Pharmacists play an essential role in the ongoing care of Chronic Obstructive Pulmonary Disease (COPD) patients, offering medication management, lifestyle guidance, and monitoring the progression of the disease. However, there are specific circumstances where referral to a specialist or other healthcare professional is necessary. This guide highlights the key indicators for when pharmacists should refer COPD patients, ensuring they receive the specialised care they require.
When to Refer: Key Indicators
Pharmacists should consider referring a patient to a specialist if any of the following occur:
- Unclear diagnosis: If the patient’s diagnosis is uncertain, further evaluation is necessary.
- Suspected new onset of severe COPD: New symptoms suggestive of severe COPD should prompt a specialist referral.
- Request for second opinion: If the patient seeks a second medical opinion.
- Onset of Cor Pulmonale: Development of right-sided heart failure secondary to COPD.
- Assessment for oxygen therapy: Patients requiring a formal assessment for long-term oxygen use.
- Long-term non-invasive ventilation: When non-invasive ventilation for chronic respiratory failure is under consideration.
- Nebuliser therapy: Referral for the assessment of long-term nebuliser use.
- Oral corticosteroid therapy: If considering prolonged oral corticosteroid treatment.
- Suspected bullous lung disease: When bullae or other significant lung changes are suspected.
- Rapid decline in FEV1: A sharp reduction in forced expiratory volume.
- Pulmonary rehabilitation: Assessment for programmes designed to improve respiratory health and physical endurance.
- Lung volume reduction procedure: If the patient may benefit from surgical lung volume reduction.
- Lung transplant: Consideration for transplant eligibility.
- Dysfunctional breathing: When breathing patterns indicate a need for further specialist input.
- Onset of symptoms under 40 years or family history of alpha-1 antitrypsin deficiency: Early onset or genetic predisposition requires investigation.
- Disproportionate symptoms: If symptoms are severe compared to lung function results.
- Frequent infections: Recurring infections that require specialist management.
- Haemoptysis: Coughing up blood, which necessitates immediate referral.
Referrals to Other Healthcare Professionals
Pharmacists should also refer COPD patients to the following professionals when specific needs arise:
- Pulmonary Rehabilitation: For patients with an MRC score over 3, especially those with excessive sputum production, where learning techniques like positive expiratory pressure (PEP) devices and active cycle breathing could be beneficial.
- Social Prescriber: If the patient has difficulty with daily activities or functional disabilities, a social prescriber can help, and further referrals to Social Services or Occupational Therapy may be appropriate.
- Dietitian: When a patient’s BMI is abnormally high or low, or has changed significantly over time (e.g., weight loss of 3kg in an older person).
- Psychological Services: If the patient struggles with anxiety or depression related to their COPD, a referral to psychological services may help manage mental health.
In Summary
In the management of COPD, pharmacists play a critical role in recognising when patients need further evaluation or specialist care. Identifying key indicators for referral ensures that patients receive the most comprehensive, appropriate treatment, addressing all aspects of their condition