Bronchiectasis / chronic suppurative lung disease (CSLD)

Emergency department referrals

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.

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

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

Chronic bronchiectasis / CSLD with any of the following:
- recurrent haemoptysis
- rapidly decreasing exercise tolerance
- unintentional weight loss

Category 2

Appointment within 90 days is desirable

Chronic bronchiectasis / CSLD with frequent (>3 per year) infective exacerbations despite optimal therapy
Stable symptomatic chronic bronchiectasis / CSLD

Category 3

Appointment within 365 days is desirable

Asymptomatic newly diagnosed or suspected bronchiectasis / CSLD

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
Ongoing treatment requires regular and coordinated primary health care and specialist review, including monitoring for complications and comorbidities. Chest physiotherapy and regular exercise should be encouraged, nutrition optimised, environmental pollutants (including tobacco smoke) avoided, and vaccines administered according to national immunisation schedules.

Referral requirements

A referral may be rejected without the following information.

Essential referral information

History and Examination

History of the disease including duration, severity and frequency of exacerbations
Management to date
Medications including previously tried medications if associated with treatment failure or problems

Pathology and Test Results

Results of previous sputum cultures

Imaging and reports

Results of previous chest CT (not during an exacerbation)

Additional referral information (useful for processing the referral)

History and Examination
- History of childhood respiratory infections (eg Whooping cough)
- Family history of cystic fibrosis
- Presence of cor pulmonale or sinus disease
Pathology and Test Results
- FBC, ESR, Immunoglobulins with IgG sub class results
- CXR
- Spirometry

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