How do I assess the need for referral to secondary care in a patient with acute cough and associated red flag symptoms?

Assess the patient for symptoms and signs that suggest a serious illness or require urgent investigation, such as breathlessness or confusion that is new or increased, or signs of sepsis, pulmonary embolism, or lung cancer, and refer to secondary care if these are present NICE NG237.

Refer immediately or within 2 weeks for urgent chest X-ray if the patient has unexplained symptoms such as persistent or recurrent chest infection, unexplained haemoptysis, finger clubbing, chest signs consistent with lung or pleural disease, or if they are aged 40 and over with unexplained symptoms like cough, fatigue, shortness of breath, chest pain, weight loss, or appetite loss NICE NG12,NICE CKS.

Consider referral for further investigation if the patient has clinical features of suspected lung or mesothelioma cancer, such as unexplained cough in those over 40 who have ever smoked or been exposed to asbestos, especially if accompanied by other symptoms like fatigue or weight loss NICE NG12,NICE CKS.