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Bronchiectasis/Chronic Suppurative Lung Disease (CSLD)

Bronchiectasis/Chronic Suppurative Lung Disease (CSLD)

Referrers should use this page when referring patients to public adult respiratory and sleep medicine outpatient services for bronchiectasis.
Emergency referral
If any of the following are present or suspected, refer the patient to the emergency department or seek emergency medical advice if in a remote region.
  • Bronchiectasis/Chronic Suppurative Lung Disease (CSLD) with any of the following concerning features:
    • altered consciousness
    • hypoxia (<92% oxygen saturation) when this is not normal for the patient (or SpO2<88% for those known to be hypoxic and usually on oxygen)
    • evidence of significant infective exacerbation (fever and/or high-volume purulent sputum) that is not responsive to empiric antibiotic treatment
    • new haemoptysis (clots or more than streaks)
    • new CXR changes indicative of cavitation, pleural effusion, consolidation or pneumonia if associated with worsening clinical symptoms
Immediate referral
Orange exclamation mark in triangle: orange alertImmediately 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).
Clinical indications for outpatient referral
If any of these issues are present, refer to outpatient services through the Central Referral Service (CRS).
  • Chronic or recurrent productive cough OR
  • Recurrent exacerbations (>3 per year) requiring antibiotic and/or hospital presentations
Mandatory information

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.

 
History
  • Relevant history, onset, duration, and severity of symptoms 
  • Details of previous treatment and outcome 
  • Current medication list
  • Any known allergies
  • Frequency of exacerbations
  • Smoking/vaping status and history
Examination
  • Nil
Investigations 
  • CT chest (ideally when patient is not acutely unwell)
  • Spirometry, with inclusion of flow volume loop (where possible)
Highly desirable
History
  • History of unintentional weight loss
  • History of childhood respiratory infections (e.g., Whooping cough)
  • Family history of cystic fibrosis
  • Previously tried medications if associated with treatment failure or problems
  • Degree of functional impairment (e.g., impact on exercise tolerance/ADLs/ability to work)
  • Cor pulmonale or sinus disease
Examination
  • Nil
Investigations
  • FBC
  • Previous sputum cultures
  • Immunoglobulins with IgG sub class results
  • CXR (if already performed)
Indicative clinical urgency category

Category 1

Appointment within 30 days

  • Chronic bronchiectasis/CSLD with any of the following:
    • Recurrent haemoptysis
    • Rapidly decreasing exercise tolerance
    • Unintentional weight loss

Category 2

Appointment within 90 days

  • Chronic bronchiectasis/CSLD with frequent (>3 per year) infective exacerbations despite optimal therapy

Category 3

Appointment within 365 days

  • Asymptomatic newly diagnosed or suspected bronchiectasis/CSLD
  • Stable symptomatic chronic bronchiectasis/CSLD
Exclusions
  • Nil
Useful information

  • See Clinician Assist WA: Bronchiectasis
  • Ongoing treatment requires regular and coordinated primary health care and specialist review, including monitoring for complications and comorbidities. Chest physiotherapy and regular exercise should be encouraged, nutrition optimised, environmental pollutants (including tobacco smoke) avoided, and vaccines administered according to national immunisation schedules.
  • Will require in-person appointment for initial assessment by multi-disciplinary team (clinician, physiotherapist, nurse); can consider telehealth for some follow up appointments

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

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