History and exam
Key diagnostic factors
common
occupational exposure
Exposure occurred with sufficient latency (at least 10 and usually 20 or more years prior to radiographical changes).[1]
A history of asbestos exposure will usually be identified because of the type of work (shipyard, construction, maintenance, vehicle brake mechanic, asbestos cement, insulation or production of tiles, shingles, gaskets, brakes, or textiles) that the patient has done.
Exposure may also be identified in children or spouses of a worker who has brought asbestos home on clothes and boots.[1]
In the US and Europe, the risk of exposure is currently greatest among construction and/or maintenance workers who work with or around previously installed asbestos.[1]
longer duration of exposure
The more asbestos inhaled, the greater the risk of developing asbestosis.[1][2]
The cumulative dose of asbestos required for pleural changes is less than that needed for asbestosis.[1] There is a latency period of around 20 years from time of first exposure to asbestos to development of radiographic changes, so the diagnosis is typically seen in individuals who began working with asbestos prior to the 1980s and are now usually more than 50 years of age.
smoking history
Smoking cigarettes increases the risk of asbestosis, but not pleural changes, presumably by reducing the ability of the lung to clear asbestos fibres.[4]
Other diagnostic factors
common
dyspnoea on exertion
Shortness of breath with activity is typically the first sign of asbestosis and increases with progression of disease. It can be absent in patients with early asbestosis and is usually absent in patients with pleural changes alone.
cough
Dry, non-productive cough; frequency increases with progression.
It can be absent in patients with early asbestosis and is usually absent in patients with pleural changes alone.
A productive cough may be seen if the patient has also developed COPD.[1]
crackles
Initially heard at bases and increases with progression of disease. It can be absent in patients with early asbestosis and is absent in patients with pleural changes alone.
Not specific to asbestosis.[1]
uncommon
indirect exposure
Absence of direct exposure to asbestos in a patient with characteristic radiographical changes may be due to contact with clothing from an individual who has been exposed.[5]
chest pain
Not typically seen in patients with asbestosis or pleural changes. Symptoms of chest tightness from shortness of breath may be confused with chest pain. Severe unremitting chest pain raises concern about cancer, particularly mesothelioma.
clubbing
Only found in advanced asbestosis, not found with pleural disease alone.
Not specific to asbestosis.[1]
Risk factors
strong
cumulative dose of inhaled asbestos
The best predictor for the development of asbestosis and asbestos-related pleural changes is the total amount of asbestos inhaled. The cumulative dose required for pleural changes is less than that needed for asbestosis.[1]
A history of occupational asbestos exposure will usually be identified because of the type of work (shipyard, construction, maintenance, vehicle brake mechanic, asbestos cement, insulation or production of tiles, shingles, gaskets, brakes or textiles) that the patient has done; exposure may also be identified in children or spouses of a worker who has brought asbestos home on clothes and boots.[1] In the US and Europe, the risk of exposure is currently greatest among construction and/or maintenance workers who work with or around previously installed asbestos.[1]
There are certain geographic areas where natural occurrence of asbestos or industrial pollution puts residents at risk due to environmental exposure.[13][14]
weak
cigarette smoking
Smoking cigarettes increases the risk of asbestosis, but not pleural changes, presumably by reducing the ability of the lung to clear asbestos fibres.[4]
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