When should I refer a patient with suspected asbestosis to a specialist for further evaluation and management?

Refer a patient with suspected asbestosis to a respiratory specialist for further evaluation and management if:

• They have unexplained respiratory symptoms such as persistent breathlessness, cough, or chest pain, especially if aged 40 years or over and with a history of asbestos exposure.
• Chest X-ray findings suggest pleural disease or features compatible with asbestosis or mesothelioma.
• There is diagnostic uncertainty or difficulty distinguishing asbestosis from other interstitial lung diseases or respiratory conditions.
• They present with symptoms or signs that raise suspicion of lung cancer or mesothelioma, such as unexplained weight loss, fatigue, haemoptysis, or finger clubbing.
• They require assessment for oxygen therapy, pulmonary rehabilitation, or other specialist interventions.

Urgent referral using a suspected cancer pathway (to be seen within 2 weeks) is indicated if there are chest X-ray findings suggestive of mesothelioma or lung cancer, or if the patient has unexplained symptoms combined with asbestos exposure.

For non-urgent cases without suspected cancer, routine referral to a respiratory specialist is appropriate for diagnosis confirmation, lung function testing, and management planning.

This approach aligns with NICE and British Thoracic Society guidance on interstitial lung disease and suspected pleural malignancy.

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