Shortness of breath/dyspnoea without a known cause
Shortness of breath/dyspnoea without a known cause
Referrers should use this page when referring patients to public adult respiratory and sleep medicine outpatient services for shortness of breath / dyspnoea without known cause.
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| 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. |
- 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
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| Clinical indications for outpatient referral |
If any of these issues are present, refer to outpatient services through the Central Referral Service (CRS).
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- Dyspnoea that limits ADLs
- New onset hypoxia
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| Mandatory information |
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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.
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| History |
- 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
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| Examination |
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| Investigations |
- ECG
- Spirometry pre and post bronchodilator
- CXR or High-Resolution CT
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| Highly desirable |
| History |
- Degree of functional impairment (e.g. impact on exercise tolerance/ADLs/ability to work)
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| Examination |
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| Investigations |
- FBC
- U&Es
- LFTs
- ESR
- TFT
- Sputum M/C/S if productive cough
- Other relevant imaging
- ECHO report
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| Indicative clinical urgency category |
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Category 1
Appointment within 30 days
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Category 2
Appointment within 90 days
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- Unexplained chronic dyspnoea of uncertain origin despite appropriate investigations listed as mandatory information
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Category 3
Appointment within 365 days
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No defined category 3 criteria
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| Useful information |
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- See Clinician Assist WA: Dyspnoea
- 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 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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