Chronic cough Referral Access Criteria

• Nil

• Nil

To contact the relevant service, see Clinician Assist WA: Acute Respiratory assessment (external site).

• Chronic cough (present for >8 weeks)

Referrals missing 'mandatory information' with no explanation provided may not be accepted by site. If 'mandatory information' is not included, the explanation must be provided in the body of the referral (e.g. patient unable to access test in regional or remote areas or due to financial reason).

This information is required to inform accurate and timely triage. If unable to attach reports, please include relevant information/findings in the body of the referral and advise where (provider) investigation/imaging was completed.

• Relevant history, onset, duration, and severity of symptoms including:
  • Associated symptoms e.g. syncope, incontinence, dyspnoea, weight loss, fever
• History of ENT problems or GORD
• Current medication list
• Any known allergies
• Details of previous treatment and outcome (Multidisciplinary clinics have been shown to be more effective than review by individual healthcare practitioners. To help triage to this pressured resource, it is important to be clear if, where and by whom the patient has been seen for this complaint previously).
• Smoking/vaping status and history

• Nil

• FBC
• Spirometry pre and post bronchodilator. With inclusion of flow volume loop (where possible)
• CT thorax: ideally high-resolution chest CT. CT thorax is mandatory if there is suspicion of malignancy, bronchiectasis, or pulmonary fibrosis. To reduce radiation exposure other cases will be evaluated first.

• Diurnal variation in symptom severity (e.g. nocturnal or positional)
• Triggers e.g. air temp, food, talking, exercise
• Swallowing difficulties
• Voice change

• Nil

• Results of previous treatment trial as defined in useful information section
• Occupational history/exposure
• Previous gastroscopy findings
• Sputum culture

Category 1

Appointment within 30 days

• No defined category 1 criteria

Category 2

Appointment within 90 days

• No defined category 2 criteria

Category 3

Appointment within 365 days

• Cough present for > 8 weeks with normal CXR or CT and normal spirometry and no improvement following treatment trial as specified in useful information section

• Nil

• See Clinician Assist WA: Chronic Cough (external site)
• There are many causes of persistent cough. These can be categorised into:
  • Respiratory e.g. eosinophilic bronchitis
  • ENT (e.g. postnasal drip)
  • Gastrointestinal e.g. reflux
  • Drug related (ACEI, aspirin, beta blockers)
  • Cardiac (e.g. heart failure)

Treatment trial:
Ensure occult sino-nasal disease, unresolved infectious bronchitis and acid reflux have been considered and treated appropriately. Support cessation in those with nicotine or other smoked drug use.

ACE inhibitors should be ceased, and an alternate medication substituted (e.g. angiotensin 2 receptor antagonists).

1. If no clear evidence of asthma, it is possible that inhaled corticosteroids may be of benefit, and a four-week trial of inhaled steroids is suggested
2. A six-week trial of intra nasal steroid should be commenced if any suspicion of rhinitis/post-nasal drip
3. If unsuccessful, reconsider the need for a CT chest scan (including high resolution images) and refer to specialist.
4. There is good evidence that trials of Proton pump inhibitors in the absence of marked reflux symptoms are unhelpful.
5. Protracted courses of antibiotics have only been shown to be of benefit in young children and their empirical use in adults is not recommended.

Spirometry: Bulk-billed spirometry can be obtained via Respiratory Care WA (external site). A list of other providers undertaking lung function testing is provided on Clinician Assist WA: Respiratory Function Testing (external site).
See MBS: Item 11505 (external site) and MBS: Item 11506 (external site) for information on completing spirometry.

Clinician resources

• New England Journal of Medicine: Chronic Cough (external site)
• European Respiratory Journal: ERS guidelines on the diagnosis and treatment of chronic cough in adults and children (external site)