What criteria should I use to decide whether to refer a patient with an acute exacerbation of COPD to secondary care?

Refer a patient with an acute exacerbation of COPD to secondary care if they have severe breathlessness, inability to cope at home, poor or deteriorating general condition, or significant comorbidities such as cardiac disease or insulin-dependent diabetes ¹.

Other criteria include oxygen saturation less than 90%, worsening peripheral oedema, new chest radiograph changes, arterial pH less than 7.35, or arterial PaO2 less than 7 kPa ¹.

Consider referral if there is rapid onset of symptoms, acute confusion or impaired consciousness, cyanosis, or if the patient is already on long-term oxygen therapy ¹.