Approach
No medicine is known to reverse or prevent the progression of interstitial fibrosis from asbestos. Pleural thickening is generally a marker of exposure and very rarely requires treatment.
Specific interventions
Advice on the importance of not smoking: the most important physician intervention given the synergy between cigarettes and asbestos for increasing the risk of lung cancer. The increased risk of lung cancer in non-smoking asbestos workers is 5.2, in smoking non asbestos-exposed individuals the risk is 10.8, but in smoking asbestos workers the risk of lung cancer is increased 53-fold.[25]
Pulmonary rehabilitation: designed to reduce symptoms and optimise functional status. It involves exercise training, education, nutritional intervention and psychosocial support and is recommended by the American Thoracic Society for patients with interstitial lung disease.[31][32] There is low- to moderate-quality evidence for improvements in dyspnoea and quality of life for people with interstitial lung disease, and moderate-quality evidence for improvements in exercise capacity.[32][33] Further studies are needed to establish the optimal exercise prescription and to determine the long-term benefits.[33]
Oxygen therapy: patients with progressive fibrosis and PaO₂ of ≤55 mmHg or oxygen saturation of ≤89% are candidates for oxygen therapy. This improves exercise tolerance and reduces the risk of developing pulmonary hypertension and cor pulmonale.
Lung transplant: patients with end-stage respiratory failure (PaO₂ <60 mmHg despite oxygen therapy) due to parenchymal disease are potential candidates for lung transplants.[34]
Pleural decortication: rarely, a patient may develop diffuse pleural thickening of sufficient extent that pleural decortications should be considered.
The use of corticosteroids or other immunosuppressants are not recommended for asbestosis given the lack of evidence of benefit and their known adverse effects.
General recommendations for chronic lung disease
Antibiotics should be given if there is evidence of infection, such as change in sputum production, fever, and increasing dyspnoea. Patients with evidence of obstructive airways disease should receive appropriate bronchodilator therapy.
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