Respiratory clinic referrals

Out-patient Referral guidance for Primary Care during COVID-19 Pandemic

  1. Referral for suspected Lung cancer will be accepted as normal
  2. If unilateral moderate to large pleural effusion in chest radiograph referral to pleural clinic accepted for ambulatory management
  3. Chronic Breathlessness and Chronic cough referrals: If there are no clinical Red Flag signs of cancer, Please give advice about life-style changes (stop smoking, keep exercising to lose weight if obese) and commence/continue best medical therapy. We will not accept any routine referrals.
  4. Routine Lung function: testing is suspended due to risk of aerosol generation during the procedure.
  5. Sleep Apnoea referrals: We are not accepting any OSAS referrals to Sleep clinics.
  6. Home Oxygen referrals: Ambulatory oxygen therapy – this is non-urgent, with limited evidence of symptomatic benefit. We will not be able to undertake assessment in order to prescribe appropriately – please do not refer.
    Long term oxygen therapy – indicated where there is evidence of chronic hypoxaemia.
    Non-urgent therapy. Patients are in vulnerable, at risk groups and risk of attending for assessment outweighs possible benefit – please do not refer.
    Palliative oxygen therapy – limited evidence that oxygen improves comfort unless significant hypoxia, suggest other symptom palliation measures such as breathing control, low dose Oramorph. For those with hypoxia and distressing symptoms at end of life, assessment not required and oxygen can be arranged by GP. We are happy to advise regarding completing prescription
  7. Poor control of Asthma and COPD /Emphysema. If the patient can be treated in the usual pathway where COVID is NOT suspected the community care suggested according to standard BTS guidelines (there is No change in existing practice ). If COVID suspected and clinically stable PHE guidance of self-isolation suggested. If clinically unwell to be treated in community, consider admission to hospital.
  8. Recurrent Lower Respiratory tract infections
    Respiratory Clinic during COVID Version 3.1 2
    Please can 3 samples of sputum MC & S to be sent to micro and AFB. Antibiotics as per sputum depending on underlying airways/lung disease. If infection still persists advice and guidance provided by written referral
  9. Patients with NEW suspected Pulmonary Tuberculosis (TB) , referrals accepted in the usual way (Chest radiograph to be completed)
  10. Suspected Interstitial lung Disease:
    • Please refer in usual manner. Patients will not be seen in clinic in the first place but will be followed up with non-urgent appointment when available. Please attach the latest spirometry printout if available but do not perform spirometry during the COVID-19 pandemic.
    • Rapidly progressively breathlessness, features of ILD, possible aetiological factors (autoimmune features, known antigen) and appearances suggestive of inflammatory ILD on CT (ground glass) – refer urgently or consider admission.