Asbestosis Clinical Presentation

Updated: Mar 05, 2020
  • Author: Christopher D Jackson, MD; Chief Editor: Zab Mosenifar, MD, FACP, FCCP  more...
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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.

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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.

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