Croatian Ministry of Health at the Department for Pulmonary Diseases of the Clinical Hospital Split.