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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

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.