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Chronic Cough

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Minimum referral criteria

Does your patient meet the minimum referral criteria?

Category 1

Appointment within 30 days is desirable

  • No category 1 criteria

Category 2

Appointment within 90 days is desirable

  • No category 2 criteria

Category 3

Appointment within 365 days is desirable

  • Cough present for > 8 weeks with normal CXR and normal spirometry and no improvement following treatment trial as specified in Other important information

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

Definitions

  • Subacute cough is a cough present for 3 to 8 weeks
  • Chronic cough has been present for over 8 weeks.

There are many causes of persistent cough. These can be categorised into:

  • Respiratory (Infective, non-asthmatic eosinophilic bronchitis, related to chronic lung disease (COPD, Bronchiectasis, restrictive LD, occupational LD, asthma), cancer, related to pleural disease, foreign body, allergic)
  • ENT (due to tonsillar /adenoidal infection, sinusitis/ rhinitis –PN drip, laryngeal/tracheal)
  • Gastrointestinal (GORD, tracheo-oesophageal fistula)
  • Cardiac (heart failure)
  • Drug related (ACEI, aspirin, beta blockers)
  • Thromboembolic (pulmonary embolism/infarction)
  • Neurological/neuromuscular (degenerative (MS, MND, nerve palsies, Stroke related)
  • Psychogenic

Acute cough (less than 3 weeks) does not usually require investigation unless there is persistent fever, haemoptysis, chest pain weight loss. It should be possible to arrive at a diagnosis in most cases by careful history and examination with directed investigations. If considering referral try to arrive at a probable diagnosis as this will determine which specialty to refer to.

Other important information for referring practitioners

Not an exhaustive list

  • Refer to HealthPathways for assessment and management information if available
  • There are many causes of persistent cough. These can be categorised into:
    • respiratory
    • ENT (PN drip)
    • gastrointestinal
    • drug related (ACEI, aspirin, beta blockers)
    • cardiac (heart failure)

Treatment trial:
Ensure occult sino-nasal disease, unresolved infectious bronchitis and acid reflux have been considered and treated appropriately. ACE inhibitors should be ceased and an alternate medication substituted (e.g. angiotensin 2 receptor antagonists).

  1. Four-week trial of PPI
  2. If unsuccessful, or symptoms of PN drip, commence a six-week trial of intra nasal steroid
  3. If unsuccessful, or evidence of asthma, commence a four-week trial of inhaled steroids
  4. If unsuccessful, complete CT chest scan (including high resolution images) and refer to specialist.

Referral requirements

A referral may be rejected without the following information.

Essential referral informaiton

History and Examination

  • Symptoms
    • Duration and severity
    • Associated syncope, incontinence, SOB
  • Relevant examination findings
    • History of ENT problems or GORD
    • Check uniform lung expansion and any percussive changes
  • Medications including results of treatment trial as per defined in Other useful information

Pathology and Test Results

  • FBC, ELFT and ESR results

Imaging and Reports

  • HRCT if the cough has been present for >8 weeks
  • CXR

Additional referral information (useful for processing the referral)

History and Examination

  • Symptoms including:
    • any diurnal variation in severity (e.g. nocturnal or positional)
    • triggers e.g. air temp, food, talking, exercise
    • swallowing difficulties
    • voice change
  • Smoking and occupational history if relevant

Imaging and reports

  • High resolution chest CT (if already performed)
  • Spirometry pre and post bronchodilator
  • Previous gastroscopy findings

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.

  • 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

  • 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

  • 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

  • Full name (including aliases)
  • Date of birth
  • Residential and postal address
  • Telephone contact number/s – home, mobile and alternative
  • Medicare number (where eligible)
  • Name of the parent or caregiver (if appropriate)
  • Preferred language and interpreter requirements
  • Identifies as Aboriginal and/or Torres Strait Islander

  • Full name
  • Full address
  • Contact details – telephone, fax, email
  • Provider number
  • Date of referral
  • Signature

  • Willingness to have surgery (where surgery is a likely intervention)
  • Choice to be treated as a public or private patient
  • Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)
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