Sections

Asbestosis

Presentation

History

A detailed occupational and potential exposure history is essential. Obtain the following information^[2]:

Employment
Exposure: Year, duration, and end; type (occupational, domestic, environmental)
Intensity: Direct contact for longer than 6 months (8 hours daily, 40 hours per week) or a high concentration of asbestos in the air breathed is considered intense exposure. Exposure risk covers an area within a 300-2200 meter radius (dependent on wind direction).
Asbestos type
Smoking history

The development of asbestosis is dose dependent, with symptoms typically appearing only after a latent period of 20 years or longer. However, the latency period may be shorter after intense exposure.

Dyspnea upon exertion is the most common symptom of asbestosis and worsens as the disease progresses. Patients may have a dry (ie, nonproductive) cough. A productive cough, however, suggests concomitant bronchitis or a respiratory infection. Patients may report nonspecific chest discomfort, especially in advanced cases.

Physical Examination

Bibasilar rales are the most important finding during examination in a patient with suspected asbesosis. Persistent and dry, they are described as fine cellophane rales or coarse Velcro rales. The rales are best auscultated at the posterior lung bases and in the lower lateral areas.

Initially, rales may be heard 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. However, note that up to one of patients may not have rales at al.

Finger clubbing is observed in 32-42% of cases of asbestosis. 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 asbestosis, patients may show the signs associated with cor pulmonale, such as cyanosis, jugular venous distention, hepatojugular reflux, and pedal edema.

Differential Diagnoses

[Guideline] Wolff H, Vehmas T, Oksa P, Rantanen J, Vainio H. Asbestos, asbestosis, and cancer, the Helsinki criteria for diagnosis and attribution 2014: recommendations. Scand J Work Environ Health. 2015 Jan. 41 (1):5-15. [Medline]. [Full Text].
Diego Roza C, Cruz Carmona MJ, Fernandez Alvarez R, et al. Recommendations for the diagnosis and management of asbestos-related pleural and pulmonary disease. Arch Bronconeumol. 2017 Aug. 53 (8):437-42. [Medline]. [Full Text].
World Health Organization. Chrysotile Asbestos. Geneva, Switzerland: World Health Organization; 2014. [Full Text].
Liu G, Cheresh P, Kamp DW. Molecular basis of asbestos-induced lung disease. Annu Rev Pathol. 2013 Jan 24. 8:161-87. [Medline]. [Full Text].
Boulanger G, Andujar P, Pairon JC, et al. Quantification of short and long asbestos fibers to assess asbestos exposure: a review of fiber size toxicity. Environ Health. 2014 Jul 21. 13:59. [Medline]. [Full Text].
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].
Yang IV, Fingerlin TE, Evans CM, Schwarz MI, Schwartz DA. MUC5B and idiopathic pulmonary fibrosis. Ann Am Thorac Soc. 2015 Nov. 12 suppl 2:S193-9. [Medline]. [Full Text].
Platenburg MGJP, Wiertz IA, van der Vis JJ, et al. The MUC5B promoter risk allele for idiopathic pulmonary fibrosis predisposes to asbestosis. Eur Respir J. 2020 Jan 16. [Medline].
Kawabata Y. Asbestos exposure results in asbestosis and usual interstitial pneumonia similar to other causes of pneumoconiosis. IntechOpen; 2019. [Full Text].
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].
Hanson R, Evilia C, Gilmer J, et al. Libby amphibole-induced mesothelial cell autoantibodies bind to surface plasminogen and alter collagen matrix remodeling. Physiol Rep. 2016 Aug. 4 (15):[Medline]. [Full Text].
Gilmer J, Harding T, Woods L, Black B, Flores R, Pfau J. Mesothelial cell autoantibodies upregulate transcription factors associated with fibrosis. Inhal Toxicol. 2017 Jan. 29 (1):10-7. [Medline]. [Full Text].
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].
Pfau JC, Serve KM, Noonan CW. Autoimmunity and asbestos exposure. Autoimmune Dis. 2014. 2014:782045. [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].
Bang KM, Mazurek JM, Wood JM, Hendricks SA. Diseases attributable to asbestos exposure: years of potential life lost, United States, 1999-2010. Am J Ind Med. 2014 Jan. 57 (1):38-48. [Medline]. [Full Text].
The National Institute for Occupational Safety and Health (NIOSH). Asbestosis. Available at http://wwwn.cdc.gov/eWorld/Grouping/Asbestosis/92. May 2017; Accessed: March 4, 2020.
Alper HE, Yu S, Stellman SD, Brackbill RM. Injury, intense dust exposure, and chronic disease among survivors of the World Trade Center terrorist attacks of September 11, 2001. Inj Epidemiol. 2017 Dec. 4 (1):17. [Medline]. [Full Text].
Clark KA, Flynn JJ 3rd, Karmaus WJJ, Mohr LC. The Effects of Pleural Plaques on Longitudinal Lung Function in Vermiculite Miners of Libby, Montana. Am J Med Sci. 2017 Jun. 353 (6):533-542. [Medline]. [Full Text].
U.S. Department of the Interior-United States Geological Survey. Mineral Commodity Summaries: Asbestos. United States Geological Survey. Available at https://minerals.usgs.gov/minerals/pubs/commodity/asbestos/. January 2017; Accessed: December 2, 2017.
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].
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].
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].
Merlo DF, Bruzzone M, Bruzzi P, et al. Mortality among workers exposed to asbestos at the shipyard of Genoa, Italy: a 55 years follow-up. Environ Health. 2018 Dec 29. 17 (1):94. [Medline]. [Full Text].
Klebe S, Leigh J, Henderson DW, Nurminen M. Asbestos, smoking and lung cancer: an update. Int J Environ Res Public Health. 2019 Dec 30. 17 (1):9712464. [Medline]. [Full Text].
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].
Reid A, de Klerk N, Musk AW. Does exposure to asbestos cause ovarian cancer? A systematic literature review and meta-analysis. Cancer Epidemiol Biomarkers Prev. 2011 Jul. 20 (7):1287-95. [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].
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].
International Labor Office. Guidelines for the use of the ILO international classification of radiographs of pneumoconioses, revised edition 2011. 2011 Nov 11. [Full Text].
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].
Lee EK, Kim JS, Kim Y, Park JS. CT Findings in People Who Were Environmentally Exposed to Asbestos in Korea. J Korean Med Sci. 2015 Dec. 30 (12):1896-901. [Medline]. [Full Text].
Tekath M, Dutheil F, Bellini R, Roche A, Pereira B, Naughton G, et al. Comparison of the ultra-low-dose Veo algorithm with the gold standard filtered back projection for detecting pulmonary asbestos-related conditions: a clinical observational study. BMJ Open. 2014 May 30. 4 (5):e004980. [Medline]. [Full Text].
Roggli VL, Gibbs AR, Attanoos R, Churg A, Popper H, Cagle P, et al. Pathology of asbestosis- An update of the diagnostic criteria: Report of the asbestosis committee of the college of american pathologists and pulmonary pathology society. Arch Pathol Lab Med. 2010 Mar. 134 (3):462-80. [Medline]. [Full Text].
[Guideline] Apostoli P, Boffetta P, Bovenzi M, et al. Position paper on asbestos of the Italian Society of Occupational Medicine. Med Lav. 2019 Dec 17. 110 (6):459-85. [Medline].

Media Gallery

Asbestosis. Asbestos pleural plaques.

of 1

Author

Christopher D Jackson, MD Faculty, Department of Internal Medicine, University of Tennessee Health Science Center College of Medicine-Memphis; Staff Physician, Christ Community Health Services; Staff Physician, Baptist Memorial Hospital

Christopher D Jackson, MD is a member of the following medical societies: American College of Physicians, Memphis Medical Society, National Medical Association, Southern Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Muthiah P Muthiah, MD, FCCP, D-ABSM Associate Professor of Medicine, Division of Pulmonary and Critical Care and Sleep Medicine, Vice Chair for Internal Medicine (VA Academic Affairs), University of Tennessee Health Science Center College of Medicine; Director of Medical Intensive Care Unit (MICU), Memphis Veterans Affairs Medical Center

Muthiah P Muthiah, MD, FCCP, D-ABSM is a member of the following medical societies: American Academy of Sleep Medicine, American College of Chest Physicians, American Thoracic Society, Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Chief Editor

Zab Mosenifar, MD, FACP, FCCP Geri and Richard Brawerman Chair in Pulmonary and Critical Care Medicine, Professor and Executive Vice Chairman, Department of Medicine, Medical Director, Women's Guild Lung Institute, Cedars Sinai Medical Center, University of California, Los Angeles, David Geffen School of Medicine

Zab Mosenifar, MD, FACP, FCCP is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, American Federation for Medical Research, American Thoracic Society

Disclosure: Nothing to disclose.

Additional Contributors

Basil Varkey, MD, FCCP Professor Emeritus, Department of Internal Medicine, Division of Pulmonary and Critical Care, Medical College of Wisconsin; Consulting Pulmonologist, Froedtert Memorial Lutheran Hospital

Basil Varkey, MD, FCCP is a member of the following medical societies: American College of Chest Physicians, American Association of Physicians of Indian Origin

Disclosure: Nothing to disclose.

Anita B Varkey, MD Assistant Professor, Department of Medicine, Loyola University Medical Center; Associate Program Director, Internal Medicine Residency; Medical Director, General Internal Medicine Clinic, Loyola Outpatient Center

Anita B Varkey, MD is a member of the following medical societies: American College of Physicians, Society of General Internal Medicine

Disclosure: Nothing to disclose.

Acknowledgements

Sat Sharma, MD, FRCPC Professor and Head, Division of Pulmonary Medicine, Department of Internal Medicine, University of Manitoba; Site Director, Respiratory Medicine, St Boniface General Hospital

Sat Sharma, MD, FRCPC is a member of the following medical societies: American Academy of Sleep Medicine, American College of Chest Physicians, American College of Physicians-American Society of Internal Medicine, American Thoracic Society, Canadian Medical Association, Royal College of Physicians and Surgeons of Canada, Royal Society of Medicine, Society of Critical Care Medicine, and World Medical Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

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