Synopsis
Distinguish benign pleural markers, asbestosis and asbestos-related malignancy, take a defensible exposure history and route suspicious symptoms urgently without overstating screening benefits.
- Asbestos exposure can cause pleural plaques, benign pleural effusion, diffuse pleural thickening, rounded atelectasis, asbestosis, lung cancer and malignant mesothelioma.
- Disease typically follows a long latency, so relevant work may have occurred decades before retirement, migration or symptom onset.
- Pleural plaques are markers of previous exposure and are usually asymptomatic; they are not themselves malignant or a precursor that transforms into mesothelioma.
Key red flags
Unilateral progressive chest pain, breathlessness, recurrent exudative effusion, nodular pleural thickening or loss of hemithoracic volume warrants urgent cancer-pathway referral.
Investigation priorities
Establish plausible exposure, latency and potential ongoing risk.
Management branches
A patient reports asbestos contact or incidental plaques are found.
- Take a task-based lifetime exposure and smoking history, assess respiratory symptoms and explain that plaques confirm exposure but do not themselves become cancer.
- For asymptomatic plaques, avoid attributing unrelated breathlessness or arranging unsupported serial CT; address smoking cessation and provide symptom safety-netting.
Key medicines
Controlled oxygenIn acute hypoxaemia titrate to 94–98% for most adults or 88–92% when hypercapnic respiratory failure risk exists, pending blood gases and any patient-specific target.
Nicotine replacement therapyChoose a licensed patch, gum, lozenge, inhalator or combination regimen according to tobacco dependence and current local stop-smoking formulary, with behavioural support and product-specific instructions.