What are the current guidelines for managing respiratory symptoms in patients with confirmed asbestosis?

Management of respiratory symptoms in patients with confirmed asbestosis primarily involves symptomatic assessment and supportive care similar to interstitial lung diseases. Patients presenting with breathlessness should be assessed for the cause and degree of hypoxia, with consideration of ambulatory and long-term oxygen therapy as appropriate. Pulmonary rehabilitation tailored to individual needs, including exercise and education, should be offered to improve functional status. For breathlessness at rest, additional assessment for oxygen needs and psychosocial support, including referral to palliative care services, is recommended. Pharmacological symptom relief with benzodiazepines and/or opioids may be considered for severe symptoms.

For cough management, treat underlying causes such as gastro-oesophageal reflux or post-nasal drip. If cough is debilitating, opioids may be used, and in intractable cases, specialist consultation for treatments like thalidomide may be warranted, although this is off-label and requires informed consent.

Given the asbestos exposure, patients with respiratory symptoms such as persistent cough, chest pain, or breathlessness, especially those aged 40 and over, should be offered urgent chest X-ray within 2 weeks to exclude malignancies such as mesothelioma or lung cancer.

Smoking cessation support should be provided to all patients who smoke. Regular monitoring of lung function and symptom progression is important, with referral to respiratory specialists if there is diagnostic uncertainty or rapid deterioration.