Asbestosis

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Asbestos, due to its unique physical properties and abundance, was widely used in commercial applications at the beginning of the 20th century. By the 1930s, reports of respiratory illnesses in workers with occupational exposure to asbestos began to surface. Inhalation of asbestos leads to a localized inflammatory response that attempts to clear inhaled asbestos fibers. This inflammatory response and retained asbestos fibers are central to the pathogenesis of asbestosis-related pulmonary disease. Asbestos causes a range of pulmonary diseases ranging from benign, incidental pleural abnormalities to progressive, fatal pulmonary fibrosis to malignant neoplasms of the lung and pleura. The benign manifestations of asbestos exposure, the focus of this chapter, can be grouped into pleural and parenchymal diseases. Asbestosis is a fibrotic, parenchymal disease caused by asbestos exposure. After several decades from initial asbestos exposure, patients develop dyspnea, exercise intolerance, and hypoxia with restrictive physiology on pulmonary function testing similar to other interstitial lung diseases. The most common pleural manifestation is pleural plaques, which are localized areas of pleural fibrosis that are often found incidentally. While normally asymptomatic, they are a marker of asbestos exposure. Other pleural manifestations tend to be symptomatic and include diffuse pleural thickening and acute benign pleural effusion. This chapter discusses pathogenesis, clinical presentation, radiographic and physiologic manifestations, and management of benign asbestos lung diseases.