What criteria should I use to determine if a patient with COPD requires referral to a specialist?

Refer a patient with COPD to a respiratory specialist if there is diagnostic uncertainty, suspected severe COPD, or if the patient requests a second opinion ¹.

Referral is indicated for assessment of oxygen therapy, long-term nebuliser therapy, oral corticosteroid therapy, lung surgery, or lung volume reduction procedures ¹.

Patients with a rapid decline in FEV1, cor pulmonale, or symptoms disproportionate to lung function should be referred ¹.

Referral is also recommended if there is suspicion of lung cancer (e.g., haemoptysis or suspicious chest X-ray features), or if there are frequent infections to exclude bronchiectasis ¹.

Patients under 40 years or with a family history of alpha-1-antitrypsin deficiency should be referred for specialist assessment ¹.

Individuals with suspected bullous lung disease, dysfunctional breathing, or who may be candidates for lung transplantation should also be referred ¹.

Referral should be considered for assessment of pulmonary rehabilitation, especially if the patient is functionally disabled or has had recent hospitalisation for an exacerbation ¹.