20th February 2025

Asbestosis

Overview and diagnosis of asbestosis

Asbestosis is interstitial fibrosis secondary to asbestos inhalation. Disease severity is correlated with length of exposure, type and quantity of asbestos.

Symptoms include gradual-onset shortness of breath and dry cough. Examination may reveal bi-basal inspiratory crackles and clubbing.

Diagnosis involves:

• Imaging: asbestosis can resemble IPF on CXR and HRCT, with reticulonodular shadowing (CXR) and subpleural fibrosis (CT). The presence of pleural thickening and plaques help to make the diagnosis of asbestosis
• Lung function tests: typically a restrictive pattern
• Biopsy: asbestos bodies may be seen

Management of asbestosis

There is no effective drug treatment for asbestosis. Supportive treatment including home oxygen may be required in advanced stages. Lung transplant is rare but can be considered.

As a high proportion of those with asbestosis die from malignancy, and cigarette smoking increases the severity and rate of progression of asbestosis, it may be appropriate to advise patients to stop smoking.

See note on nintedanib – this has now been approved as a treatment option for chronic progressive fibrosing interstitial lung diseases.