Asbestosis is a chronic (long-term) lung condition caused by prolonged exposure to asbestos.
Asbestos is a general term for a group of minerals made of microscopic fibres. In the past, it was widely used in construction.
Asbestos can be very dangerous. It does not present a health risk if it is undisturbed, but if material containing asbestos is chipped, drilled, broken or allowed to deteriorate, it can release a fine dust that contains asbestos fibres.
When the dust is breathed in, the asbestos fibres enter the lungs and can gradually damage them over time. For asbestosis to develop, prolonged exposure to relatively high numbers of the fibres is necessary. However, it is not the only factor, as many people avoid getting asbestosis, despite heavy exposure.
Symptoms of asbestosis
Breathing in asbestos fibres may eventually scar the lungs of some people, which can lead to a number of symptoms, including:
shortness of breath – this may only occur after physical activity at first, but it can eventually become a more constant problem
a persistent cough
fatigue (extreme tiredness)
in more advanced cases, clubbed (swollen) fingertips
Nowadays, most people who are diagnosed with asbestosis were exposed many years ago, before there were effective controls on exposure to asbestos fibres in the workplace.
See your GP if you have the above symptoms and you think you may have been exposed to asbestos in the past.
There is no cure for asbestosis once it has developed, because it is not possible to reverse the damage to the lungs.
One of the most important things someone with the condition can do is to stop smoking, if they smoke. This is because the symptoms are more likely to get worse in people who smoke, and smoking also increases the risk of lung cancer in people with asbestosis.
If necessary, treatments such as oxygen therapy can improve the quality of life of someone with asbestosis.
The outlook for asbestosis can vary significantly, depending on the extent of damage to the lungs and whether any other conditions are present.
Asbestosis can get worse over time and severe cases can place a significant strain on a person's health and shorten their life expectancy, but in many cases the condition progresses very slowly or not at all.
However, people with asbestosis have a higher risk of developing other serious and potentially life-threatening conditions, such as:
pleural disease – where the membrane covering the lungs (pleura) becomes thicker, which can further contribute to breathlessness and chest discomfort
mesothelioma – a type of cancer that affects the membrane that covers the lungs, heart and gut
Overall, more people with asbestosis die as a result of one of the cancers mentioned above, or from natural causes, than from asbestosis itself.
If you have been diagnosed with asbestosis, you may be able to claim compensation. This can be done through:
industrial injuries disablement benefit – this is a weekly benefit that may be paid to people with asbestosis who were exposed to asbestos while in employment (but not self-employed)
a civil claim for compensation through the courts – you will need to obtain legal advice about how to do this
a claim for a lump compensation sum under the Pneumoconiosis etc. (Workers' Compensation) Act 1979 – if you have asbestosis, or you are the dependant of someone who has died from the condition, and you haven't been able to get compensation through the courts because the employer who exposed you (or the person on whose behalf you are claiming) has ceased trading
There are three main types of asbestos that were used in construction. Two of these – called crocidolite and amosite – were banned in 1985 (although voluntary bans came into force earlier than this) and the use of the third type (chrysotile) was widely banned in 1999.
However, despite these strict regulations having been in place for a number of years, large amounts of asbestos are still found in many older buildings.
It's therefore important to take precautions to reduce your risk of inhaling asbestos fibres if you live or work in a building that may contain asbestos.
If you are concerned that your house may contain asbestos, you can seek advice from an environmental health officer at your local authority or council. Do not attempt to remove any materials that you think may contain asbestos yourself.
If your job means you could potentially be exposed to asbestos fibres, make sure you are fully aware of what you can do to reduce your risk. Do not attempt to remove any asbestos you come across, unless you have been trained in how to do this safely.
Who is affected
Asbestosis is a relatively rare condition, because it takes a considerable degree of asbestos exposure to cause it, and regulations to restrict exposure have been in place for many years.
However, in 2011 there were 178 deaths directly caused by asbestosis and 429 where the condition was thought to have played a role. 980 new cases were assessed for industrial injuries disablement benefit during 2012.
Causes of asbestosis
Asbestosis is caused by breathing in asbestos fibres. People working in certain trades are more likely to have been exposed to asbestos in the past.
What is asbestos?
Asbestos is a general term for a group of minerals made of microscopic fibres. Materials containing asbestos used to be widely used in construction, because they are strong, durable and fire-resistant.
There were three main types of asbestos in commercial use:
crocidolite ("blue asbestos")
amosite ("brown asbestos")
chrysotile ("white asbestos")
All these types of asbestos are hazardous if a material containing them becomes damaged and the fibres are released into the air.
No crocidolite was imported into the UK after 1970, and both amosite and crocidolite were banned in 1985 (although voluntary bans on the industrial use of both these materials came into force earlier than this). Chrysotile was not banned until 1999.
This means that, although asbestos is no longer used, materials containing asbestos are still found in many older buildings.
How asbestos fibres affect the lungs
When you inhale a foreign body, such as a dust particle, cells in the lungs called macrophages usually hunt and break the particle down before it gets into your lung tissues and bloodstream.
However, asbestos fibres are too difficult for the macrophages to break down. In an attempt to break down the fibres, the macrophages release substances that are intended to destroy the fibres, but actually cause the tiny air sacs in your lungs (alveoli) to become damaged and permanently scarred over time. This scarring is what is known as asbestosis.
Alveoli are crucial in transferring oxygen from the air into your bloodstream and removing carbon dioxide from your bloodstream. If they become damaged and scarred, these processes will be affected, resulting in symptoms such as breathlessness.
For asbestosis to develop, prolonged exposure – usually over many years – to relatively high numbers of asbestosis fibres is necessary.
Occupations associated with asbestos exposure
The use of asbestos increased significantly after World War II. It peaked during the 1970s, before declining during the 1980s and 1990s. You may have been exposed to asbestos if you worked in an industry such as building or construction, where asbestos was used during this time period.
Occupations particularly associated with exposure to asbestos during this period include:
plumbers, pipefitters and steamfitters
sheet metal workers
heating, air-conditioning and refrigeration mechanics
Now that asbestos is no longer used, those most at risk of being exposed to asbestos fibres include people whose jobs put them at risk of damaging any asbestos remaining in older buildings, such as caretakers, electricians and demolition workers.
The Health and Safety Executive (HSE) website has more information about when you are most likely to be at risk of asbestos exposure.
When diagnosing asbestosis, your GP will first ask about your symptoms and listen to your lungs with a stethoscope (a medical instrument used to listen to the heart and lungs).
If your lungs have been affected by asbestos, they will usually make a crackling noise when you breathe in.
Your GP will also ask about your work history, particularly about periods when you may have been exposed to asbestos, how long you may have been exposed, and whether you were issued with any safety equipment, such as a face mask, when you were working.
Referral to a specialist
If asbestosis is suspected, you will be referred to a specialist in lung diseases for tests to confirm any lung scarring. These may include:
a chest X-ray – to detect abnormalities in the structure of your lungs that could be caused by asbestosis
a computerised tomography (CT) scan of the lungs – which produces more detailed images of the lungs and the membrane covering the lungs and can help identify less obvious abnormalities
lung function tests – to assess the impact of damage of the lungs, determine how much air your lungs can hold and assess how well oxygen crosses the membrane of the lungs into your bloodstream
Before confirming a diagnosis of asbestosis, the chest specialist will also consider and rule out other possible causes of lung inflammation and scarring, such as rheumatoid arthritis.
There is no cure for asbestosis, as the damage to the lungs is irreversible. However, you can take steps to reduce your symptoms and improve your quality of life.
These are outlined below.
If you have been diagnosed with asbestosis and you smoke, it's very important to stop as soon as possible.
Smoking can make your symptoms of breathlessness worse and significantly increase your risk of developing lung cancer at a later stage.
Speak to your GP for help with giving up smoking. They can advise about nicotine replacement therapies and prescription medicines that can greatly increase your chances of quitting successfully. Your GP can also put you in touch with local support groups in your area.
If you have asbestosis, your lungs will be more vulnerable to infection.
It's recommended that you have the influenza (flu) vaccination to protect against flu, and the pneumococcal vaccination to protect you from the bacteria that can cause serious conditions, such aspneumonia. Your GP can arrange for you to have these vaccinations.
You will need the flu vaccine every year to ensure you stay protected. Most people only require one dose of the pneumococcal vaccine, although additional booster shots may be recommended if your general health is poor.
Long-term oxygen therapy
If you have severe asbestosis, your body may not be getting all the oxygen it needs to function properly. Oxygen therapy may be recommended if you have low levels of oxygen in your blood.
Oxygen therapy is supplied through a machine called an oxygen concentrator, which purifies oxygen from the air in the room and produces a more oxygen-rich supply of air.
This oxygen-rich air is breathed in through a mask or a small, soft plastic tube placed just inside your nostrils (nasal cannula).
You may be given a small, portable oxygen tank and mask, to be used when you're out of the house. This is known as ambulatory oxygen.
It's very important not to smoke when you are using an oxygen concentrator. This is because high concentrations of oxygen are highly flammable, and a lit cigarette or flame could cause a fire or an explosion.
Most people with asbestosis will not benefit from any specific medication for the condition, unless you have another condition also affecting the lungs, such as chronic obstructive pulmonary disease (COPD).
More severe cases may benefit from medicines, such as small doses of morphine to reduce breathlessness and a cough.
Serious side effects are uncommon, because the dose is so small. The most common problem is constipation, and a laxative will usually be given at the same time to help you pass stools.
Although asbestos is no longer widely used in the UK, it's still important to take precautions to reduce your risk of exposure, because it's still found in many old buildings.
Strict regulations were introduced in 1970 to regulate the use of asbestos in the workplace.
However, the import, supply and use of brown (amosite) and blue (crocidolite) asbestos was not banned in the UK until 1985. White asbestos (chrysotile) was banned in 1999, except for a small number of specialist uses of the material.
This means that buildings that were built or refurbished before the year 2000 could still contain asbestos.
Asbestos in your home
If you are concerned that your house may contain asbestos, you can seek advice from an environmental health officer at your local authority or council.
In these circumstances, it may be best to leave any asbestos-containing materials where they are – especially if they are in good condition and unlikely to get damaged. You should check the condition of the materials from time to time to make sure they haven't been damaged or started to deteriorate.
Slightly damaged asbestos-containing materials can sometimes be repaired by sealing or enclosing them. However, this should only be done by someone with the necessary training. Any badly-damaged asbestos material that cannot be protected should be removed by someone who is appropriately trained. Your local environmental health officer can advise you about this.
If you are planning any home improvements, repairs or maintenance, and you intend to bring in any additional workers or contractors, you should inform them of any asbestos materials in your home before they start work. This will help reduce the risks of any asbestos-containing material being disturbed.
You can search for who to contact about asbestos in your home on the GOV.UK website.
Asbestos in your workplace
If your job doesn't directly put you at risk of asbestos exposure, but you are concerned about asbestos in your workplace, speak to the building duty holder about what they are doing to monitor and manage the situation.
A duty holder is someone who is responsible for maintaining and repairing non-domestic premises.
If any asbestos-containing materials in your workplace are assessed as being in good condition, and not in a position where they are likely to be damaged, they will usually be left in place and monitored.
However, asbestos-containing materials that are in a poor condition or are likely to be damaged during the normal use of the building should be sealed, enclosed or removed as appropriate.
Working with asbestos
If your job means that you could potentially be exposed to asbestos fibres, make sure the appropriate precautions are taken before and during any work you do.
The Health and Safety Executive (HSE) has drawn up the following checklist for employers, managers and traders to go through before carrying out work on a building that may contain asbestos:
Identify whether asbestos is present and determine its type and condition – this may mean checking with the building manager or having the area surveyed.
Carry out a risk assessment to determine whether it's possible to carry out the work, while avoiding the risk of asbestos exposure completely.
Decide if the work needs to be carried out by a licensed contractor – the removal of certain types of asbestos-containing material will need to be done by a contractor holding a licence from the HSE.
If the work is not licensable, decide if the work needs to be notified – some jobs require the relevant enforcing authority to be notified of what you are doing
Ensure that those carrying out the work are suitably trained – any worker who may disturb asbestos during their daily work needs to receive appropriate training, so that they can protect themselves and others.
Steps that may help reduce your exposure to asbestos during your work include wearing protective equipment (such as a suitable face mask), cleaning up as you go (using a vacuum cleaner or wet rags, rather than sweeping) and not using power tools whenever possible.
Want to know more?
The HSE website has more information about:
managing and working with asbestos
dos and don'ts when working with asbestos
task sheets outlining how to carry out non-licensed work with asbestos
You may also find it useful to read the Control of Asbestos Regulations (2012), which outline the measures that should be in place to reduce the risk of asbestos exposure.