Asthma

• Acute exacerbation of asthma not responding to therapy
• Asthma with any of the following concerning features:
  • coexistent pneumothorax
  • silent chest
  • cardiovascular compromise
  • altered consciousness
  • relative bradycardia
  • decreasing rate and depth of breathing
  • cyanotic or SpO2 <92% on room air

•  Nil

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

• On two regular medicines (usually as one combination inhaler) AND
        a. had more than one exacerbation in the last 12 months OR
        b. uncontrolled symptoms e.g., reliever use > 3x/week or night-time wakening
• Diagnostic uncertainty or atypical features
• Any previous life-threatening episode
• Special circumstances such as competitive athletes

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 reasons).

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.

• Duration and severity of daytime and/or night-time symptoms
• Frequency of exacerbations
• Smoking/vaping status and history
• Current medication list
• Any known allergies
• Oral prednisolone use (including maintenance as well as acute dosage and frequency)
• Previous hospitalisations for asthma
• Assessment of adherence to treatment, stating the number of preventer inhalers provided in the last 12 months

• Nil

•  Spirometry, with inclusion of flow volume loop (where possible)

• Approximate age at diagnosis
• Previously tried respiratory medications
• Aeroallergen sensitivity
• Triggers
• Relevant past medical history

• Nil

• FBC

Category 1

Appointment within 30 days

• History of life-threatening asthma in the past 12 months requiring ventilation or ICU admission
• Unstable asthma with consistent FEV1 < 60% predicted
• Asthma caused or exacerbated by workplace exposure where patient is unable to work as a result

Category 2

Appointment within 90 days

• Asthma with any of the following:
  • Inadequate control despite optimal treatment (see Useful Information for optimal control)
  • Frequent after-hours attendance despite optimal treatment
  • Related hospital admission/s in last 3 months
  • Need for oral corticosteroids on >2 occasions in last year OR cumulative prednisolone dose >500-1000mg in any 2 consecutive years
  • Caused/exacerbated by workplace exposure where patient still able to work

Category 3

Appointment within 365 days

•  Uncertainty about diagnosis

•  Asthma education in absence of a consultation. Consider referral to Asthma WA

• See Clinician Assist WA: Asthma in Adults
• See Asthma Handbook on: Assessing patients’ adherence to asthma treatment
• The aim of asthma management is to control the disease. Complete control is defined as:
  • No day or night symptoms
  • Minimal or no need for short-acting beta agonist treatment (less than 2 times per week)
  • No exacerbations
  • No limitations on physical activity
  • Minimal side effects of treatment
• Will require in-person appointment for initial assessment to allow further testing and nurse review for inhaler coaching. Subsequent appointments can be telehealth if deemed appropriate.

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

Clinician resources

• National Asthma Council Australia including Asthma Action Plans
• National Asthma Campaign (NAC) literature
• Australian Asthma Handbook