Respiratory and Sleep Medicine

  • 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.

    Asthma

    • Acute exacerbation of asthma not responding to therapy
    • Asthma with any of the following features:
      • coexistent pneumothorax
      • pneumonia
      • silent chest
      • cardiovascular compromise
      • drowsiness
      • poor respiratory effort
      • SpO2 ≤92%
      • failure to respond to acute management
    • Respiratory distress

    Bronchiectasis / chronic suppurative lung disease (CSLD)

    • 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 haemoptysis (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

    • Cystic fibrosis with any of the following concerning features:
      • respiratory distress
      • new haemoptysis (clots or more than streaks)
      • pleural effusion
      • consolidation/pneumonia/fever
      • non- response to antibiotics for chest infection

    Haemoptysis without known lung disease

    • 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
    • Any haemoptysis associated with pulmonary infiltrates on CXR/CT chest or acute derangement in renal function

    Interstitial lung disease (ILD)

    • Acute exacerbations of known ILD with any of the following concerning features:
      • increasing breathlessness
      • worsening hypoxaemia
      • new arrhythmia/chest pain
    • Newly diagnosed or suspected ILD with radiographic evidence with worsening dyspnoea (at rest or with dressing/undressing)

    Lung cancer

    • 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 hypercalcaemia/hyponatremia
      • symptomatic pleural effusion

    Mediastinal lymphadenopathy

    • Evidence of SVC obstruction
    • Significant hypercalcaemia
    • Radiological evidence of airway obstruction

    Pleural disorders

    • Large symptomatic pleural effusion(s)
    • Features of infection/sepsis
    • Acute pneumothorax

    Pulmonary hypertension

    • Pulmonary hypertension with acute decompensation (hypoxia or right heart failure)

    Recurrent respiratory infections without known lung disease

    • Severe infection with breathlessness at rest, new hypoxaemia (SpO2 <92-96%)

    Sarcoidosis

    • 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

    Shortness of breath / dyspnoea without a known cause

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

    Tuberculosis / non-tuberculosis mycobacterial infections

    • Suspected tuberculosis with significant haemoptysis (defined as repeated expectoration of 5mL (1tsp) of blood or single episode of >20mL (1tbsp)

    Non-tuberculosis mycobacterial infections

    • Suspected tuberculosis with significant haemoptysis (defined as repeated expectoration of 5mL (1tsp) of blood or single episode of >20mL (1tbsp)

  • Please note this is not an exhaustive list of all conditions for outpatient services and does not exclude consideration for referral unless specifically stipulated in the CPC out of scope section.

  • The following are not routinely provided in a public Respiratory and Sleep Medicine service.

    • Chest pain without abnormalities on CT chest
    • Occupational lung screening
    • Lung cancer screening
    • Direct screening for TB – should be referred to contact and immigration screening regional Tuberculosis control centres)
    • Pleural plaques

Last updated: 3 December 2024

© State of Queensland (Queensland Health) 2023

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