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Chronic suppurative pulmonary disease

Red flags

Consider immediate referral for patients with the following:

  • Signs of pleural effusion with pyrexia
  • Altered consciousness
  • Hypoxia (<90% oxygen saturation)
  • Moderate new haemoptysis
  • New signs of pneumonia
  • New CXR changes of cavitation (fluid levels)

Other important information for referring practitioners

Diagnosis

  • Suspect if patient has:
    • Chronic productive wet cough for over 8 weeks.
    • CXR changes persisting over 6 weeks
  • High resolution CT scan of the chest is essential to diagnose bronchiectasis
    • Non diagnostic CT with symptoms of bronchiectasis are likely to have CSPD
  • Sputum culture should be from lower respiratory tract
  • Spirometry (> 6 years of age)

Other tests to consider

  • Sweat test especially in children
  • Mycobacterial culture
  • Full immunoglobulins including total IgE and IgG subclasses
  • Aspergillus serological testing
  • HIV testing
  • Barium swallow
  • Neutrophil function tests and lymphocyte subsets
  • Echocardiogram if considering pulmonary hypertension

Aims of treatment

  • Improve symptom control
  • Reduce frequency of acute exacerbations
  • Preserve lung function
  • Maintain QoL

Management of the chronic disease should involve:

  • Regular monitoring for complications and co-morbidities
  • Anti-smoking measures
  • Vaccination
    • Pneumococcal
    • Influenza (yearly)
    • Pertussis
  • Specialist involvement
  • Physiotherapy
    • Chest physiotherapy
    • Exercise and rehab programs
  • Optimise nutrition
  • Long term use of:
    • Oral or nebulised antibiotics
    • Corticosteroids
    • Bronchodilators
    • Mucoactive agents
      • May provide benefit in individual patients but these are not routinely recommended.

Commonly involved organisms in adults

  • Pseudomonas aeruginosa
  • Haemophilus influenza (non-typeable)
  • Non-tuberculous mycobacteria
  • Aspergillus species
  • 25-45% fail to grow pathogenic bacteria.

Commonly involved organisms in children

  • Haemophilus influenza (non-typeable)
  • Streptococcus pneumoniae
  • Moraxella catarrhalis

Referral requirements

A referral may be rejected without the following information.

Essential referral information

  • Reason for referral
  • History of chronic suppurative pulmonary disease
    • Duration
    • Severity
    • Frequency of exacerbations
    • FH of cystic fibrosis
  • Management to date
    • Include last two specialist letters if seen previously at another centre
  • Other relevant medical conditions
  • Medications
    • Include previously tried medications if associated with treatment failure or problems
    • Include full medication list and allergies
  • Investigations
    • FBC (eosinophil count, anaemia, high WCC),ESR
    • Immunoglobulins and IgG sub classes
    • Sputum culture ( including mycobacterium culture)
    • Spirometry
    • CXR
    • CT scan of chest (essential)

Additional referral information (useful for processing the referral)

  • Allergy testing
  • Aspergillus serological testing
  • Sweat test

Consider referral if

  • Chronic suppurative pulmonary disease is poorly controlled despite optimal therapy
  • Doubt about diagnosis unable to be resolved despite investigation in primary care
  • Frequent infective exacerbations especially if unable to establish a causative organism

Out of catchment!

Metro North Health is responsible for providing public health services to the people who reside within its boundaries. Special consideration is made for patients requiring tertiary care or services that are not provided by their local Hospital and Health Service. If your patient lives outside the Metro North Health area and you wish to refer them to one of our services, inclusion of information regarding their particular medical and social factors will assist with the triaging of your referral.

  • Impact on employment
  • Impact on education
  • Impact on home
  • Impact on activities of daily living
  • Impact on ability to care for others
  • Impact on personal frailty or safety
  • Identifies as Aboriginal and/or Torres Strait Islander

  • To establish a diagnosis
  • For treatment or intervention
  • For advice and management
  • For specialist to take over management
  • Reassurance for GP/second opinion
  • For a specified test/investigation the GP can’t order, or the patient can’t afford or access
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)
  • Clinical judgement indicates a referral for specialist review is necessary

  • Presenting symptoms (evolution and duration)
  • Physical findings
  • Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
  • Body mass index (BMI)
  • Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
  • Current medications and dosages
  • Drug allergies
  • Alcohol, tobacco and other drugs use

  • Full name (including aliases)
  • Date of birth
  • Residential and postal address
  • Telephone contact number/s – home, mobile and alternative
  • Medicare number (where eligible)
  • Name of the parent or caregiver (if appropriate)
  • Preferred language and interpreter requirements
  • Identifies as Aboriginal and/or Torres Strait Islander

  • Full name
  • Full address
  • Contact details – telephone, fax, email
  • Provider number
  • Date of referral
  • Signature

  • Willingness to have surgery (where surgery is a likely intervention)
  • Choice to be treated as a public or private patient
  • Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)
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