Shortness of breath / dyspnoea without a known cause

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.

    • Dyspnoea of uncertain origin with any of the following concerning features:
      • acute dyspnoea at rest
      • new hypoxia (SpO2 ≤90%)
      • accompanied by confusion
    • Refer to HealthPathways or local guidelines
    • 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 HT)
      • vascular (pulmonary emboli, infarction)
      • ENT/endocrine related (laryngeal obstruction, thyroid enlargement causing tracheal compression, thyrotoxicosis)
      • gastrointestinal (GORD, tracheo-oesophageal fistula, aspiration)
      • haematological (anaemia, leukaemias)
      • neurological/neuromuscular (degenerative (MS, MND, myasthenia gravis, Guillian-Barre syndrome)
      • psychogenic (anxiety)
      • fitness or obesity related
      • drug related
    • It is important to at least arrive at a probable diagnosis as this will determine which specialty to refer. 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
Category 1
(appointment within 30 calendar days)
  • Severe breathlessness (stops for breath walking for a few minutes or breathless with daily activities such as dressing) Class 3-4 dyspnoea Breathlessness on minimal exertion around house with daily activities severely affected
  • Oxygen saturation 90-92% at rest
Category 2
(appointment within 90 calendar days)
  • Breathlessness walking for longer periods short distance on level ground at own pace with no unexplained by other explanation processes with some limitation on daily activities
Category 3
(appointment within 365 calendar days)
  • Unexplained Stable breathlessness on strenuous exertion (hurrying or walking upstairs or inclines) greater than expected for age and level of fitness with minimal effect on daily activities

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

  • CT chest
  • Relevant cardiac investigations such as echocardiography
  • Smoking history
  • FBC

3. Additional referral information Useful for processing the referral

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

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

© State of Queensland (Queensland Health) 2023

Except as permitted under the Copyright Act 1968, no part of this work may be reproduced, communicated or adapted without permission from Queensland Health. To request permission email ip_officer@health.qld.gov.au1.