Shortness of breath/dyspnoea without a known cause Referral Access Criteria

• Dyspnoea of uncertain origin with any of the following concerning features:
  • acute unexplained dyspnoea at rest
  • demonstrated new hypoxia (SpO2 < 92%)
  • with acute confusion
  • acute dyspnoea with other concerning features including stridor, chest pain, haemoptysis

Immediately contact on-call registrar or service to arrange immediate respiratory assessment (seen within 7 days):

• Nil

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

• Dyspnoea that limits ADLs
• New onset hypoxia

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
• Relevant medical conditions
• Current medication list
• Any known allergies
• Smoking/vaping status and history
• Occupational history/exposure

•  SpO2 on room air

• ECG
• Spirometry pre and post bronchodilator
• CXR or High-Resolution CT

• Degree of functional impairment (e.g. impact on exercise tolerance/ADLs/ability to work)

• Nil

• FBC
• U&E
• LFT
• ESR
• TFT
• Sputum MCS if productive cough
• Other relevant imaging
• ECHO report

Category 1

Appointment within 30 days

•  Grade 3/4 dyspnoea (external site)

Category 2

Appointment within 90 days

• Unexplained chronic dyspnoea of uncertain origin despite appropriate investigations listed as mandatory information

Category 3

Appointment within 365 days

•  No defined category 3 criteria

• Nil

• See Clinician Assist WA: Dyspnoea (external site)
• There are many causes of shortness of breath. These can be categorised into:
  • respiratory (Infective, 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, leukaemia’s)
  • neurological/neuromuscular (MS, MND, myasthenia gravis, Guillain-Barre syndrome)
  • psychogenic (anxiety)
  • chronic debility 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 working diagnosis in most cases by careful history and examination with directed investigations
• In the case of genuine uncertainty, a telephone discussion with the respiratory physician on-call may be of benefit.

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

• BMJ Best Practice: Assessment of dyspnoea: Diagnosis approach (external site)
• BMJ Best Practice: Assessment of dyspnoea: Differential diagnosis of breathlessness (external site)
• Modified Medical Research Council (mMRC): Dyspnoea Scale (external site)