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Asthma

ADULT

If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.


Asthma

  • Acute exacerbation of asthma not responding to therapy
  • Asthma with any of the following concerning features:
    • coexistent pneumothorax
    • pneumonia
    • silent chest
    • cardiovascular compromise
    • altered consciousness
    • relative bradycardia
    • decreasing rate and depth of breathing

Bronchiectasis / chronic suppurative lung disease (CSLD)

  • Bronchiectasis / CSLD with any of the following concerning features:
    • altered consciousness
    • hypoxia (<90% oxygen saturation) when this is not normal for the patient
    • evidence of significant infective exacerbation (fever and/or high volume purulent sputum)
    • new haemoptysis (clots or more than streaks
    • new CXR changes indicative of cavitation, consolidation or pneumonia

Chronic obstructive pulmonary disease (COPD)

  • Acute exacerbation not responding to outpatient therapy
  • Acute respiratory failure

Cystic fibrosis

  • Cystic fibrosis with any of the following concerning features:
    • respiratory distress
    • new haemoptysis (clots or more than streaks)
    • pleural effusion
    • consolidation/pneumonia/fever
    • non- response to antibiotics for chest infection

Haemoptysis without known lung disease

  • Significant haemoptysis defined as repeated expectoration of 5mL (1tsp) of blood or single episode of >20mL (1tbsp)
  • Any haemoptysis with acute dyspnoea, measured hypoxia, altered consciousness, hypotension, tachycardia or chest pain

Interstitial lung disease (ILD)

  • Acute exacerbations of known ILD with any of the following concerning features:
    • severely breathless/Class 4 dyspnoea (ADL’s affected by dyspnoea)
    • demonstrated worsening hypoxaemia
    • new arrhythmia/chest pain
  • Newly diagnosed or suspected ILD with radiographic evidence with Class 4 dyspnoea (ADLs affected by dyspnoea)

Lung cancer

  • Suspected or known lung cancer with any of the following concerning features:
    • massive haemoptysis
    • suspected large airway obstruction
    • severe dyspnoea
    • SVC obstruction
    • hypercalcaemia/hyponatremia with confusion
    • symptomatic pleural effusion

Pleural disorders

  • Large symptomatic pleural effusion
  • Acute pneumothorax

Pulmonary hypertension

  • Acute decompensation (hypoxia or right heart failure) with pulmonary hypertension

Sarcoidosis

  • Hypercalcaemia with acute kidney injury

Shortness of breath / dyspnoea without a known cause

  • Dyspnoea of uncertain origin with any of the following concerning features:
    • acute dyspnoea at rest
    • demonstrated hypoxia (SpO2 < 90%)
    • accompanied by confusion

Tuberculosis / non-tuberculosis mycobacterial infections

  • Suspected tuberculosis with significant haemoptysis (defined as repeated expectoration of 5mL (1tsp) of blood or single episode of >20mL (1tbsp)

  • Refer to Healthpathways or local guidelines.
  • The aim of asthma management is to control the disease. Complete control is defined as:
    • No day or night symptoms
    • Minimal or no need for beta agonist treatment (less than 2 times per week)
    • No exacerbations
    • No limitations on physical activity
    • Minimal side effects of treatment

Clinician resources

Patient resources

Minimum Referral Criteria

  • Category 1
    (appointment within 30 calendar days)
    • History of life threatening asthma in the past 12 months requiring ventilation or ICU admission
    • Unstable asthma with consistent FEV1 < 60% predicted
    • Asthma caused or exacerbated by workplace exposure where patient is unable to work as a result
  • Category 2
    (appointment within 90 calendar days)
    • Inadequate asthma control as defined in Other useful information despite optimal treatment
    • Asthma related hospital admission/s in the last 3 months
    • Need for oral corticosteroids on more than 1 occasion in the last year
    • Asthma with frequent after-hours attendance (ED or after-hours GP) despite optimal treatment
    • Asthma caused or exacerbated by workplace exposure where patient is still able to work as a result
  • Category 3
    (appointment within 365 calendar days)
    • Uncertainty about diagnosis
    • Asthma education where this cannot be provided in the community

Please insert the below information and minimum referral criteria into referral

1. Reason for request Indicate on the referral

  • To establish a diagnosis
  • For treatment or intervention not otherwise accessible to the patient
  • For advice regarding management
  • To engage in an ongoing shared care approach between primary and secondary care
  • Reassurance for GP/second opinion
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)

2. Essential referral information Referral will be returned without this

  • Approximate age at diagnosis
  • Duration and severity of symptoms (breathlessness, chest tightness, wheezing and cough)
  • Frequency of exacerbations
  • Management including:
    • current medications (including complete list of all patient’s medications)
    • previously tried respiratory medications
  • Oral prednisolone use
  • Previous hospitalisations for asthma
  • Allergies
  • Spirometry (if available)

3. Additional referral information Useful for processing the referral

  • Allergy testing results
  • Triggers
  • Assessment of adherence to treatment
  • Smoking status
  • Family history of asthma
  • FBC results
  • CXR
  • Comorbid conditions

4. Request

Patient's Demographic Details

  • Full name (including aliases)
  • Date of birth
  • Residential and postal address
  • Telephone contact number/s – home, mobile and alternative
  • Medicare number (where eligible)
  • Name of the parent or caregiver (if appropriate)
  • Preferred language and interpreter requirements
  • Identifies as Aboriginal and/or Torres Strait Islander

Referring Practitioner Details

  • Full name
  • Full address
  • Contact details – telephone, fax, email
  • Provider number
  • Date of referral
  • Signature

Relevant clinical information about the condition

  • Presenting symptoms (evolution and duration)
  • Physical findings
  • Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
  • Body mass index (BMI)
  • Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
  • Current medications and dosages
  • Drug allergies
  • Alcohol, tobacco and other drugs use

Reason for request

  • To establish a diagnosis
  • For treatment or intervention
  • For advice and management
  • For specialist to take over management
  • Reassurance for GP/second opinion
  • For a specified test/investigation the GP can't order, or the patient can't afford or access
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)
  • Clinical judgement indicates a referral for specialist review is necessary

Clinical modifiers

  • Impact on employment
  • Impact on education
  • Impact on home
  • Impact on activities of daily living
  • Impact on ability to care for others
  • Impact on personal frailty or safety
  • Identifies as Aboriginal and/or Torres Strait Islander

Other relevant information

  • Willingness to have surgery (where surgery is a likely intervention)
  • Choice to be treated as a public or private patient
  • Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)

  • Please note that where appropriate and where available, the referral may be streamed to an associated public allied health and/or nursing service.  Access to some specific services may include initial assessment and management by associated public allied health and/or nursing, which may either facilitate or negate the need to see the public medical specialist.

  • A change in patient circumstance (such as condition deteriorating, or becoming pregnant) may affect the urgency categorisation and should be communicated as soon as possible.

  • Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.

 

Version: 6
Last updated: 26 March 2019

© State of Queensland (Queensland Health) 2020

Except as permitted under the Copyright Act 1968, no part of this work may be reproduced, communicated or adapted without permission from Queensland Health. To request permission email ip_officer@health.qld.gov.au.

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