What investigations are recommended for confirming a diagnosis of pneumoconiosis in a patient presenting with respiratory symptoms?

To confirm a diagnosis of pneumoconiosis in a patient presenting with respiratory symptoms, the initial recommended investigation is a chest X-ray, which should be performed urgently if the patient is aged 40 or over and has relevant exposure history such as asbestos, or presents with symptoms like cough, chest pain, or shortness of breath NICE NG12. This imaging helps identify characteristic lung changes such as fibrosis or pleural plaques associated with pneumoconiosis NICE NG12.

Further evaluation often includes high-resolution computed tomography (HRCT) of the thorax, which provides more detailed imaging to detect early or subtle interstitial changes and differentiate pneumoconiosis from other lung diseases NICE NG115. HRCT is particularly useful when chest X-ray findings are inconclusive or when symptoms are disproportionate to spirometric impairment NICE NG115.

Spirometry is also recommended to assess lung function and identify any obstructive or restrictive patterns, although it is not diagnostic on its own NICE NG115. Additional tests such as transfer factor for carbon monoxide (TLCO) may be used to evaluate gas exchange abnormalities NICE NG115.

In cases with a history of asbestos exposure, urgent chest X-ray is emphasized to exclude mesothelioma or lung cancer, which can present with similar symptoms NICE NG12.

Supporting investigations may include full blood count to exclude other causes of symptoms and sputum culture if infection is suspected NICE NG115.

Recent literature highlights the importance of early detection methods, including the use of HRCT and detailed occupational history, to improve diagnosis of pneumoconiosis such as silicosis and asbestosis Austin et al. 2021Valeyre & Letourneux 1999. Work-related lung diseases require a combination of clinical, radiological, and occupational exposure assessment for accurate diagnosis Weston 2011.