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 NICE CKS.
Referral is indicated for assessment of oxygen therapy, long-term nebuliser therapy, oral corticosteroid therapy, lung surgery, or lung volume reduction procedures NICE CKS.
Patients with a rapid decline in FEV1, cor pulmonale, or symptoms disproportionate to lung function should be referred NICE CKS.
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 NICE CKS.
Patients under 40 years or with a family history of alpha-1-antitrypsin deficiency should be referred for specialist assessment NICE CKS.
Individuals with suspected bullous lung disease, dysfunctional breathing, or who may be candidates for lung transplantation should also be referred NICE CKS.
Referral should be considered for assessment of pulmonary rehabilitation, especially if the patient is functionally disabled or has had recent hospitalisation for an exacerbation NICE CKS.