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

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Asbestosis. Asbestos pleural plaques.

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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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