Indications for Referral of Patient with COPD to Pulmonologist

• uncertainty about the diagnosis of the COPD?

• findings suspicious for alpha-1 antitrypsin deficiency (onset at young age, unexplaiend cirrhosis, family history)?

• signs and symptoms suggestive of cor pulmonale?

• hemoptysis or other findings suspicious for lung cancer?

• severe airflow obstruction?

• severe functional impairment?

• rapid deterioration in pulmonary function?

• persistent symptoms despite optimum management?

• frequent exacerbations or recurrent infections?

• home oxygen therapy or non-invasive ventilation?

• nebulizer therapy?

• surgery such as lung volume reduction surgery, lung transplantation, or bullectomy?

• pulmonary rehabilitation?