21st February 2025

Asbestosis

Asbestosis is an interstitial lung disease caused by progressive pulmonary fibrosis in response to inhaled asbestos fibres.

Presentation of asbestosis

The initial symptoms of asbestosis are usually progressive dyspnoea and a dry cough. These usually develop decades after asbestos exposure. 

Signs may include bilateral fine crackles on auscultation (usually starting at the bases), reduced chest expansion and finger clubbing.

Investigation of asbestosis

Initial screening is with a chest X-ray, which may show bilateral interstitial changes. The presence of asbestos-related pleural changes may support a diagnosis of asbestosis as the cause of interstitial changes. Chest X-ray changes can be subtle in early disease so more sensitive HRCT may be considered.

Pulmonary function testing will usually demonstrate a restrictive pattern with reduced TLCO but also reduced KCO as lung parenchyma is affected. If there has been a significant smoking history, there may also be an obstructive element to the results.

Lung biopsy is not normally required.

Management of asbestosis

There is currently no disease-modifying treatment for asbestosis so focus should be on supportive treatment, including avoiding further asbestos exposure, smoking cessation, pulmonary rehabilitation, long-term oxygen therapy and pneumococcal and influenza vaccines.