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

Patients with suspected occupational lung disease should be referred to a specialist for further evaluation and management when:

• There is diagnostic uncertainty after initial assessment including history, clinical examination, lung function tests, chest X-ray, and consideration of occupational exposures.
• Symptoms such as persistent breathlessness, cough, or chest signs suggestive of interstitial lung disease or other occupational lung pathology are present, especially if accompanied by abnormal lung function or radiological findings.
• There is suspicion of serious conditions such as mesothelioma or lung cancer, particularly in patients aged 40 or over with relevant exposure history (e.g., asbestos) and symptoms like unexplained chest pain, cough, or shortness of breath, warranting urgent chest X-ray and specialist referral.
• Specialist multidisciplinary team input is needed for diagnosis confirmation, including possible bronchoalveolar lavage, lung biopsy, or advanced imaging, especially when idiopathic pulmonary fibrosis or other interstitial lung diseases are suspected.
• There is a need for optimisation of therapy, assessment for advanced treatments (e.g., oxygen therapy, pulmonary rehabilitation), or consideration of lung volume reduction or transplantation in chronic lung diseases related to occupational exposure.

Referral should be timely to ensure accurate diagnosis, appropriate management, and to exclude malignancy or other serious complications.

References: ¹, ², ³