Contradictory to recognised asbestos exposure diseases, a deadly and progressive inflammatory fibrotic lung condition was emerging in Libby residents, eventually named Lamellar Pleural Thickening, or ‘Libby Disease’. Simultaneously, systemic autoimmune diseases such as lupus and rheumatoid arthritis were occurring more frequently within this population, along with a high frequency of autoantibodies directed against the nucleus of the cell, so-called antinuclear autoantibodies.

Taken together, this provoked the notion that LAA may elicit an autoimmune response within exposed individuals and suggested that this altered response may lead to Libby Disease.  

There is no doubt that environmental exposure to asbestos is an urgent public health matter, and the devastating effects which are still experienced to this day in Libby are a grim reminder of the ongoing dangers that this phenomenon poses.

There remains a need to raise awareness amongst clinicians working with autoimmune and general inflammatory diseases so that LAA exposure may be recognised at an earlier stage and considered as a possible cause, particularly since it is highly unlikely that this issue remains confined to the Libby area since millions of homes and buildings remain insulated with the material.