Shaping better health
REMEDY : BNSSG referral pathways

Chronic Obstructive Pulmonary Disease (COPD)

Checked: 18-05-2018 by vicky.ryan Next Review: 18-05-2019

Principles of Management

For advice on assessment and management of COPD please refer to the Primary Care COPD Guidelines  updated in March 2018.

The guidelines have been produced locally and are based on the GOLD guidelines (2017). They give advice on COPD severity classification and appropriate treatments as well as advice on inhaler options and when to refer.

Please also see the Community Respiratory Service section for advice on Admission avoidance, Pulmonary rehab and  LTOT assessment and other community services.

Referral Guidance

Refer to Bristol Community Health's COPD Referral Pathway (word doc)

Patients who are not suitable for community services or needing consultant input should be referred to secondary care respiratory clinics via e-referral.

For more immediate concerns then please consider the Respiratory Hot Clinic.

Smoking Cessation for Patients with COPD

Smoking is the main cause of COPD and of the 7,000 people who have been diagnosed with COPD in Bristol, approximately 2,240 (32%) of them continue to smoke (BLF, Commissioning Excellence in COPD, 2010). By helping them to quit, then Emergency Admissions for COPD could be reduced by 40% (Euphix 2009), with an average cost saving of £1, 576 (BLF-Commissioniong Excellence in COPD 2010).

Please see the Smoking Cessation page for advice on support to stop services in your local area

Lung Volume Reduction

Refer to information leaflet for the management of Emphysema with Lung Volume Reduction through bronchoscopy.

Inclusion Criteria:

  • FEV1 Less Than 50% Predicted

  • MRC Breathlessness >3

  • 6 Minute Walk Distance - 100 metres – 450 metres

  • Stopped Smoking for 6 Months

  • Have Completed Pulmonary Rehabilitation Programme - or willing to do so

Exclusion Criteria:

  • Current Smokers

  • Sputum Producing Bronchiectasis

  • Significant Asthma Component

  • Suspected Lung Cancer (Lung Nodules)

  • Severe Co-Morbid Conditions


LVR Referral

Referral for Lung Volume Reduction should be made via e-referral to named consultant ( Dr Nabil Jarad )

Information for Patients

Information is available to patients at each stage of their condition.

Please check the  Guide for professionals to appropriate information and when to give this to patients.

Services to help with your respiratory condition - is a leaflet produced by BNSSG for patients with information regarding local resouces.

The British Lung Foundation website also has a range of patient support resources including:

  • Breathlessness: What to do if you often get out of breath.
  • How to stop smoking, It's never too late to quit
  • First steps to living with COPD
  • COPD patient passport: Walk 10 steps to the best COPD care
  • COPD Self -management plan

Inhaler prescribing information lists all available inhaler devices. This site lists all available devices however, prescribing should be in line with recommendations on the BNSSG Formulary