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Chronic obstructive pulmonary disease - Management
When should I refer a person with COPD to a respiratory specialist?

  • If lung cancer is suspected, refer the person urgently to a respiratory specialist to be seen within 2 weeks — see the CKS topic on Lung cancer - suspected.
    • If the person with chronic obstructive pulmonary disease (COPD) reports haemoptysis, suspect lung cancer and refer urgently.
  • Other reasons for referral to a respiratory specialist include:
    • Diagnostic uncertainty.
      • Referral may be needed for this reason for black and Asian people, for whom normal ranges for forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) are not known.
    • COPD that is very severe (for example FEV1 less than 30% predicted) or worsening (rapid decline in FEV1).
    • Continued smoking, if the primary healthcare professional considers that referral would increase the likelihood of smoking cessation.
    • The person with COPD requests a second opinion.
    • Cor pulmonale.
    • Dysfunctional breathing (abnormal breathing patterns associated with anxiety).
    • Onset of symptoms at an age younger than 40 years, or a family history of alpha1-antitrypsin deficiency.
    • Frequent infections.
    • Symptoms disproportionate to lung function.
    • For pulmonary rehabilitation (for a person who considers themselves functionally disabled by COPD), if direct referral is not possible.
    • For assessment of the need for:

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