C5. Specialist referral
Confirmation of the diagnosis of COPD and differentiation from chronic asthma, other airway diseases or occupational exposures that may cause airway narrowing or hyper- responsiveness, or both, often requires specialised knowledge and investigations. Indications for which consultation with a respiratory medicine specialist may be considered are shown in Box 6.
|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|
FEV1, forced expiratory volume in 1s; COPD, chronic obstructive pulmonary disease.
Box adapted from British Thoracic Society Statement (British Thoracic Society 2008b).