Shortness of breath / dyspnoea without a known cause

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.

  • Dyspnoea of uncertain origin with any of the following concerning features:
    • acute dyspnoea at rest
    • demonstrated hypoxia (SpO2 < 90%)
    • accompanied by confusion

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

Category 2

Appointment within 90 days is desirable

  • Unexplained chronic dyspnoea of uncertain origin

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

  • Refer to HealthPathways for assessment and management information if available
  • There are many causes of shortness of breath. These can be categorised into:
    • respiratory (Infective, related to chronic lung disease (COPD, bronchiectasis, restrictive LD, occupational LD, asthma, TB), cancer, foreign body, allergic, sarcoid)
    • cardiac (heart failure, ischaemic heart disease, valvular heart disease, arrhythmias, pulmonary HT)
    • vascular (pulmonary emboli, infarction)
    • ENT/endocrine related (laryngeal obstruction, thyroid enlargement causing tracheal compression, thyrotoxicosis)
    • gastrointestinal (GORD, tracheo-oesophageal fistula, aspiration)
    • haematological (anaemia, leukaemias)
    • neurological/neuromuscular (degenerative (MS, MND, myasthenia gravis, Guillian-Barre syndrome)
    • psychogenic (anxiety)
    • chronic debility or obesity related
    • drug related
  • It is important to at least arrive at a probable diagnosis as this will determine which specialty to refer. It should be possible to arrive at a diagnosis in most cases by careful history and examination with directed investigations.

Referral requirements

A referral may be rejected without the following information.

History and Examination

  • Details and timeline of symptoms including duration and severity
  • Relevant medical conditions
  • Smoking and occupational history if relevant

Imaging and Reports

  • CXR

Additional referral information (Useful for processing the referral)

History and Examination

  • Pulse oximetry

Pathology and Test Results

  • FBC, ELFT, ESR, ACE level, calcium level results
  • Sputum M/C/S if productive cough

Imaging and Reports

  • Lung function pre and post bronchodilator
  • ECG
  • Other relevant imaging

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.)