Bronchiectasis / chronic suppurative lung disease (CSLD)

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
The Prince Charles Hospital (07) 3139 4000

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
- new presence of non-tuberculous mycobacterium (NTM) in sputum culture
Other features of Allergic Bronchopulmonary Aspergillosis (ABPA)
Associated hypoxaemia (≤92%)

Category 2

Appointment within 90 days is desirable

Chronic bronchiectasis / CSLD with frequent (≥3 per year) infective exacerbations despite optimal therapy
Suspected non-tuberculous mycobacterial pulmonary disease (see Non-tuberculous mycobacterium infections)
Hospital admission for exacerbation of bronchiectasis in last 12 months
Pseudomonas or MRSA colonisation on sputum culture
Progressive lung disease on serial imaging (TSANZ)
Bronchiectasis with moderate disability (TSANZ)
Bronchiectasis associated with hypoxaemia (92-96%) without other cause

Category 3

Appointment within 365 days is desirable

Stable symptomatic chronic bronchiectasis / CSLD requiring specialist review

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
Patients BTS 2019
Training in sputum clearance techniques. Patients should receive/be provided by a respiratory physiotherapist
Pulmonary rehabilitation should be offered to all patients who are functionally limited by breathlessness (please see Pulmonary Rehabilitation | Metro North Health)
Routine use of inhaled corticosteroids and bronchodilators are not recommended unless other indications for therapy
Annual influenza vaccination, pneumococcal vaccination and COVID-19 vaccination should be offered to all patients
A self-management (action) plan should be considered

Referral requirements

A referral may be rejected without the following information.

Essential referral information

Medications including previously tried medications if associated with treatment failure or problems
Results of previous sputum cultures

Additional referral information

Echocardiography if available
FBC, ESR, Immunoglobulins with IgG sub class results
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