Patient has severe lung disease, evidenced by:

_____ poor response to bronchodilators
_____ forced expiratory volume in one second (FEV) after bronchodilator, less than 30% of predicted*
_____ increased visits to Emergency Department
_____ increased hospitalizations for pulmonary infections/respiratory failure
_____ decrease in FEV1 on serial testing of greater than 40 ml per year*
_____ presence of cor pulmonale or right heart failure due to lung disease evidenced by:

____ echocardiographic documentation*
____ EKG*
____ chest x-ray*
____ physical signs of RHF

_____ hypoxemic at rest on supplemental oxygen:

____ pO2, < 55 mm Hg on supplemental O2
____ O2 saturation < 88% on supplemental O2

_____ hypercapnia (pCO2 > 50 mm Hg)
_____ unintentional weight loss > 10% of body weight in past six months
_____ resting tachycardia (heart rate > 100 per minute)

*These tests are helpful evidence but should not be required if not readily available.