question about diagnosing asbestos related symptoms i have

[robgt350]

I think I might have either Pulmonary fibrosis or asbestosis from working on ships as a boiler repair man in the 1990’s. I recall working daily repairing and replacing machines that had or contained asbestos. I have signs of sever short of breath, some chest pains, non productive cough, unable to do a lot of physical activities and some nail clubbing. I took an chest x-ray last year and my doctor said it was “unremarkable” but I insisted something is wrong. He agrees asbestos might be a big factor. So I have an appointment with a pulmonologist next month for further testing. I bought a hand held spirometer to do self-pulmonary function tests and I get readings; FVC =45%-55% of predicted values, FEV/FVC% = 45%-55% on a regular daily basis for the past month. By pulse oximetery reading is around 95% on room air and heart rate around 80bpm. When I exercise (fast walk) my pulse oxygen is around 93%-94% and my pulse is around 110 beats per minute.
My questions are,
Can I still be diagnosed with asbestosis, or pulmonary fibrosis without any signs (fibrosis, scaring, damage, inflammation, ect) on my xray or HRCT?
Can my health complaints above be early symptoms of asbestosis or pulmonary fibrosis that cannot be seen on chest x-rays or HRCT?
Can I be diagnosed only by my long term exposure to asbestos, my symptoms, pulmonary function tests? Should I ask for early treatment?
Thank you so much
Rob

[robgt350]

thank you

[David Tinkelman, M.D.]

You ask:  My questions are,
Can I still be diagnosed with asbestosis, or pulmonary fibrosis without any signs (fibrosis, scarring, damage, inflammation, etc) on my x-ray or HRCT?
Can my health complaints above be early symptoms of asbestosis or pulmonary fibrosis that cannot be seen on chest x-rays or HRCT?
Can I be diagnosed only by my long term exposure to asbestos, my symptoms, pulmonary function tests? Should I ask for early treatment?
Thank you so much  

Yes, you could be given the presumptive diagnosis of asbestosis with a Chest X-ray interpreted as normal but that would be unlikely and never  with a normal CT Scan, given your reported PFT values, the degree of your shortness of breath and your stated limitation in the performance of physical activity.

Yes, to the second question, as well.  Your symptoms could be on the basis of asbestosis and/or pulmonary fibrosis, with a “normal” chest X-ray but never with a normal CT, if your symptoms are on the basis of one of these two diseases.  In some instances of a negative chest X-ray, “crackles” or “rales” can be heard by the examining physician.

The answer again, especially with well-documented exposure to asbestos and pulmonary function test results consistent with the diagnosis, is that asbestosis could be a presumptive diagnosis.

Your best bet would be to see a Pulmonologist with a special interest in Occupational  (Environmental) Medicine, best of all a physician with significant experience with asbestosis.

There is no treatment that will change/remove the asbestos in your lungs but persons with that disease often have obstruction to air flow, as is the case with COPD, and that obstruction may be partially reversible in response to bronchodilator drugs.

Good luck