In an evaluation of the possibility of type III procollagen N-terminal propeptide (PIIINP) being an early marker of the active fibrotic process in asbestos-exposed workers, 91 asbestos workers had higher serum PIIINP concentrations than 108 referents. In 24 workers exposed to low levels of airborne asbestos, the serum PIIINP was higher than in the referents but lower than in an exposed group with higher exposure; furthermore a significant correlation (r = 0.63) was found between serum PIIINP and individual cumulative exposure. These data suggest a dose-effect relationship between asbestos exposure and PIIINP serum concentration. In addition workers with a reduced pulmonary function had higher PIIINP values than the referents or the exposed workers with normal pulmonary function. The serum PIIINP levels were related to asbestos exposure even at low airborne concentrations and may represent an early biological marker of impending fibrotic process induced by asbestos.