Distinct comorbidity profiles and outcomes in asbestosis versus idiopathic pulmonary fibrosis: a 6-year prospective cohort study

Our plain-English summary of Distinct comorbidity profiles and outcomes in asbestosis versus idiopathic pulmonary fibrosis: a 6-year prospective cohort study, by Y. Song, Y. Wang, N. Dilixiati, et al (BMC Pulmonary Medicine, 2026).

The study

• Authors: Y. Song, Y. Wang, N. Dilixiati, D. Wang, Y. Wang, Q. Ye
• Journal: BMC Pulmonary Medicine
• Published: 2026;26(1)
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Asbestosis and idiopathic pulmonary fibrosis (IPF) share overlapping clinical and pathological features; however, differences in comorbidities and prognostic patterns between the two diseases remain poorly defined. This study aimed to compare comorbidities and prognostic factors associated with pulmonary fibrosis progression and mortality in asbestosis and IPF.

Methods: This prospective cohort study included 254 patients with asbestosis and 548 patients with IPF enrolled between 2016 and 2020, with follow-up through 2022. Outcomes included progressive pulmonary fibrosis (PPF) and all-cause mortality. Multivariable Cox models were applied to identify independent risk factors associated with these outcomes.

Results: Patients with asbestosis exhibited a higher comorbidity burden. Specifically, they more frequently had asthma, lung cancer, pleural disease, cardiovascular/cerebrovascular disease, and connective tissue disease, whereas emphysema was more common in IPF (all P < 0.05). Over a median follow-up of 44 months (IQR 24-61), IPF patients had a higher cumulative incidence of endpoint events than those with asbestosis. In asbestosis, a usual interstitial pneumonia (UIP) pattern on HRCT predicted disease progression. In IPF, risk factors for progression included hypoxemia, forced vital capacity (FVC) < 80%, and UIP compared with probable UIP. Interestingly, combined emphysema was protective against IPF progression. Mortality in asbestosis was associated with lung cancer, pulmonary hypertension (PH), and atrial fibrillation, whereas in IPF, it was linked to FVC < 80% and PH.

Conclusions: Asbestosis and IPF show distinct comorbidity patterns and prognostic drivers. IPF prognosis is mainly determined by fibrosis severity, while asbestosis mortality is driven largely by asbestos-related complications.

© 2026. The Author(s).

In plain English

This prospective cohort study at Beijing Chao-Yang Hospital, China, compared 254 patients with asbestosis and 548 with idiopathic pulmonary fibrosis (IPF), diagnosed in 2016 to 2020 and followed to November 2022. Asbestosis patients had a median of 10 years of asbestos exposure. The article did not give a breakdown of fiber types for the patients. Asbestosis patients more often had asthma, lung cancer, benign pleural disease, cardiovascular or cerebrovascular disease and connective tissue disease, while emphysema was more common in IPF. Follow-up data existed for 97 asbestosis and 264 IPF patients. Five-year cumulative rates of fibrosis progression were 59.26% (asbestosis) and 73.45% (IPF), and of death 14.35% and 33.44%. In asbestosis, a definite usual interstitial pneumonia pattern on CT was linked to progression. Death from any cause was linked to lung cancer, pulmonary hypertension and atrial fibrillation. In IPF, death from any cause was linked to forced vital capacity below 80% of predicted and pulmonary hypertension. The authors concluded that asbestosis deaths are driven largely by what they called asbestos-related complications, and IPF outcomes mainly by fibrosis severity. They noted possible selection bias.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Prospective cohort study comparing asbestosis with idiopathic pulmonary fibrosis (IPF), using Cox regression to identify factors linked to fibrosis progression and death
• Who was studied: 802 patients diagnosed at Beijing Chao-Yang Hospital, China, between January 2016 and December 2020: 254 with asbestosis and 548 with IPF. They were followed to November 30, 2022. Longitudinal follow-up data were available for 97 asbestosis patients (median 59 months) and 264 IPF patients (median 38 months). Asbestosis patients were older (median age 69 vs 65) and less often male (45.28% vs 89.60%).
• Exposure: Asbestos exposure among asbestosis patients: median 10 years (interquartile range 6 to 26). The article gave no fiber-type breakdown or job details for the cohort. Chrysotile is mentioned only speculatively in the discussion. Asbestosis was diagnosed by multidisciplinary discussion using the International Labour Organization classification.
• Main results:
  • Compared with IPF patients, asbestosis patients had significantly higher frequencies of asthma, benign pleural diseases (diffuse pleural thickening, plaques, effusion), arrhythmias, heart failure, hypertension, hyperlipidemia, cerebrovascular disease, connective tissue diseases and lung cancer (all P less than 0.05).
  • IPF patients had a significantly higher prevalence of emphysema than asbestosis patients (P less than 0.001).
  • Malignant tumors were present in 12.60% of asbestosis patients versus 4.93% of IPF patients.
  • Among patients with follow-up, the five-year cumulative rate of progressive pulmonary fibrosis was 59.26% in asbestosis (46 patients) versus 73.45% in IPF (164 patients).
  • Among patients with follow-up, the five-year cumulative mortality was 14.35% in asbestosis (11 patients) versus 33.44% in IPF (56 patients).
  • In asbestosis, a definite UIP pattern on CT was independently linked to fibrosis progression (adjusted HR 5.36, 95% CI 1.77 to 16.19; P = 0.003).
  • In IPF, independent predictors of progression were baseline hypoxemia (adjusted HR 2.49, 95% CI 1.32 to 4.69) and FVC below 80% predicted (adjusted HR 1.44, 95% CI 1.03 to 2.01). A definite UIP pattern (adjusted HR 1.41, 95% CI 1.01 to 1.98) was also a predictor.
  • In IPF, emphysema was associated with lower risk of progression (adjusted HR 0.66, 95% CI 0.48 to 0.90).
  • In asbestosis, all-cause death was independently associated with three conditions: lung cancer (adjusted HR 4.32, 95% CI 1.21 to 15.48), pulmonary hypertension (adjusted HR 4.86, 95% CI 1.20 to 19.74) and atrial fibrillation (adjusted HR 4.47, 95% CI 1.27 to 15.71).
  • In IPF, all-cause death was independently associated with FVC below 80% predicted (adjusted HR 1.97, 95% CI 1.13 to 3.42) and pulmonary hypertension (adjusted HR 2.23, 95% CI 1.04 to 4.77).
• The authors' conclusion: The authors concluded that asbestosis and IPF show distinct comorbidity patterns and prognostic drivers. In their view, IPF prognosis is mainly determined by fibrosis severity, while asbestosis mortality is driven largely by asbestos-related complications.
• Limitations the authors state:
  • The study required baseline lung function and CT data. This may introduce selection bias by excluding sicker patients, so the findings may not apply to critically ill patients.
  • About one-third of IPF patients received antifibrotic therapy, which could have slowed progression.
  • Mesothelioma was rarely recorded among asbestosis patients, which the authors suggested may reflect underreporting or missed diagnoses.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Asbestosis.

Medical terms in this study, explained in our Lexicon: Idiopathic, Pulmonary Fibrosis, Cohort Study, Lung Cancer, Emphysema, Interstitial, High-Resolution CT (HRCT), Disease Progression.

Related studies

• The Its Not JUST Idiopathic pulmonary fibrosis Study (INJUSTIS): description of the protocol for a multicentre prospective observational cohort study identifying biomarkers of progressive fibrotic lung disease — F. Khan, I. Stewart, et al. (2019)
• Usual interstitial pneumonia in asbestos-exposed cohorts - concurrent idiopathic pulmonary fibrosis or atypical asbestosis? — R.L. Attanoos, F.S. Alchami, et al. (2016)
• Radiological characteristics, histological features and clinical outcomes of lung cancer patients with coexistent idiopathic pulmonary fibrosis — K.A. Khan, M.P. Kennedy, et al. (2015)
• Antifibrotic treatment response and prognostic predictors in patients with idiopathic pulmonary fibrosis and exposed to occupational dust — V. Casillo, S. Cerri, et al. (2019)
• The comparison of high-resolution computed tomography findings in asbestosis and idiopathic pulmonary fibrosis — M. Akira, K. Morinaga (2016)
• Clinical and radiological criteria for the differential diagnosis between asbestosis and idiopathic pulmonary fibrosis: Application in two cases — A. Stufano, A. Scardapane, et al. (2021)

Browse more research in BMC Pulmonary Medicine, or return to medical research.