Swelling of legs, feet and ankles may indicate the development of pulmonary hypertension and requires GP assessment.
Consider hospital outpatient referral if:
• Frequent exacerbations to exclude bronchiectasis.
• If considering nebulised treatments or oxygen.
• Unintentional weight loss – for chest X-ray (lung cancer?). Consider investigation to exclude other causes.
• Severe symptoms or signs of cor pulmonale (e.g.: ankle swelling; MRC grade 4 / 5; FEV1 <30%; Sa0<92%).
• Diagnostic uncertainty e.g. symptoms disproportionate to lung function at initial assessment or follow up.
• Never smoked / occasional smoker.
• Age < 40 years.and requires GP assessment