Primary Care Management Prior to referral

  • COPD Prescribing Guidelines
  • Advice on treatment or investigations can be requested via the respiratory email advice and guidance service.


When to Refer for Consultant review:

  • High frequency of exacerbations  or  uncontrolled symptoms despite treatment optimisation
    • Before referral: Follow Cornwall COPD guideline - review fundamentals of COPD management
    • Has inhaled treatment been optimised & inhaler technique/adherence checked?
    • Chest Xray, Spirometry, FBC, BNP if indicated
  • Onset of less than 40 years of age
    • Before referral: Perform Spirometry with reversibility, send blood for alpha 1 antitrypsin, Chest Xray
  • Diagnostic uncertainty
    • Before referral: Chest Xray, Spirometry with reversibility , FBC, ECG & BNP if indicated
  • For assessment for lung surgery in bullous disease
    • Before referral: Chest Xray, Spirometry, FBC
  • Patients with Cor pulmonale
    • Before referral: Chest Xray, Spirometry, FBC


When to Refer to Community Specialist Nurses

  • Assessments for Long term home oxygen
  • Assessments for Ambulatory oxygen
  • Assessments for need for a Nebuliser
  • Palliative symptoms support.
  • Patients with frequent exacerbations and admissions

Inclusion Criteria:

  • Sats </= 92% on air
  • FEV <30% predicted
  • Cyanosis
  • Secondary polycythaemia

Exclusion Criteria:

  • Continued smoking is an absolute contraindication to oxygen therapy at home.

Please refer to the specialist nurses via the following email cpn-tr.MidRespiratoryTeam@nhs.net


Heathy Outlook for COPD click here

Pulmonary Rehabilitation click here

Smoker Free Cornwall https://www.healthycornwall.org.uk/make-a-change/smokefree-cornwall/

COPD Inhaler Prescribing Guidelines click here