Asthma, stridor and wheeze

PAEDIATRIC

  • If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or follow local emergency care protocols or seek emergent medical advice if in a remote region.

    • Infants who have apnoea or cyanosis during paroxysms of coughing
    • Children with recurrent or persistent respiratory symptoms who have had an episode of choking suggestive of a possible inhaled foreign body
    • Recent onset or escalating stridor and respiratory distress
    • Acute respiratory distress not responding to community management.
  • NB: Some services children may be directed to and seen by nurse practitioners or advanced practice nurses
    • In the majority of cases, it is thought inappropriate for children to wait more than 6 months for an outpatient initial appointment
    • Next of kin or person(s) who is legally responsible for patient consent, with the exception of children under guardianship orders with the Department of Child Safety, Seniors and Disability Services, should be present at the first outpatient appointment.
    • If you have a reason to suspect a child in Queensland is experiencing harm, or is at risk of experiencing harm, you need to contact Child Safety Services
    • Statement of intent – the prioritisation of health services for children and young people in the child protection system

    Clinician resources

    • The Asthma Foundation provides a support service with education and spacer devices. Call 1800 ASTHMA (1800 278 462).
    • Consider  referral to an asthma educator or a community asthma nurse:
      • newly diagnosed asthma
      • poorly controlled asthma
      • severe asthma e.g. requiring PICU
      • compliance issues
      • concerns regarding home management
      • patients from a non-English speaking background
    • Australian Asthma Handbook from the National Asthma Council
    • Australian Society of Clinical Immunology and Allergy
Minimum Referral Criteria
Category 1
(appointment within 30 calendar days)
  • Infants < 1 year with effect on sleep or feeding due to chronic or recurrent wheeze
  • Stridor without respiratory distress
  • Persistent breathlessness affecting sleep or quality of life
  • Recent history of severe or life threatening respiratory illness
  • Asthma with unexplained clinical findings, e.g. focal signs, abnormal voice or cry, dysphagia, inspiratory stridor
  • A child:
    • at risk of entering the child protection system (0 – 18 years of age)
    • currently in out of home care (OOHC) (0 – 18 years of age), or
    • Adolescents transitioning to adult healthcare following an out of home care experience (15 – 25 years of age)
    where they have previously been on a waiting list for this problem and were removed without receiving a service
Category 2
(appointment within 90 calendar days)
  • Asthma with failure to respond to conventional treatment (particularly inhaled corticosteroids above 400 micrograms per day or frequent use of steroid tablets) and use of asthma plan
  • Faltering growth
  • Doubt about diagnosis of asthma
Category 3
(appointment within 365 calendar days)
  • No category 3 criteria

Please insert the below information and minimum referral criteria into referral

1. Reason for request Indicate on the referral

  • 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

2. Essential referral information Referral will be returned without this

  • Current assessment of asthma control: good, partial, poor
  • Current medications
  • Frequency of oral steroid use in the previous 3 months
  • Note if the child has been hospitalized or not, and how often
  • Report presence or absence of concerning features
    • Paediatric ICU admission
    • History of chronic lung disease
    • Extreme prematurity
  • Confirmation of OOHC (where appropriate)

3. Additional referral information Useful for processing the referral

Highly desirable information – may change triage category

  • Note symptom frequency over the last 3 months:
    • every day
    • episodes of wheeze every week but not every day
    • episodes every month but not every week
    • episodes less than once per month
  • Height/weight/head circumference and growth charts with prior measurements if available.
  • Presence or absence of sleep, feeding or exercise related symptoms.
  • Copy of asthma management plan, if applicable

Desirable information- will assist at consultation

  • Assessment of adherence to medication
  • History of allergic/atopic disease (and family history of same)
  • Other past medical history
  • Immunisation history
  • Developmental history
  • Medication history
  • Significant psychosocial risk factors (especially parents mental health, family violence, housing and financial stress, Department of Children, Youth Justice and Multicultural Affairs involvement)
  • Other physical examination findings inclusive of CNS, birth marks or dysmorphology
  • Any relevant laboratory results or medical imaging reports, urinalysis result
  • Spirometry Reports, if available in children able to perform test (children over 8)

4. Request

  • Patient's Demographic Details

    • 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

    Referring Practitioner Details

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

    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
    • 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

    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

    Clinical modifiers

    • 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

    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.)

  • If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or follow local emergency care protocols or seek emergent medical advice if in a remote region.

    • Please note that where appropriate and where available, the referral may be streamed to an associated public allied health and/or nursing service.  Access to some specific services may include initial assessment and management by associated public allied health and/or nursing, which may either facilitate or negate the need to see the public medical specialist.

    • A change in patient circumstance (such as condition deteriorating, or becoming pregnant) may affect the urgency categorisation and should be communicated as soon as possible.

    • Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.

Last updated: 4 December 2024

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