Restrictive lung disease (RLD) or Idiopathic pulmonary fibrosis (IPF)

Red flags

Consider immediate referral for patients with the following:

Acute exacerbations of RLD/IPF showing the following features

  • Severely breathless
    • WHO IV Dyspnoea (ADL’s affected by Dyspnoea)
  • Unable to walk between rooms (when previously mobile)
  • Unable to eat or sleep secondary to dyspnoea
  • Altered mental state
  • Worsening hypoxaemia or cor pulmonale
  • Oxygen saturation <90% at rest
  • Clinical signs of pneumonia
  • New signs of heart failure
  • New arrhythmia/chest pain

Other important information for referring practitioners

In view of the serious and potential progressive nature of some of these conditions early referral is appropriate. Consider referral if:

  • RLD/IPF is suspected
  • Considering the requirement for home oxygen therapy
  • Infective exacerbation

Conditions in this category

  • Idiopathic pulmonary fibrosis
  • Non-specific interstitial pneumonia
  • Connective tissue associated interstitial lung disease
  • Sarcoidosis

Management considerations

  • Assess lung function
  • Assess for oxygen therapy
  • Assess for pulmonary rehabilitation
  • Smoking cessation
  • Identify and treat infective exacerbations
  • Consider referral for lung transplantation
  • Advance care planning and palliative care
  • Assess co-morbidities:
    • Anxiety and depression
    • Ischaemic heart disease
    • Lung cancer
    • Pulmonary hypertension
    • Diabetes

Referral requirements

A referral may be rejected without the following information.

  • Reason for referral
  • History of RLD/IPF or symptoms
    • Duration
    • Severity
  • 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)
    • Spirometry
    • CXR
    • HRCT chest
    • Serum ACE if sarcoidosis is suspected;
    • Auto-antibody screen

Additional referral information (useful for processing the referral)

  • Allergy testing
  • Gas transfer studies

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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