Asthma, stridor and wheeze

Emergency department referrals

All urgent cases must be discussed with the on-call Registrar to obtain appropriate prioritisation and treatment.

Contact through:

Caboolture Hospital (07) 5433 8888
Redcliffe Hospital (07) 3883 7777
Royal Brisbane and Women's Hospital (07) 3646 8111

Urgent cases accepted via phone must be accompanied with a written referral and a copy faxed immediately to the Central Patient Intake Unit: 1300 364 952.

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

Infants who have apnoea or cyanosis during paroxysms of coughing
Children with recurrent or persistent respiratory symptoms who have had an episode of choking suggestive of a possible inhaled foreign body
Recent onset or escalating stridor and respiratory distress
Acute respiratory distress not responding to home management
Acute respiratory symptoms causing inability to feed or sleep in an infant

Does your patient wish to be referred?

Minimum referral criteria

Does your patient meet the minimum referral criteria?

Category 1

Appointment within 30 days is desirable

Infants < 1 year with effect on sleep or feeding due to chronic or recurrent wheeze
Stridor without respiratory distress
Persistent breathlessness affecting sleep or quality of life
Recent history of severe or life threatening respiratory illness
Asthma with unexplained clinical findings, e.g. focal signs, abnormal voice or cry, dysphagia, inspiratory stridor
A child currently in out of home care (OOHC) or at risk of entering or leaving OOHC, where they have previously been on a waiting list for this problem and were removed without receiving a service

Category 2

Appointment within 90 days is desirable

Asthma with failure to respond to conventional treatment (particularly inhaled corticosteroids above 400 micrograms per day or frequent use of steroid tablets) and use of asthma plan
Faltering growth
Doubt about diagnosis of asthma

Category 3

Appointment within 365 days is desirable

No category 3 criteria

If your patient does not meet the minimum referral criteria

Consider other treatment pathways or an alternative diagnosis.

If you still need to refer your patient:

Please explain why (e.g. warning signs or symptoms, clinical modifiers, uncertain about diagnosis, etc.)
Please note that your referral may not be accepted or may be redirected to another service

Other important information for referring practitioners

Not an exhaustive list

Refer to HealthPathways for assessment and management information if available

NB: For some services, children may be directed to and seen by nurse practitioners or advanced practice nurses

The Asthma Foundation provides a support service with education and spacer devices. Call 1800 ASTHMA (1800 278462).
Consider referral to an asthma educator or a community asthma nurse:
- newly diagnosed asthma
- poorly controlled asthma
- severe asthma e.g. requiring PICU
- compliance issues
- concerns regarding home management
- patients from a non-English speaking background
If you have a reason to suspect a child in Queensland is experiencing harm, or is at risk of experiencing harm, you need to contact Child Safety Services: Department of Children, Youth Justice and Multicultural Affairs
Clinical urgency is the dominant consideration in the prioritisation of a referral for a child currently in out of home care (OOHC), or at risk of entering or leaving OOHC

Referral requirements

A referral may be rejected without the following information.

Essential referral information

History and Examination

General referral information
Current assessment of asthma control: good, partial, poor
Current medications
Frequency of oral steroid use in the previous 3 months
Note if the child has been hospitalized or not, and how often
Report presence or absence of concerning features
- Paediatric ICU admission
- History of chronic lung disease
- Extreme prematurity
Confirmation of OOHC (where appropriate)

Additional referral information (useful for processing the referral)

Highly desirable information – may change triage category

Note symptom frequency over the last 3 months:
- every day
- episodes of wheeze every week but not every day
- episodes every month but not every week
- episodes less than once per month
Height/weight/head circumference and growth charts with prior measurements if available.
Presence or absence of sleep, feeding or exercise related symptoms.
Copy of asthma management plan, if applicable

Desirable information – will assist at consultation

Assessment of adherence to medication
History of allergic/atopic disease (and family history of same)
Other past medical history
Immunisation history
Developmental history
Medication history
Significant psychosocial risk factors (especially parents mental health, family violence, housing and financial stress, Department of Children, Youth Justice and Multicultural Affairs involvement)
Other physical examination findings inclusive of CNS, birth marks or dysmorphology
Any relevant laboratory results or medical imaging reports, urinalysis result
Spirometry Reports, if available in children able to perform test (children over 8)

Out of catchment

Metro North Health is responsible for providing public health services to the people who reside within its boundaries. Special consideration is made for patients requiring tertiary care or services that are not provided by their local Hospital and Health Service. If your patient lives outside the Metro North Health area and you wish to refer them to one of our services, inclusion of information regarding their particular medical and social factors will assist with the triaging of your referral.

Clinical Modifiers (where relevant)

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

Reason for Referral (essential)

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 Information (essential)

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