Respiratory and Sleep Medicine

  • 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

    Pulmonary embolism

    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)

  • 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.

  • 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)

Last updated: 8 July 2021

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