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.