When should I refer a patient with silicosis to a specialist for further evaluation or management?

You should refer a patient with silicosis to a specialist for further evaluation or management because silicosis is a form of interstitial lung disease (ILD) ²,⁶. People with ILD should be referred to secondary care for specialist management ²,⁶.

Specific reasons for referral that apply to conditions like silicosis include:

• Diagnostic Uncertainty: Refer if there is difficulty distinguishing the condition from other respiratory conditions such as chronic obstructive pulmonary disease (COPD) or asthma, or if the diagnosis is uncertain ¹,²,⁴.
• Clinical Features: Consider referral if the patient presents with clinical features suggestive of pulmonary fibrosis, such as persistent breathlessness on exertion, persistent cough, bilateral inspiratory crackles, or clubbing of the fingers, especially in those over 45 years of age ⁷.
• Exclusion of Occupational Exposure: When assessing suspected pulmonary fibrosis, a detailed history should include blood tests to help exclude alternative diagnoses, including lung diseases associated with environmental and occupational exposure ⁷.
• Multidisciplinary Team Diagnosis: The diagnosis of conditions like idiopathic pulmonary fibrosis (and by extension, other fibrotic lung diseases like silicosis) requires the consensus of a multidisciplinary team with expertise in interstitial lung disease ⁷.
• Suspected Lung Cancer: If lung cancer is suspected (e.g., due to haemoptysis, suspicious features on chest X-ray, or other symptoms like persistent cough, chest pain, shortness of breath, or finger clubbing, particularly with a history of asbestos exposure), an urgent chest X-ray or a suspected cancer pathway referral is necessary ¹,⁵,⁶.