referral criteria from primary care - COPD

Last reviewed 10/2018

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 (1,2):

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


Exclude carcinoma of the bronchus


  1. NICE (2010). Chronic obstructive pulmonary disease - management of chronic obstructive pulmonary disease in adults in primary care and secondary care
  2. Thorax (1997); 52 (suppl 5):S1-S32)