Chronic cough
Adult

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Emergency Referrals

Important

If you believe your patient requires immediate attention, please refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice.

Acute exacerbation of asthma not responding to therapy
Asthma with any of the following features:
- coexistent pneumothorax
- pneumonia
- silent chest
- cardiovascular compromise
- SpO2 <<92%
- Failure to respond to acute management
- Respiratory distress
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 hemoptysis (clots or more than streaks
- new CXR changes indicative of cavitation, consolidation or pneumonia
Chronic obstructive pulmonary disease (COPD)
- Acute exacerbation not responding to outpatient therapy
- Acute respiratory failure
Cystic fibrosis with any of the following concerning features:
- respiratory distress
- new hemoptysis (clots or more than streaks)
- pleural effusion
- consolidation/pneumonia/fever
- non- response to antibiotics for chest infection
Significant haemoptysis defined as repeated expectoration of 5mL (1tsp) of blood or single episode of >20mL (1tbsp)
Any haemoptysis associated with pulmonary infiltrates on CXR/CT chest or acute derangement in renal function
Acute exacerbations of known ILD with any of the following concerning features:
- severely breathless/Class 4 dyspnoea  (ADL’s affected by dyspnoea)
- demonstrated worsening hypoxemia
- new arrhythmia/chest pain
Newly diagnosed or suspected ILD with radiographic evidence with Class 4 dyspnoea  (ADLs affected by dyspnoea
Suspected or known lung cancer with any of the following concerning features:
- massive haemoptysis (coughing up teaspoons or more of fresh blood)
- suspected large airway obstruction
- severe dyspnoea
- SVC obstruction
- significant hypercalcemia/hyponatremia with confusion
- symptomatic pleural effusion
Large symptomatic pleural effusion(s)
Features of infection/sepsis
Acute pneumothorax
Pulmonary hypertentsion with acute decompensation (hypoxia or right heart failure)
Pulmonary embolism
Severe infection with breathlessness at rest, new hypoxaemia (SpO2 <92-96%)
Dyspnoea of uncertain origin with any of the following concerning features:
- acute dyspnoea at rest
- new hypoxia (SpO2 < 90%)
- accompanied by confusion
Significant hypercalcaemia with acute kidney injury
Acute, severe symptoms – Lofgrens syndrome (fever, erythema nodosum and bilateral hilar lymphadenopathy)
Features of neuro-sarcoidosis such as headache, visual disturbance, ataxia or cranial nerve palsy
Suspected tuberculosis with significant haemoptysis (defined as repeated expectoration of 5mL (1tsp) of blood or single episode of >20mL (1tbsp)
Evidence of SVC obstruction
Significant hypercalcaemia
Radiological evidence of airway obstruction

Useful Management Information

Chronic cough is frequently associated with underlying airway hypersensitivity. Many other factors can be contributory, categorised into:
- respiratory
- drug related (ACE inhibitors)
- gastrointestinal (symptomatic GORD)
- ENT (symptomatic rhinosinusitis; laryngeal hypersensitivity)

Treatment options:

ACE inhibitors should be ceased for at least 6 weeks, and an alternate medication substituted as required (e.g. angiotensin 2 receptor antagonists).
Ensure asthma, symptomatic acid reflux (heartburn), sino-nasal disease, and unresolved infectious bronchitis and have been considered and treated appropriately.
Commence a four-week trial of inhaled steroids for evidence of asthma (typical symptoms, atopy, obstructive spirometry, raised blood eosinophils or FeNO)
Four-week trial of PPI if symptoms of heartburn
Consider a six-week trial of intra nasal steroid for features of chronic rhinosinusitis

NOTE: in the absence of specific diagnostic features, ‘blind’ trials of treatment of secondary diseases (asthma, GORD, rhinosinusitis, etc) are no longer advocated for chronic cough

Clinician resources

CICADA Full Position Statement - Lung Foundation Australia
Chronic Cough in Adults | British Thoracic Society | Better lung health for all (brit-thoracic.org.uk
New England Journal of Medicine – Chronic Cough article

Minimum Referral Criteria

Does your patient meet the minimum referral criteria?

Category 1 (appointment within 30 calendar days)	No category 1 criteria
Category 2 (appointment within 90 calendar days)	Recurrent cough syncope in the presence of cough persisting >8 weeks
Category 3 (appointment within 365 calendar days)	Cough present for > 8 weeks with normal Chest X-Ray and normal spirometry and no improvement following treatment trial as specified in Useful Management Information
If the patient does not meet the criteria for referral but the referring practitioner believes the patient requires specialist review, a clinical override may be requested: 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.

Standard Referral Information

Reason for request

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

Relevant clinical information about the condition

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
All conservative options that have been pursued unsuccessfully prior to referral
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
Any special care requirements where relevant (e.g tracheostomy in place, oxygen required)
Current medications and dosages
Drug allergies
Alcohol, tobacco and other drugs use

Patient's Demographic Details

Full name (including aliases)
Date and country of birth
Residential and postal address including whether patient resides at an aged care facility
Telephone contact number/s – home, mobile and alternative
Medicare number (where eligible)
Name of the parent or caregiver (if appropriate)
Name of delegate and contact details (Department of Corrective Services)
Preferred language and interpreter requirements
Identifies as Aboriginal and/or Torres Strait Islander
Any special needs, access requirements and/or disability relevant to the referral

Referring Practitioner Details

Full name
Full address
Contact details – telephone, fax, email
Provider number
Date of referral
Signature
Nominated general practitioner’s details (if known), if the nominated general practitioner is different from the referring practitioner

Other relevant information

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.)

Essential Referral Information

Associated effects such as syncope, incontinence, SOB
FBC, ELFT and ESR
CT chest
History of smoking, occupational exposures, respiratory or ENT problems, or GORD
Medication history, especially including ACE inhibitor use (which should be avoided), and results of treatment trials as defined in Other useful information
Relevant examination findings

Additional Referral Information

Spirometry and FeNO result (exhaled nitric oxide) if available
CXR, if performed
Previous gastroscopy findings or ENT assessment details where relevant

Send Referrals To

Smart Referrals

Preferred Method
About Smart Referrals

Secure Web Transfer

Send to: Gold Coast Health Service District

Internal Referrals

Respiratory (E-Blueslips)
Sleep Clinic Adult (E-Blueslips)

Fax

(07) 5687 4497

Post

Booking and Referral Centre
Gold Coast University Hospital
1 Hospital Boulevard
Southport QLD 4215

Enquiries

1300 559 083

Related HealthPathways

No directly related pathways found

HealthPathways home page

Service Availability

Dr Maninder Singh

Medical Director Respiratory and Sleep Medicine

Facilities

Gold Coast University Hospital

Robina Hospital

If you would like to send a named referral, please address it to the specialist listed above, who will allocate a suitably qualified specialist to see the patient. Alternatively, you can view a full list of our specialists.

Chronic coughAdult