Table 2 COPD: criteria for referral to a specialist respiratory outpatient clinic
ReasonPurpose
Diagnostic uncertainty and exclusion of asthmaEstablish diagnosis and optimise treatment. Check degree of reversibility of airflow obstruction
Unusual symptoms such as haemoptysisInvestigate cause including exclusion of malignancy
Rapid decline in FEV1Optimise management
Suspected severe COPDOptimise management
Onset of cor pulmonaleConfirm diagnosis and optimise treatment
Assessment of home oxygen therapy: burst, ambulatory or long-term oxygen therapyOptimise management, measure blood gases and prescribe oxygen therapy
Assessing the need for pulmonary rehabilitationOptimise treatment and refer to specialist or community-based rehabilitation service
Bullous lung diseaseConfirm diagnosis and refer to medical or surgical units for bullectomy
COPD <40 years of ageEstablish diagnosis and exclude α1-antitrypsin deficiency
Assessment for lung transplantation or lung volume reduction surgeryIdentify criteria for referral to transplant centres
Frequent chest infectionsRule out co-existing bronchiectasis
Dysfunctional breathingEstablish diagnosis and refer for pharmacological and non-pharmacological management

  • FEV1, forced expiratory volume in 1 s; COPD, chronic obstructive pulmonary disease.