Box 8: Indication for referral to specialist respiratory outpatient services

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

Moderate or severe COPD

Optimise management

Onset of cor pulmonale

Confirm diagnosis and optimise treatment

Assessment of home oxygen therapy: 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 alpha1-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