Reason | Purpose |
Diagnostic uncertainty and exclusion of asthma | Establish diagnosis and optimise treatment. Check degree of reversibility of airflow obstruction |
Unusual symptoms such as haemoptysis | Investigate cause including exclusion of malignancy |
Rapid decline in FEV1 | Optimise management |
Suspected severe COPD | Optimise management |
Onset of cor pulmonale | Confirm diagnosis and optimise treatment |
Assessment of home oxygen therapy: burst, ambulatory or long-term oxygen therapy | Optimise management, measure blood gases and prescribe oxygen therapy |
Assessing the need for pulmonary rehabilitation | Optimise treatment and refer to specialist or community-based rehabilitation service |
Bullous lung disease | Confirm diagnosis and refer to medical or surgical units for bullectomy |
COPD <40 years of age | Establish diagnosis and exclude α1-antitrypsin deficiency |
Assessment for lung transplantation or lung volume reduction surgery | Identify criteria for referral to transplant centres |
Frequent chest infections | Rule out co-existing bronchiectasis |
Dysfunctional breathing | Establish diagnosis and refer for pharmacological and non-pharmacological management |
FEV1, forced expiratory volume in 1 s; COPD, chronic obstructive pulmonary disease.