It may be useful to refer patients to specialist services, when there is:

• Diagnostic uncertainty

• Unusual symptoms, rapid decline, complex care needs, or for

• Particular indications such as assessment for long term oxygen therapy (LTOT), long volume reduction surgery (LVRS), specialist respiratory nurse

It is highly recommended that referral also be made to:

• Promote physical activity through referral to pulmonary rehabilitation, as appropriate

• And referral to palliative care services, as appropriate, in conjunction with multidisciplinary team (MDT) assessment