Asbestosis risk factors

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Kim-Son H. Nguyen, M.D., M.P.A., Beth Israel Deaconess Medical Center, Harvard Medical School, Boston MA, Cafer Zorkun, M.D., Ph.D. [2]

Overview

• Asbestos exposure occurs most commonly in the workplace.

  • Miners and millers of asbestos are at risk, but at even greater risk are people exposed during manufacturing and construction.
  • Maintenance, repair, and removal of asbestos-containing material can also result in significant exposures.
  • The health risk to building occupants where asbestos is in good repair and undisturbed is thought to be insignificant.
  • Occupational Safety & Health Administration (OSHA) regulations require special precautions in areas where the concentration is > 0.2 fibers per cubic milliliter of air.
  • About 8% of asbestos workers will die of respiratory failure secondary to asbestosis, and asbestos workers have a 50% chance of dying from malignancy (versus 18% chance for the average American).

• Asbestosis is a slowly progresive disease, so only a subset of patients progress on to respiratory failure.

  • Risk factors for progression include:

    • Cumulative exposure
    • Duration of exposure
    • Degree of symptoms
    • Cigaretter smoking
    • Diffuse pleural thickening
    • Honeycombing on high-resolution computed tomography (HRCT)
    • High concentrations of inflammatory cells on BAL

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