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Referral for advice, or specialist investigations or treatment may be appropriate at any stage of disease, not just for the most severely disabled patients. Some possible reasons for referral include (1):
Reason | Purpose |
There is diagnostic uncertainty | Confirm diagnosis and optimise therapy |
Suspected severe COPD | Confirm diagnosis and optimise therapy |
The patient requests a second opinion | Confirm diagnosis and optimise therapy |
Onset of cor pulmonale | Confirm diagnosis and optimise therapy |
Assessment for oxygen therapy | Optimise therapy and measure blood gases |
Assessment for long-term nebuliser therapy | Optimise therapy and exclude inappropriate prescriptions |
Assessment for oral corticosteroid therapy | Justify need for long-term treatment or supervise withdrawal |
Bullous lung disease | Identify candidates for surgery |
A rapid decline in FEV1 | Encourage early intervention |
Assessment for pulmonary rehabilitation | Identify candidates for pulmonary rehabilitation |
Assessment for lung volume reduction surgery | Identify candidates for surgery |
Assessment for lung transplantation | Identify candidates for surgery |
Dysfunctional breathing | Confirm diagnosis, optimise pharmacotherapy and access other therapists |
Onset of symptoms under 40 years or a family history of alpha-1 antitrypsin deficiency | Identify alpha-1 antitrypsin deficiency, consider therapy and screen family |
Uncertain diagnosis | Make a diagnosis |
Symptoms disproportionate to lung function deficit | Look for other explanations including cardiac impairment, pulmonary hypertension, depression and hyperventilation |
Frequent infections | Exclude bronchiectasis |
Haemoptysis | Exclude carcinoma of the bronchus |
People who are referred do not always have to be seen by a respiratory physician. In some cases they may be seen by members of the COPD team who have appropriate training and expertise.
Reference:
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