Referrals
Chronic cough referral checklist
Key investigations, urgent criteria, and referral note elements for chronic cough.
Last reviewed 2026-01-05|respiratory | cough | workup
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Minimum pre-referral workup
- Duration longer than 8 weeks and smoking or vaping history.
- Medication review, including ACE inhibitor exposure.
- Chest x-ray report within the past year.
- Spirometry with bronchodilator response if available.
- Assessment of upper airway symptoms and reflux history.
Urgency tier
- Hemoptysis.
- Unintentional weight loss or persistent fever.
- Significant dyspnea, hypoxia, or abnormal vital signs.
- Abnormal chest x-ray suggesting malignancy or infection.
- Immunosuppression or known lung disease with rapid decline.
Referral packet checklist
- Onset, pattern, and triggers for cough.
- Smoking history, occupational exposures, and travel.
- Prior trials (inhalers, reflux therapy, nasal therapy) and response.
- Chest imaging and spirometry results.
- Current medications and comorbidities (asthma, GERD).
Pre-referral optimization tasks
- Optimize inhaler technique and trigger-avoidance counseling where appropriate.
- Review smoking and vaping cessation supports and first-line reflux or upper-airway measures.
- Confirm return precautions for hemoptysis, worsening dyspnea, or clinical deterioration.