What are the management options for asbestosis?

From the Guidelines

Management of asbestosis should focus on supportive care, preventing disease progression, and improving quality of life, with the primary recommendation being to immediately stop any further asbestos exposure. This approach is based on the irreversible nature of asbestos-related lung damage, with treatment aimed at slowing progression and improving quality of life rather than reversing the fibrotic changes 1. The diagnosis of asbestosis imposes a duty to inform the patient that he or she has a disease that is work-related, to report the disease, and to inform the patient that he or she may have legal or adjudication options for compensation 1.

Key Management Strategies

• Smoking cessation is essential as it can accelerate lung damage and increase cancer risk in asbestos-exposed individuals 1
• Pulmonary rehabilitation programs can help improve exercise capacity and quality of life
• Supplemental oxygen therapy is recommended for patients with hypoxemia (oxygen saturation below 88%)
• Annual influenza vaccinations and pneumococcal vaccines (Prevnar 13 followed by Pneumovax 23) are important to prevent respiratory infections
• Regular monitoring with pulmonary function tests every 1-2 years and chest imaging helps track disease progression
• Corticosteroids and immunosuppressants have not shown significant benefit
• Lung transplantation may be considered in severe cases with respiratory failure
• Patients should also be monitored for complications like lung cancer, mesothelioma, and pulmonary hypertension

Screening and Surveillance

• Screening for lung cancer using periodic (annual) chest films, low-dose computed tomography, or sputum cytology has not been shown to be effective in preventing mortality or improving quality of life in populations of smokers without known adverse occupational exposures 1
• Screening for colorectal cancer is recommended by the American Cancer Society for persons more than 50 years of age, and it is reasonable to screen for this condition in asbestos-exposed workers due to the potential increased risk of colon cancer 1

From the Research

Management Options for Asbestosis

The management of asbestosis is primarily focused on relieving symptoms and preventing further exposure to asbestos.

• There is no efficient medical treatment for asbestosis, as stated in the study 2.
• The diagnosis of asbestosis is based on professional exposure, compatible interstitial lung and pleural disease, and the exclusion of alternative hypotheses, which can be comforted by bronchoalveolar lavage (cytology and biometeorology) 2.
• High-resolution CT is the most performant investigation, particularly in the presence of asbestosis, either minimal or of recent origin 2.
• Various evolutions are possible, including stability, progression to respiratory insufficiency, and increased incidence of bronchial carcinoma 2.
• Life expectancy is reduced in severe cases, and asbestosis is recognized as a professional disease 2.

Screening and Monitoring

• A better recognition of asbestosis necessitates a performance policy of depistage in populations with significant present or past exposure and an appropriate diagnostic strategy, including high-resolution CT 2.
• Continued monitoring of individuals exposed to asbestos, even decades after the cessation of exposure, is recommended, as pulmonary function tests (PFTs) may decline and CT findings may worsen over time 3.
• The role of imaging in the management of patients with previous asbestos exposure and asbestos-related pulmonary disease is crucial, with particular emphasis on the radiographic appearance of the disease and the discussion of various imaging modalities and their utility 4.

Risk Factors and Associations

• Asbestos exposure may cause asbestos-related lung diseases, including asbestosis, pleural abnormalities, and malignancies, and the role of asbestos exposure in the development of small airway obstruction remains controversial 5.
• The duration of exposure to asbestos was significantly associated with the forced expiratory volume in the first second (FEV1)/forced vital capacity (FVC) ratio and the predicted percentage of MEF25 or MEF50 according to the regression analysis in non-smoking patients with asbestosis 5.
• A community-based case-control study aimed to analyze the risk and protective factors associated with asbestos-related diseases and to investigate the incidence of new clinical manifestations in patients already diagnosed with some form of ARD 6.