When should I refer a patient with suspected pneumoconiosis to a specialist for further evaluation?

Refer a patient with suspected pneumoconiosis to a specialist for further evaluation when there is diagnostic uncertainty or when the diagnosis needs confirmation and optimisation of therapy. This includes cases where occupational exposure history suggests pneumoconiosis, and symptoms such as persistent breathlessness, cough, or abnormal chest X-ray findings are present.

Additionally, urgent referral is warranted if the patient is aged 40 or over with respiratory symptoms (such as cough, chest pain, or shortness of breath) and a history of asbestos exposure, to exclude mesothelioma or lung cancer. An urgent chest X-ray should be offered within 2 weeks in these cases.

Referral may also be appropriate at any stage of the disease, not only in severe cases, to confirm diagnosis, optimise therapy, and consider further investigations such as lung function tests and CT thorax.