The signs and symptoms of asbestosis rarely appear within the first 10 years of exposure to asbestos. Most patients display symptoms after 20 to 30 years following first exposure. This often confuses the diagnosis, especially if a patient does not report prior to asbestos exposure. Radiological examination (x-ray, CT), asbestos bodies in the sputum / BAL, and asbestos fiber counts on lung biopsy contribute to a conclusive diagnosis. Abnormalities detected on a pulmonary function test is non-specific for asbestosis but should be used as a means to assess the extent of impairment and monitor disease progression.
Signs and Symptoms of Asbestosis
One of the first symptoms for which patients seek medical attention is difficulty breathing (dyspnea). It is present from the early clinical stages of the disease and worsens as the disease progresses. Initially it appears as exertional dyspnea meaning that the difficulty breathing only arises with activity, the severity of which does not correlate to the level of activity. With time it persists even during rest.
It is a non-specific symptom for asbestosis and since this disease in fairly rare in comparison to other respiratory and cardiovascular diseases, asbestosis should not be the first consideration without other presenting symptoms and a definitive etiology. In smokers, the chronic obstructive pulmonary diseases (chronic bronchitis, emphysema) should be first excluded.
Coughing and Chest Pain
A dry cough (non-productive) that is persistent and often associated with chest pain may gradually arise. A productive cough (cough with sputum) may be seen over time and is more pronounced during secondary infections (acute). Once again, COPD should be considered in smokers and the various other more common causes of chest pain with coughing. Pleural plaques are the most common manifestation of asbestos exposure and it is important to identify symptoms of pleurisy although features like a pleural effusion (fluid around the lungs) is not always seen even with pleural involvement.
Clubbing is an advanced sign of asbestosis but as with the other symptoms mentioned above, it is not specific for asbestos-related lung diseases. Clubbing is a bulbous enlargement of the fingertips with distortion of the fingernail making it appear very curved or humped (refer to pictures below).
Other symptoms of asbestosis
The presence of other symptoms may be related to complications or other asbestos-related diseases. Signs of cyanosis with peripheral edema (swelling of the legs and sometimes hands) may be an indication of right sided heart failure. Unintentional weight loss with lymphadenopathy (enlarged lymph nodes), hemoptysis (coughing up blood) and malaise may be related to carcinoma of the lung or pleura (mesothelioma) and need to be investigated immediately, especially in a patient with confirmed asbestosis.