Respiratory and Sleep Medicine

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  Emergency

  If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or follow local emergency care protocols 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)
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  CPC in scope Not an exhaustive list

  Please note this is not an exhaustive list of all conditions for outpatient services and does not exclude consideration for referral unless specifically stipulated in the CPC out of scope section.

  • Asthma ADULT
  • Bronchiectasis / chronic suppurative lung disease (CSLD) ADULT
  • Chronic cough ADULT
  • Chronic obstructive pulmonary disease (COPD) ADULT
  • Cystic fibrosis ADULT
  • Haemoptysis without known lung disease ADULT
  • Interstitial lung disease (ILD) ADULT
  • Lung cancer (Respiratory) ADULT
  • Pleural disorders ADULT
  • Pulmonary hypertension ADULT
  • Recurrent respiratory infections without known lung disease ADULT
  • Sarcoidosis ADULT
  • Shortness of breath / dyspnoea without a known cause ADULT
  • Sleep disordered breathing (suspected or confirmed) ADULT
  • Sleep disorders excluding sleep disordered breathing ADULT
  • Tuberculosis / non-tuberculosis mycobacterial infections ADULT
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  CPC out of scope

  The following are not routinely provided in a public Respiratory and Sleep Medicine service.

  • Chest wall pain
  • Non-cardiac chest pain
  • Occupational lung assessment
  • Respiratory function testing in the absence of a consultation
  • Direct screening TB – should be referred to contact and immigration screening (TB control centre)