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Referral criteria from primary care – COPD

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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Referral for advice, or specialist investigations or treatment may be appropriate at any stage of disease, not just for the most severely disabled patients. Some possible reasons for referral include (1):



There is diagnostic uncertainty

Confirm diagnosis and optimise therapy

Suspected severe COPD

Confirm diagnosis and optimise therapy

The patient requests a second opinion

Confirm diagnosis and optimise therapy

Onset of cor pulmonale

Confirm diagnosis and optimise therapy

Assessment for oxygen therapy

Optimise therapy and measure blood gases

Assessment for long-term nebuliser therapy

Optimise therapy and exclude inappropriate prescriptions

Assessment for oral corticosteroid therapy

Justify need for long-term treatment or supervise withdrawal

Bullous lung disease

Identify candidates for surgery

A rapid decline in FEV1

Encourage early intervention

Assessment for pulmonary rehabilitation

Identify candidates for pulmonary rehabilitation

Assessment for lung volume reduction surgery

Identify candidates for surgery

Assessment for lung transplantation

Identify candidates for surgery

Dysfunctional breathing

Confirm diagnosis, optimise pharmacotherapy and access other therapists

Onset of symptoms under 40 years or a family history of alpha-1 antitrypsin deficiency

Identify alpha-1 antitrypsin deficiency, consider therapy and screen family

Uncertain diagnosis

Make a diagnosis

Symptoms disproportionate to lung function deficit

Look for other explanations including cardiac impairment, pulmonary hypertension, depression and hyperventilation

Frequent infections

Exclude bronchiectasis


Exclude carcinoma of the bronchus

People who are referred do not always have to be seen by a respiratory physician. In some cases they may be seen by members of the COPD team who have appropriate training and expertise.


  1. National Institute for Health and Clinical Excellence (NICE) 2018. Chronic obstructive pulmonary disease: Management of chronic obstructive pulmonary disease in adults in primary and secondary care.


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