Respiratory referral criteria

Conditions treated

• children established or considered for long term ventilation
• sleep-related respiratory failure and apnoea
• congenital lung abnormalities
• severe and complex asthma (please follow SEL criteria for referral to tertiary service)
  1. Children prescribed maintenance oral steroids (≥4 weeks over past 12 months)
  2. Admission to PICU in past 2 years
  3. On-going poor control despite optimised management in secondary care and the prescription of high dose inhaled corticosteroids plus a long acting beta agonist. Poor asthma control is defined as (one or more of):
     • Recurrent severe exacerbations in the past year (≥2 per year requiring high dose oral corticosteroids)
     • Persistent chronic symptoms (most days for >3 months) or an Asthma Control Test (ACT) or Childhood Asthma Control Test (C-ACT) score persistently of <20
  4. Using ≥6 SABAs per year despite optimisation of management in secondary care
  5. Persistent airflow limitation (FEV1/FVC <80% or < LLN) despite prescription of high dose ICS (as per NICE guideline*) plus LABA
  6. If diagnostic uncertain after secondary care clinic
• rare lung diseases of infancy
• bronchopulmonary dysplasia on oxygen and not weaning as expected or have more than 2 respiratory admissions despite management optimisation in secondary care
• congenital anomaly of larynx, trachea and bronchus
• suspected bronchiectasis in children

Exclusions

Please refer to the General Paediatrics department or relevant specialist for the following:

• chronic cough
• wheeze
• recurrent chestiness
• asthma (of a severity less than NRAD/BTS/NICE criteria for referral to a specialist)
• viral induced wheeze
• recurrent URTI
• recurrent pneumonia (if less than 3 documented pneumonia per year)
• chest wall deformities -please refer to the chest wall clinic
• Patients with cystic fibrosis - Please refer to CF Centre at Kings College Hospital

Please note that for certain conditions requiring long term care, after the initial assessment we may redirect the patient to their regional centre if the child is outside our network referral pathway

Administrative requirements

To book transport or a translator if required and to indicate this in the referral letter.

To ensure that we have all of the patient’s up to date details, including:

• address
• contact numbers
• NHS number
• ethnic group