Asbestos-Related Pulmonary Disease Management

Core Management Principles

• The American Thoracic Society recommends removing patients from further asbestos exposure to potentially avoid more rapid progression of lung disease, though specific evidence for benefit is lacking 2, 3, 4.
• Aggressive smoking cessation counseling is critical, as the interaction between smoking and asbestos exposure dramatically enhances the risk of lung cancer, according to the American Journal of Respiratory and Critical Care Medicine 1, 5, 6, 7.
• Administering pneumococcal and annual influenza vaccines, unless contraindicated, reduces morbidity from infectious complications in patients with compromised lung function, as suggested by the American Journal of Respiratory and Critical Care Medicine 2, 3, 4.

Symptomatic Management

• Treating concurrent obstructive airway disease (COPD or asthma) with standard bronchodilators and inhaled corticosteroids may reduce morbidity from mixed disease, according to the American Journal of Respiratory and Critical Care Medicine 2, 3, 4.
• Managing advanced complications, such as cor pulmonale, secondary polycythemia, and respiratory insufficiency/failure, using standard approaches for chronic respiratory disease is recommended by the American Journal of Respiratory and Critical Care Medicine 2, 3, 4.

Surveillance and Monitoring

• Monitoring with chest radiographs and pulmonary function tests every 3-5 years for persons with significant asbestos exposure history, when time since initial exposure is 10 years or more, is recommended by the American Journal of Respiratory and Critical Care Medicine 1, 5, 8, 3.
• The American Journal of Respiratory and Critical Care Medicine suggests not performing routine screening for lung cancer or mesothelioma using periodic chest films, low-dose CT, or sputum cytology, as these have not been shown to improve mortality or quality of life in asbestos-exposed populations 1, 5, 3, 4.
• Screening for colorectal cancer in patients over 50 years of age may be beneficial, as there may be an elevated risk with asbestos exposure, according to the American Journal of Respiratory and Critical Care Medicine 1, 5, 3, 4.

Important Clinical Caveats

• All patients with asbestosis should be considered at risk of progressive lung disease, regardless of initial impairment level, as stated by the American Journal of Respiratory and Critical Care Medicine 2, 3, 4.
• Informing patients of work-related disease status and potential legal/compensation options, and performing objective impairment evaluation consistent with the specific compensation system rules, using American Thoracic Society guidelines, is recommended by the American Journal of Respiratory and Critical Care Medicine 2, 3, 4.
• Counseling patients about risk of disease progression, malignancy risk, the synergistic effect of smoking and asbestos on lung cancer risk, and risks from other occupational/environmental carcinogens is crucial, according to the American Journal of Respiratory and Critical Care Medicine 1, 5, 6, 7.