Asbestosis Clinical Presentation
- Author: Basil Varkey, MD, FCCP; Chief Editor: Zab Mosenifar, MD, FACP, FCCP more...
History and Physical Examination
Because the development of asbestosis is dose dependent, symptoms appear only after a latent period of 20 years or longer. This latent period may be shorter after intense exposure.
Dyspnea upon exertion is the most common symptom and worsens as the disease progresses. Patients may have a dry (ie, nonproductive) cough. A productive cough suggests concomitant bronchitis or a respiratory infection. Patients may report nonspecific chest discomfort, especially in advanced cases.
Rales are the most important finding during examination. Persistent and dry, they are described as fine cellophane rales or coarse Velcro rales. The rales are best auscultated at the bases of the lungs posteriorly and in the lower lateral areas.
Initially, physicians hear rales in the end-inspiratory phase. In advanced disease, however, rales may be heard during the entire inspiratory phase. Occasionally, the presence of rales precedes radiographic finding abnormalities and pulmonary function test abnormalities. Rales are not to be expected in all patients; one third of them may not have this symptom.
Finger clubbing is observed in 32-42% of cases. This finding is not necessarily related to the severity of disease.
Reduced chest expansion in advanced disease correlates with restrictive ventilatory impairment and reduced vital capacity. In advanced disease, patients may show the following signs associated with cor pulmonale: cyanosis, jugular venous distention, hepatojugular reflux, and pedal edema.
Churg A, Stevens B. Enhanced retention of asbestos fibers in the airways of human smokers. Am J Respir Crit Care Med. 1995 May. 151(5):1409-13. [Medline].
Gwinn MR, DeVoney D, Jarabek AM, Sonawane B, Wheeler J, Weissman DN. Meeting report: mode(s) of action of asbestos and related mineral fibers. Environ Health Perspect. 2011 Dec. 119(12):1806-10. [Medline].
Antao VC, Larson TC, Horton DK. Libby vermiculite exposure and risk of developing asbestos-related lung and pleural diseases. Curr Opin Pulm Med. 2012 Mar. 18(2):161-7. [Medline].
Pfau JC, Sentissi JJ, Weller G, Putnam EA. Assessment of autoimmune responses associated with asbestos exposure in Libby, Montana, USA. Environ Health Perspect. 2005 Jan. 113(1):25-30. [Medline].
Marchand LS, St-Hilaire S, Putnam EA, Serve KM, Pfau JC. Mesothelial cell and anti-nuclear autoantibodies associated with pleural abnormalities in an asbestos exposed population of Libby MT. Toxicol Lett. 2012 Jan 25. 208(2):168-73. [Medline].
Dumortier P, De Vuyst P. Asbestos exposure during uncontrolled removal of sprayed-on asbestos. Ann Occup Hyg. 2012 Jan. 56(1):49-54. [Medline].
Karjalainen A, Piipari R, Mantyla T, et al. Asbestos bodies in bronchoalveolar lavage in relation to asbestos bodies and asbestos fibres in lung parenchyma. Eur Respir J. 1996 May. 9(5):1000-5. [Medline].
Phelka AD, Finley BL. Potential health hazards associated with exposures to asbestos-containing drywall accessory products: A state-of-the-science assessment. Crit Rev Toxicol. 2012 Jan. 42(1):1-27. [Medline].
Sichletidis L, Chloros D, Spyratos D, et al. Mortality from occupational exposure to relatively pure chrysotile: a 39-year study. Respiration. 2009. 78(1):63-8. [Medline].
Wang X, Yano E, Qiu H, Yu I, Courtice MN, Tse LA. A 37-year observation of mortality in Chinese chrysotile asbestos workers. Thorax. 2012 Feb. 67(2):106-10. [Medline].
LaDou J, Castleman B, Frank A, Gochfeld M, Greenberg M, Huff J. The case for a global ban on asbestos. Environ Health Perspect. 2010 Jul. 118(7):897-901. [Medline].
Amar RK, Jick SS, Rosenberg D, Maher TM, Meier CR. Incidence of the Pneumoconioses in the United Kingdom General Population between 1997 and 2008. Respiration. 2012 Jun 7. [Medline].
Kim SY, Kim YC, Kim Y, Hong WH. Predicting the mortality from asbestos-related diseases based on the amount of asbestos used and the effects of slate buildings in Korea. Sci Total Environ. 2015 Oct 26. 542 (Pt A):1-11. [Medline].
Hammond EC, Selikoff IJ, Seidman H. Asbestos exposure, cigarette smoking and death rates. Ann N Y Acad Sci. 1979. 330:473-90. [Medline].
Camargo MC, Stayner LT, Straif K, Reina M, Al-Alem U, Demers PA. Occupational exposure to asbestos and ovarian cancer: a meta-analysis. Environ Health Perspect. 2011 Sep. 119(9):1211-7. [Medline].
Ameille J, Letourneux M, Paris C, Brochard P, Stoufflet A, Schorle E, et al. Does asbestos exposure cause airway obstruction, in the absence of confirmed asbestosis?. Am J Respir Crit Care Med. 2010 Aug 15. 182(4):526-30. [Medline].
Antao VC, Pinheiro GA, Wassell JT. Asbestosis mortality in the USA: facts and predictions. Occup Environ Med. 2009 May. 66(5):335-8. [Medline].
Centers for Disease Control and Prevention. Asbestosis-related years of potential life lost before age 65 years. United States 1968-2005. MMWR. 2008 Dec 12. 57:1321-25.
Billings CG, Howard P. Asbestos exposure, lung cancer and asbestosis. Monaldi Arch Chest Dis. 2000 Apr. 55(2):151-6. [Medline].
Hammar SP, Abraham JL. Commentary on pathologic diagnosis of asbestosis and critique of the 2010 Asbestosis Committee of the College of American Pathologists (CAP) and Pulmonary Pathology Society's (PPS) update on the diagnostic criteria for pathologic asbestosis. Am J Ind Med. 2015 Oct. 58 (10):1034-9. [Medline].
Ross RM. The clinical diagnosis of asbestosis in this century requires more than a chest radiograph. Chest. 2003 Sep. 124(3):1120-8. [Medline].
Voisin C, Fisekci F, Voisin-Saltiel S, Ameille J, Brochard P, Pairon JC. Asbestos-related rounded atelectasis. Radiologic and mineralogic data in 23 cases. Chest. 1995 Feb. 107(2):477-81. [Medline].
Sette A, Neder JA, Nery LE, Kavakama J, Rodrigues RT, Terra-Filho M, et al. Thin-section CT abnormalities and pulmonary gas exchange impairment in workers exposed to asbestos. Radiology. 2004 Jul. 232(1):66-74. [Medline].