Asbestos is a leading cause of occupational disease in Germany; in 2007 about 2000 new cases of asbestos-associated occupational diseases were recognized. It may be assumed that in Europe (Italy, Denmark, Sweden) and also in the USA a large number of cases remain unrecognized. In addition to occupational medical evaluation of a case on the basis of work anamnesis and clinical and radiological findings, pathological-anatomical examination of lung tissue can be important. Tissue analysis using histological procedures and dust analysis can identify asbestos-associated disease with a high level of certainty. Because minimal asbestos-associated fibrotic changes in lung tissue (grade 1 asbestosis) are not verifiable by computer tomography (CT or HRCT) or radiological examination, pathological-anatomical diagnosis is indispensable. Quantitative lung dust analysis is the gold standard to quantify body asbestos levels and in combination with histological examination it is an effective tool to evaluate asbestos-associated lung fibrosis. Therefore a definite rejection of the existence of occupational disease No. 4104 without analysis of lung parenchyma is not justified. Cumulative fibre-year doses are not an adequate parameter for the evaluation of asbestos-associated lung fibrosis. The use of limit values (concentrations of asbestos fibres or asbestos bodies) correlating with a 2-fold increase in the risk of developing lung cancer or with a cumulative exposure dose of 25 fibre-years has no scientific basis.
