What are the key clinical features to consider when diagnosing asbestosis in a patient with a history of asbestos exposure?

When diagnosing asbestosis in a patient with a history of asbestos exposure, key clinical features to consider include persistent exertional breathlessness and a chronic cough, which are common presenting symptoms. On physical examination, bilateral inspiratory crackles (often described as 'Velcro-like') and digital clubbing may be present. Spirometry typically shows a restrictive pattern, although obstructive patterns can occasionally occur. Radiological assessment is crucial; chest X-ray may reveal pleural plaques and interstitial fibrosis, but high-resolution CT (HRCT) of the thorax is more sensitive for detecting early interstitial changes characteristic of asbestosis, such as subpleural fibrosis and honeycombing. A detailed occupational history confirming asbestos exposure is essential to support the diagnosis. Lung function tests including spirometry and gas transfer measurements help assess the extent of impairment. Multidisciplinary team evaluation involving respiratory physicians, radiologists, and specialist nurses is recommended to integrate clinical, functional, and imaging findings for a confident diagnosis. If uncertainty remains, further investigations such as bronchoalveolar lavage or lung biopsy may be considered, balancing diagnostic yield against procedural risks. It is also important to differentiate asbestosis from other asbestos-related diseases such as mesothelioma and lung cancer, which may present with overlapping symptoms but require urgent chest X-ray and specialist referral. Overall, the diagnosis relies on a combination of clinical features, confirmed asbestos exposure, lung function impairment, and characteristic radiological findings ¹ (Gefter et al., 1984; Sahin and Koksal, 2023).