 we present a case of progressive interstitial fibrosis in a retired shipyard worker who was exposed to asbestos during the postwar era of the late 1940s and 1950s , when asbestos exposures in the workplace were not regulated . 
 forty years later , at 63 years of age , the patient presented with restrictive lung disease . 
 the patient was diagnosed with asbestos - related pleural disease and parenchymal asbestosis . 
 he remained stable for the next 7 years , but then he began to manifest rapid clinical progression , which raised the possibility of an unusual variant of asbestosis , a concomitant interstitial process , or an unrelated disease . 
 lung biopsy was not undertaken because of the patient 's low pulmonary reserve and limited treatment options . 
 an empiric trial of oral steroids was initiated , but his pulmonary status continued to deteriorate and he died of pulmonary failure at 72 years of age . 
 many diseases result in pulmonary interstitial fibrosis . 
 ideally , open lung biopsy should be performed , but this procedure inevitably causes complications in many patients with end - stage restrictive lung disease . furthermore , while the presence of asbestos bodies in tissue sections is a sensitive and specific marker of asbestos exposure , neither this finding nor any other charge is a marker indicative of asbestosis or the severity of asbestosis . with the enactment of the asbestos standard in the united states , asbestos exposures have been decreasing in this country . 
 however , industries that produce asbestos products and wastes continue to expand in developing countries . 
 prevention of asbestos - related lung disease should be a global endeavor , and asbestos exposures should be regulated in both developed and developing countries.imagesfigure 1figure 2figure 3figure 4 
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