Indications for referral for COPD

Assessment by a respiratory physician can be useful to verify the diagnosis of COPD, to identify patients with asthma or overlap of asthma and COPD and to differentiate COPD from other airway diseases or occupational exposures that can cause respiratory disease.

Indications for referral to a respiratory physician for COPD lists indications for which consultation with a respiratory specialist may be considered.

For patients with end-stage COPD, consider referral to a palliative care service. See also Prognosis, palliative care and advance care planning.

Figure 1. Indications for referral to a respiratory physician for COPD

  • diagnostic uncertainty
  • frequent exacerbations or persistent symptoms despite optimal drug and nondrug therapy (including pulmonary rehabilitation)
  • unusual symptoms (eg haemoptysis)
  • rapid decline in FEV1
  • COPD in a patient younger than 40 years (to investigate for alpha1-antitrypsin deficiency)
Note: COPD = chronic obstructive pulmonary disease; FEV1 = forced expiratory volume in 1 second