'Can you also treat people with suspected COPD?' This is what a GP recently asked me. 'Yes, we can' is what I told him. The fact that we are a top-tier teaching hospital does not automatically mean that we can only give the most complex care and procedures such as lung and heart transplantations.

Other than patients with end-stage pulmonary disease, who have pulmonary fibrosis, lung emphysema or cystic fibrosis, we also care for patients who live locally; I see various types of lung patients who have been referred by their GP or their regional hospital - including patients with suspected COPD.

These patients will get an appointment in our COPD Diagnostic Clinic. This clinic was founded based on patient needs and professional input from referring doctors. I also incorporated advice from the National COPD Working Group which I am a member of. We found inspiration during a visit to the Pulmonology Department at a regional hospital together with our pulmonology nurses. The key question in this process is: how can we offer our patients the best possible COPD care together? Together meaning the GP, the referring pulmonologist at the regional hospital and myself as the specialist at a university medical center - we each have our own role to play.

GPs want to refer patients to the UMC Utrecht, so that they can be given the best diagnosis and treatment, but they do not want to 'lose' their patients to us. Equally, patients prefer to be referred back to their trusted GP provided of course that their condition permits this. GPs also stated that they wanted to have a clear and substantiated answer on whether their patients have asthma or COPD. The distinction between these two conditions is indeed hard to make: both have overlapping symptoms. This is why more extensive lung function testing is necessary to make a precise diagnosis - we have all the means and expertise available here to do exactly that.

The COPD Clinic at the DH&L is organized in such a way that patients undergo all the necessary examinations during just one visit to this hospital, after which they are immediately diagnosed and given a proposed treatment plan. This all happens under the close supervision of a pulmonology nurse. GPs are also informed immediately at the end of the appointment. In summary, all those involved are guaranteed the best diagnosis and the referring doctors continue to treat their patients.

Nevertheless, collaborations with referring doctors extend beyond this. I continue to be in contact with GPs and other pulmonologists in the region and around the Netherlands, and I also work with physical therapists. We have a joint duty of care towards our patients which is dynamically shared between the GP, the regional hospital and the university hospital. It is therefore important that we all know what we are working on and what to expect, so that we can offer patients the very best continuity of care.'

COPD-care in UMC Utrecht