Guidelines Summary

In 2014, an update to the 1997 consensus Helsinki guidelines for the diagnosis of asbestos-related disorders was published. The guidelines define asbestosis as diffuse interstitial fibrosis of the lung as a consequence of exposure to asbestos dust. The following criteria should be used to identify asbestos exposure^[1]:

Over 0.1 million amphibole fibers (>5 μm) per gram of dry lung tissue, or
Over 1 million amphibole fibers (>1 μm) per gram of dry tissue, as measured by electron microscopy in a qualified laboratory, or
Over 1,000 asbestos bodies per gram of dry tissue (100 asbestos bodies per gram of wet tissue), or
Over 1 asbestos body per milliliter of bronchoalveolar lavage fluid, as measured by light microscopy in a qualified laboratory.

The guidelines recommend the use of computed tomography (CT) imaging in the diagnosis of asbestos-related diseases under the following circumstances:

A borderline finding of lung fibrosis (International Labor Office [ILO] 0/1-1/0) is detected;
There is a discrepancy between a lung function finding of restriction and radiographs interpreted as normal;
Widespread pleural changes severely hamper the radiographic visibility of the lung parenchyma.

The criteria for diagnosis of asbestosis on CT scans include:

Sum grade of ≥2–3 bilateral irregular opacities in the lower zones according to the reference film, or
Bilateral honeycombing (sum grade ≥2) would be sufficient to represent fibrosis, according to the ICOERD system (International Classification of high-resolution CT [HRCT] for Occupational and Environmental Respiratory diseases classification).

The guidelines further note that in histopathology, bronchiolar wall fibrosis has been associated with asbestos exposure and other exposures including smoking. Subpleural curvilinear lines or dots in HRCT are findings of bronchiolar fibrosis.^[1]

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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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