Chronic Obstructive Pulmonary Disease (COPD) Referral Access Criteria
Chronic Obstructive Pulmonary Disease (COPD) Referral Access Criteria
| Referrers should use this page when referring patients to public adult respiratory and sleep medicine outpatient services for chronic obstructive pulmonary disease. |
| Emergency referral |
 If any of the following are present or suspected, refer the patient to the emergency department or seek emergency medical advice if in a remote region. |
- Acute exacerbation not responding to therapy in primary care setting (e.g. oral antibiotics with or without prednisolone)
- Acute respiratory failure and/or respiratory distress with or without acute confusion
- New haemoptysis (clots or more than streaks)
- Persistent consolidation/pneumonia/fever that is not responsive to antibiotic treatment
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| Clinical indications for outpatient referral |
If any of these issues are present, refer to outpatient services through the Central Referral Service (CRS).
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- Dyspnoea that limits ADLs
- Recurrent cough
- Fatigue
- Frequent chest infections (>3 in 12 months)
- Increased sputum production
- Haemoptysis
- Rapid decline in FEV1
- Moderate (40-59% FEV1) or severe (<40% FEV1) COPD
- COPD < 40 years of age
- Dysfunctional breathing
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| Mandatory information |
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Referrals missing 'mandatory information' with no explanation provided may not be accepted by site. If 'mandatory information' is not included, the explanation must be provided in the body of the referral (e.g. patient unable to access test in regional or remote areas or due to financial reason).
This information is required to inform accurate and timely triage. If unable to attach reports, please include relevant information/findings in the body of the referral and advise where (provider) investigation/imaging was completed.
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| History |
- Relevant history, onset, duration, and severity of symptoms including dyspnoea
- History of acute exacerbations
- Details of current and previous treatment and outcome
- Current medication list
- Any known allergies
- Smoking/vaping status and history
- Relevant past medical history
- Degree of functional impairment (e.g. impact on exercise tolerance/ADLs/ability to work)
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| Examination |
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| Investigations |
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Spirometry, with inclusion of flow volume loop (where possible)
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| Highly desirable |
| History |
- History of childhood/adolescent lung disease
- Occupational history/exposure
- Vaccination status
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| Examination |
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| Investigations |
- FBC
- U&E
- LFT
- Desaturation on exertion e.g. walking for a 6-minute period with the GP or nurse
- ECHO
- Sputum culture
- CT chest
- Recent CXR (within last 12 months)
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| Indicative clinical urgency category |
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Category 1
Appointment within 30 days
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- COPD with chronic respiratory failure
- COPD with worsening right heart failure
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Category 2
Appointment within 90 days
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- Recurrent (>3 in 12 months) acute exacerbations or acute presentations to emergency
- Uncontrolled but stable symptoms on daily basis that limit ADLs/Grade 4 dyspnoea (external site)
- Requiring assessment for oxygen therapy
- COPD with demonstrated severe airflow obstruction (FEV1 <40%)
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Category 3
Appointment within 365 days
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Stable COPD for consideration for pulmonary rehabilitation or education (where community services are not available)
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| Exclusions |
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Referral for oxygen therapy in COPD for patients who are active smokers
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