Asbestosis is a condition characterized by diffuse interstitial fibrosis of the lung due to exposure to asbestos dust.
Asbestos is a type of naturally occurring mineral that is resistant to heat.
Exposure to asbestos occurs through inhalation of fibers from environments containing asbestos products.
The incidence of asbestosis is related to the cumulative dose of inhaled asbestos fibers.
The greater the cumulative dose, the higher the incidence.
Fibers with a diameter less than 3-micro meters can penetrate cell membranes and induce fibrosis.
Fibers with a greater diameter cannot penetrate cell membranes and are phagocytosed by alveolar macrophages, releasing various cytokines that cause cellular damage.
The inflammation starts in the areas of alveolar bifurcations.
It causes activation of alveolar macrophages and release of inflammatory cytokines, reactive oxygen species, and various growth factors, which ultimately result in lung fibrosis.
Smokers are at a higher risk of developing asbestosis as they have defective mucociliary clearance in the airways.
Asbestosis can lead to various complications, including pulmonary hypertension, cor-pulmonale, right heart failure, and progressive respiratory insufficiency.
In addition, asbestosis is a significant risk factor for the development of lung carcinoma.
The symptoms of asbestosis usually begin to appear after about 20 years of initial exposure.
However, some individuals may experience symptoms sooner if the exposure is high.
Dyspnea on exertion is the most common symptom of asbestosis, and it becomes more severe when the disease progresses.
Patients may also have a chronic, dry cough.
If the cough is productive, concomitant bronchitis or a respiratory tract infection should be suspected.
In advanced cases, patients may also complain of chest discomfort.
On auscultation, bi-basal rales can be heard. These are more prominent over the posterior lung bases.
Finger clubbing is observed in about 30 to 40% of cases.
In advanced cases, reduced chest expansion can also be seen.

A diagnosis of asbestosis is made with a combination of the following.
A history of significant exposure to asbestos.
Dyspnea upon exertion.
Bi-basal crepitations.
Characteristic changes of pulmonary fibrosis on imaging studies.
And restrictive pattern of lung disease on pulmonary function studies.
It is important to note that these changes must be seen in the absence of other fibrotic diseases that mimic asbestosis.
Drugs are not effective in the treatment of asbestosis per se.
However, treatment with antibiotics is required for respiratory tract infections.
In addition, patients should be immunized with influenza and pneumococcal vaccines.
If the patient develops hypoxia at rest, supplemental oxygen may be needed.
In advanced cases, palliative care may be needed for the relief of distressing symptoms.

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