Chronic cough

ADULT
  • 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.

    • No emergency indicators identified; routine prioritisation applies
    • Refer to HealthPathways or local guidelines.
    • 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
Minimum Referral Criteria
Category 1
(appointment within 30 calendar days)
This refers to a cough present for at least 8 weeks with no clear cause and which may be dry or moist.  Chronic sputum production should be considered under the Suppurative Lung Disease category.
  • 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 persisting for >8 weeks despite clinical assessment including CXR and spirometry, and management of associated contributory factors  as specified in Other useful information

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 not otherwise accessible to the patient
  • For advice regarding management
  • To engage in an ongoing shared care approach between primary and secondary care
  • Reassurance for GP/second opinion
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)

2. Essential referral information Referral will be returned without this

  • 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

3. Additional referral information Useful for processing the referral

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

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: 3 December 2024

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