Indications for referral of a patient with COPD to a pulmonary specialist:
(1) uncertainty about the diagnosis
(2) severe airflow obstruction
(3) severe functional impairment
(4) rapid deterioration in pulmonary function
(5) determining if the use of home oxygen is appropriate
(6) findings suspicious for alpha-1 antitrypsin deficiency (onset at young age, unexplained cirrhosis, family history)
(7) persistent symptoms despite optimum management
(8) frequent exacerbations or recurrent infections
(9) hemoptysis or other findings suspicious for lung cancer
(10) signs and symptoms suggestive of cor pulmonale
(11) evaluation for advanced treatments (use of nebulizer, home non-invasive ventilation, lung volume reduction surgery, lung transplantation, bullectomy)
(12) evaluation for pulmonary rehabilitation
