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Current RMA Instruments
|Reasonable Hypothesis SOP||59 of 2021|
|Balance of Probabilities SOP||60 of 2021|
Changes from previous Instruments
- ICD-9-CM Codes: 501
- ICD-10-AM Codes: J61
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, 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 is unlikely to have been experienced by Australian military personnel since at least the 1980s. Some rare instances of exposure sufficient to meet the asbestosis SOP factors may potentially have occurred in certain trades or on certain deployments. Generally these exposures are likely to have been documented. 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 significantly higher than for pleural plaques or mesothelioma. The potential for high level inhalational exposure to airborne asbestos fibres 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
Conditions not covered by SOP
- fibrosing alveolitis - fibrosing interstitial lung disease SOP
- fibrosing interstitial lung disease*
- pleural plaque*
- pulmonary fibrosis* - fibrosing interstitial lung disease SOP
* another SOP applies
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.
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.
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 the same factors for asbestos exposure as those in the asbestosis SOP, so effectively, asbestos-related fibrosing interstitial lung disease is covered by both SOPs.