Shortness of breath / dyspnoea without a known cause
Adult

On this page

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 concerning features:
- coexistent pneumothorax
- pneumonia
- silent chest
- cardiovascular compromise
- altered consciousness
- relative bradycardia
- decreasing rate and depth of breathing
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 with acute dyspnoea, measured hypoxia, altered consciousness, hypotension, tachycardia or chest pain
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
- suspected large airway obstruction
- severe dyspnoea
- SVC obstruction
- hypercalcemia/hyponatremia with confusion
- symptomatic pleural effusion
Large symptomatic pleural effusion
Acute pneumothorax
Acute decompensation (hypoxia or right heart failure) with pulmonary hypertension
Pulmonary embolism
Dyspnoea of uncertain origin with any of the following concerning features:
- acute dyspnoea at rest
- demonstrated hypoxia (SpO2 < 90%)
- accompanied by confusion
Suspected tuberculosis with significant haemoptysis (defined as repeated expectoration of 5mL (1tsp) of blood or single episode of >20mL (1tbsp)

Useful Management Information

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 hypertension)
- vascular (pulmonary emboli, infarction)
- ENT/endocrine related (laryngeal obstruction, thyroid enlargement causing tracheal compression, thyrotoxicosis)
- gastrointestinal (GORD, tracheo-oesophageal fistula, aspiration)
- haematological (anaemia, leukemia)
- 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 to. It should be possible to arrive at a diagnosis in most cases by careful history and examination with directed investigations.

Clinician resources

Minimum Referral Criteria

Does your patient meet the minimum referral criteria?

Category 1 (appointment within 30 calendar days)	Class 3-4 dyspnoea Oxygen saturation 90-92% at rest
Category 2 (appointment within 90 calendar days)	Unexplained chronic dyspnoea of uncertain origin
Category 3 (appointment within 365 calendar days)	No category 3 criteria
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

Details and timeline of symptoms including variability and severity
Relevant medical conditions
Chest X-Ray
Smoking and occupational history (if relevant)

If a specific test result is unable to be obtained due to access, financial, religious, cultural or consent reasons a Clinical Override may be requested. This reason must be clearly articulated in the body of the referral.

Additional Referral Information

FBC
ELFT
ESR
TFT
Lung function pre and post bronchodilator
ECG
Sputum M/C/S if productive cough
Other relevant imaging
Pulse oximetry

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.

Shortness of breath / dyspnoea without a known causeAdult