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Asthma

When to consider referral

  • Diagnosis unclear
  • Unexpected clinical findings (ie crackles, clubbing, cyanosis, cardiac disease).
  • Unexplained restrictive spirometry.
  • Suspected occupational asthma.
  • Persistent non-variable breathlessness.
  • Monophonic wheeze or stridor.
  • Prominent systemic features (myalgia, fever, weight loss).
  • Chronic sputum production.
  • CXR shadowing.
  • Marked blood eosinophilia (>1 x 109/L).
  • Poor response to asthma treatment.
  • Patients who have had a life threatening asthma attack should have life long follow-up (BTS guidelines 2012)

Primary care investigations/management prior to referral

  • Investigations required prior to referral:
    • Spirometry (within the past 6 months)
    • CXR (within the past 6 months)
  • Primary care management prior to referral
    • Simple asthma should be managed in primary care via the treatment ladder linked below. Referrals for uncomplicated asthma where the patient has not exhausted the options on the ladder will be cancelled, unless reasoning for the referral is explicit.
    • Please include a history of therapy tried before with referral.

 

Management options for asthma

https://www.brit-thoracic.org.uk/document-library/clinical-information/asthma/btssign-asthma-guideline-quick-reference-guide-2016/ (page 12)

 

 

Clinic options available

  • Routine respiratory clinics all see asthma patients

 

Red Flags

  • Persistent haemoptysis in smoker/ex-smoker age >40 years
  • CXR suggestive of malignancy
  • Normal CXR where there is a high suspicion of lung cancer