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Clinical Practice Guideline Recommendations for Non-Malignant Asbestos-Related Diseases in an Asbestos-Exposed Population: An Evidence-to-Decision Framework

Year: 2026

Type: article

Abstract: Introduction: Asbestos exposure is a well-established cause of malignant and non-malignant respiratory diseases. In Colombia, despite Law 1968/2019 banning asbestos use, asbestos in the built environment remains a risk to public health. Recent regulations (Decrees 04021/2021 and 0221/2023) mandate a national care pathway for exposed individuals, underscoring the need for evidence-based diagnostic and follow-up recommendations. Objective: The objective is to formulate clinical practice recommendations for the detection and monitoring of non-malignant asbestos-related diseases in asbestos-exposed populations within the Colombian healthcare system, using the Evidence-to-Decision (EtD) framework. Methods: A multidisciplinary working group applied the GRADE-EtD approach to three priority questions (PICO format): Optimal screening test for surveillance of asbestos-exposed individuals; appropriate follow-up for individuals with negative screening results; and follow-up criteria for those with abnormal findings. Systematic searches were performed in Medline, Embase, Cochrane Library, BVS, and Google Scholar. Eligible studies included diagnostic accuracy research, observational studies, and clinical practice guidelines in English or Spanish. Evidence quality was assessed using Joanna Briggs Institute tools and AGREE II for guidelines. Results: From 1253 records screened for Question 1, 23 studies were included; for Questions 2 and 3, two and three studies met criteria, respectively. Chest X-ray (CXR) with International Labour Organization (ILO) classification demonstrated sensitivity ranging from 0.60 to 0.94 and specificity from 0.47 to 0.88 compared with computerized tomography (CT) or High-Resolution CT (HRCT). No harm from CXR was reported in the literature. Evidence supported complementing CXR with pulmonary function testing and clinical history (including smoking and occupational exposure). In individuals with normal CXR and lung function results, follow-up every three years was advised; abnormal findings should prompt HRCT evaluation to confirm disease and guide management. Conclusions: The working group conditionally recommends CXR with ILO classification as the primary screening tool for surveillance of non-malignant asbestos-related diseases in asbestos-exposed populations in Colombia, supplemented by targeted clinical and lung function assessment. Periodic follow-up is necessary for exposed individuals regardless of baseline findings. These guidelines provide a standardized approach that aligns with national policy and can facilitate early detection and equitable care, and may be resource-efficient.

Source: International Journal of Environmental Research and Public Health

DOI: 10.3390/ijerph23101301