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Asbestosis H003

Document
Last amended 
4 July 2017

In this section

Current RMA Instruments:
Reasonable Hypothesis SOP
55 of 2013
Balance of Probabilities SOP
56 of 2013
Changes from previous Instruments:

SOP Bulletin 167

ICD Coding:
  • ICD-9-CM Codes: 501
  • ICD-10-AM Codes: J61
Brief description

Asbestosis is scarring of the lungs due to the inhalation of large quantities of airborne asbestos fibres over a long period.  It is a type of fibrosing interstitial lung disease, but is covered by a stand alone SOP.  See further comments below.

Confirming the diagnosis

The diagnosis of asbestosis is made on the basis of the clinical history, findings on examination and on spirometry testing, and radiological imaging. A High resolution CT or MRI scan is generally required.  Lung biopsy may be performed in some cases.

Asbestosis is difficult to distinguish from some other forms of fibrosing interstitial lung disease. A history of sufficient exposure to asbestos dust is a critical component in making the diagnosis.  Asbestosis is increasingly an historical diagnosis.  The level of exposure necessary to cause the condition should not have been experienced by any Australian military personnel since at least the 1980s.  Some naval personnel with long term service prior to then may have had sufficient exposure to have developed the condition.  The level of exposure needed is much higher than for pleural plaques or mesothelioma.  The potential for high level asbestos dust exposure to have occurred needs to be considered before a diagnosis of asbestosis is accepted.

The relevant medical practitioner is a specialist respiratory or general physician. 

Additional diagnoses covered by SOP
  • Nil
Conditions not covered by SOP
  • fibrosing alveolitis - fibrosing interstitial lung disease SOP
  • fibrosing interstitial lung disease*
  • mesothelioma*
  • pleural plaque*
  • pulmonary fibrosis* - fibrosing interstitial lung disease SOP

* another SOP applies

Clinical onset

Asbestosis generally presents with shortness of breath (dyspnoea) which is progressive.  Once the diagnosis has been confirmed, backdating of clinical onset to the commencement of dyspnoea may be possible if the clinical picture is consistent with asbestosis and not some other cause of shortness of breath.

Clinical worsening

In asbestosis there is usually progressive deterioration in respiratory function.  Establishing clinical worsening beyond the normal course of the disease would be difficult and would require speciailist opinion.  There is no current treatment that will alter the underlying course of the condition.

Comments

If the diagnosis of asbestosis is established by the demonstration of sufficient asbestos bodies in the lung on histology, or based on a convincing history of heavy inhalational asbestos exposure, then this SOP applies.  If fibrosing interstitial lung disease is present, but a diagnosis of asbestosis cannot be confirmed, then the fibrosing interstitial lung disease SOP applies.  That SOP has factors for asbestos exposure, so effectively, asbestos-related fibrosing interstitial lung disease is covered by both SOPs.