Chronic cough

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Useful Management Information

There are many causes of persistent cough. These can be categorised into:
- Respiratory
- ENT (PN drip)
- Gastrointestinal
- Drug related (ACEI, aspirin, beta blockers)
- Cardiac (heart failure)

Treatment trial:
Ensure occult sino-nasal disease, unresolved infectious bronchitis and acid reflux have been considered and treated appropriately. ACE inhibitors should be ceased, and an alternate medication substituted (e.g. angiotensin 2 receptor antagonists).

Four-week trial of PPI
If unsuccessful, or symptoms of PN drip, commence a six-week trial of intra nasal steroid
If unsuccessful, or evidence of asthma, commence a four-week trial of inhaled steroids
If unsuccessful, complete CT chest scan (including high resolution images) and refer to specialist.

Clinician resources

New England Journal of Medicine – Chronic Cough article

Minimum Referral Criteria

Category 1	No category 1 criteria
Category 2	No category 2 criteria
Category 3	Cough present for > 8 weeks with normal Chest X-Ray and normal spirometry and no improvement following treatment trial as specified in Useful Management Information
If your patient doesn't meet the minimum referral criteria If the patient does not meet the criteria for referral but the referring practitioner believes the patient requires specialist review, a clinical override may be requested: Please explain why (e.g. warning signs or symptoms, clinical modifiers, uncertain about diagnosis, etc.) Please note that your referral may not be accepted or may be redirected to another service.

Standard Referral Information

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

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
All conservative options that have been pursued unsuccessfully prior to referral
Body mass index (BMI)
Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes, BMI), noting these must be stable and controlled prior to referral
Any special care requirements where relevant (e.g tracheostomy in place, oxygen required)
Current medications and dosages
Drug allergies
Alcohol, tobacco and other drugs use

Patient's Demographic Details

Full name (including aliases)
Date and country of birth
Residential and postal address including whether patient resides at an aged care facility
Telephone contact number/s – home, mobile and alternative
Medicare number (where eligible)
Name of the parent or caregiver (if appropriate)
Name of delegate and contact details (Department of Corrective Services)
Preferred language and interpreter requirements
Identifies as Aboriginal and/or Torres Strait Islander
Any special needs, access requirements and/or disability relevant to the referral

Referring Practitioner Details

Full name
Full address
Contact details – telephone, fax, email
Provider number
Date of referral
Signature
Nominated general practitioner’s details (if known), if the nominated general practitioner is different from the referring practitioner

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.)

Essential Referral Information

Symptoms
- Duration and severity
- Associated syncope, incontinence, SOB
Relevant examination findings (if applicable)
- History of ENT problems or GORD
- Check uniform lung expansion and any percussive changes
Medications including results of treatment trial as per defined in Other useful information
FBC
ELFT
ESR
Chest X-Ray

If a specific test result is unable to be obtained due to access, financial, religious, cultural or consent reasons a Clinical Override may be requested. This reason must be clearly articulated in the body of the referral.

Additional Referral Information

Symptoms including:
- any diurnal variation in severity (e.g. nocturnal or positional)
- triggers e.g. air temp, food, talking, exercise
- swallowing difficulties
- voice change
High resolution chest CT (if already performed)
Spirometry pre and post bronchodilator
Smoking and occupational history if relevant
Previous gastroscopy findings

Send Referrals To

Smart Referrals

Not available

Internal Referrals

Not available

Fax

Not available

Post

Not Available

Enquiries

Not available

Service Availability

Facilities

Gold Coast University Hospital

Robina Hospital

If you would like to send a named referral, please address it to the specialist listed above, who will allocate a suitably qualified specialist to see the patient. Alternatively, you can view a full list of our specialists.

Chronic cough

Useful Management Information

Minimum Referral Criteria

If your patient doesn't meet the minimum referral criteria

Essential Referral Information

Additional Referral Information

Send Referrals To

Smart Referrals

Internal Referrals

Fax

Post

Enquiries

Service Availability

Facilities