Services

Respiratory department

Services explained

* For urgent referrals of suspected cancers, a specific urgent referral form should always be used and faxed to the dedicated Two-Week Referral (TWR) office on 020 8725 0778 who will ensure that the patient is given an appointment within 14 days. Copies of the form are available the TWR office by calling 0208 725 1111.

Asthma

The Asthma clinic sees patients with asthma of varying severity and aims to provide an accurate diagnosis of the different variants of this condition. Advice on avoidance strategies and treatment with local (inhaled) and systemic therapies are key parts of the service. Management of patients with anaphylactic tendencies, cough and associated disorders is also available. A nurse-led clinic is run once or twice a week to complement the medical clinic. Skin prick testing, bronchodilator reversibility assessment and serological (immunological) tests are also available.

Chronic Obstructive Pulmonary Disease (COPD)

A multi-disciplinary team provides comprehensive care for COPD patients who access our services as out-patient referrals or through emergency hospital admission. The team works collaboratively with community COPD nurses and has strong links with primary care, encouraging joined-up care for COPD patients. Routine referrals are seen within 2-4 weeks. A specialist nurse or doctor is available to provide advice for patients or healthcare professionals on all aspects of COPD or to see urgent referrals on week days. Our services provided include diagnosis, education and self-management plans, management of severe or complex COPD (including nebulised antibiotics for chronic infection, support for home non-invasive ventilation, links with secondary pulmonary hypertension service and palliative care), nebuliser and oxygen assessment as well as access to structured pulmonary rehabilitation. St George's Healthcare has an active clinical research programme that aims to improve care for COPD patients.

Sarcoidosis and Interstitial Lung Disease (ILD)

The dedicated Sarcoidosis and ILD weekly clinic offers a state-of-the-art evaluation and treatment programme. The core service comprises specialist Chest physicians trained in ILD collaborating with thoracic radiologists, pathologists, rheumatologists, cardiothoracic surgeons and pulmonary hypertension physicians in an interdisciplinary manner. Diagnostic modalities provided include high-resolution CT scanning using the latest multi-detector row scanners, bronchoscopic examination with bronchoalveolar lavage and biopsy, full lung function and exercise testing, echocardiography, right heart catheterisation and thoracic surgical biopsy. Emphasis is placed on comprehensive characterisation of the disease process and providing the most up-to-date guidance on treatment options to the patient and their carers. A joint rheumatology-ILD clinic run by consultants with subspecialty training in this area is held every three months.

Rapid Access Lung Shadow Clinic (for urgent lung cancer referrals)

We offer a complete diagnostic and therapeutic thoracic malignancy service. Patients with suspected lung cancer (either symptoms or radiological suspicion) are fast-tracked for the Tuesday morning consultant-led Rapid Access Lung Shadow Clinic. Portable pleural ultrasound is available in this clinic. Our weekly MDT (with a comprehensive team of 10 consultants) meets every Monday morning to discuss cases prior to a specialist joint oncology clinic with medical and clinical oncologists. Thoracic surgical clinics and diagnostic ultrasound lists also run on a Monday morning to facilitate urgent referrals. In addition, diagnostics and clinics are conducted at Queen Mary's Hospital and patients are brought to St George's Healthcare for treatment. We have strong links with the Kingston lung cancer MDT service with a physician and surgeon contributing to this service.

Lung Infections

Patients with slow-to-resolve infections and/or bronchiectasis are prioritised to one of several general respiratory clinics, unless where TB is suspected. Blood tests for infective markers including fungal serology, sputum induction, diagnostic bronchoscopy, HIV testing and immune function testing are available.

Tuberculosis

All outpatient referrals to the TB service are reviewed by the TB consultant and/or a specialist TB nurse within 24 hours of receipt. In addition to a weekly TB clinic, there is also a Rapid Access nurse-led clinic, Mantoux clinic and a therapy monitoring service. In addition to conventional chest imaging, blood tests, Mantoux skin test, sputum induction and bronchoscopy, an in-house interferon-gamma release assay (IGRA) based the Elispot® technology has been available since 2007 to enhance the diagnosis of latent TB infection. Healthcare worker screening and exclusion of latent TB infection in potential recipients of systemic anti-biological therapy (e.g. anti-TNF-alpha agents) are important aspects of the TB service. All patients on prophylaxis or full treatment are closely monitored for compliance and the emergence of potential side effects, including by DOT (Directly Observed Therapy) if necessary.

Sleep Disordered Breathing

There are two clinics a week dedicated to the assessment and investigation of patients with sleep-disordered breathing. We undertake home sleep studies on patients with suspected Obstructive Sleep Apnoea Syndrome (OSAS). For those in whom the diagnostic sleep study is positive, a full continuous positive airway pressure (CPAP) service is provided. Close links with the Ear, Nose and Throat (ENT) and bariatric surgeons ensure that alternative therapeutic options are made available where such approaches are more appropriate. The Sleep service is supported by a full-time sleep nurse specialist and fully-trained clinical physiologists.

Asbestos-related Lung Disease and Mesothelioma

Patients with suspected asbestos-associated lung or pleural disease are prioritised to see specialist physicians well-versed in these conditions. Advice and guidance on industrial compensation may be provided. Patients with suspected mesothelioma are managed through the Thoracic Malignancy MDT service. Other occupational lung diseases, including occupational asthma, are also comprehensively evaluated.

Pulmonary Hypertension (PH)

The PH programme is a large multidisciplinary service interfacing with colleagues in anaesthesia, cardiology, cardiothoracic surgery, haematology, intensive care, radiology, respiratory medicine and rheumatology. It concentrates on the diagnosis and management of patients with suspected pulmonary hypertension associated with cardiac, pulmonary and haematological disorders including thromboembolic and sickle cell disease. In addition to inpatient care, there is a weekly outpatient clinic and right heart catheterisation service. All referrals and requests for inter-hospital transfers can be made directly to Professor Madden or his team. At present, amalgamation with the pulmonary hypertension service at the Royal Brompton Hospital is underway; once established, it is envisaged to be able to offer a wide expertise in the comprehensive management of patients with PH throughout southern England.

Flexible Bronchoscopy

Two flexible fibreoptic bronchoscopy lists (Monday and Friday) are run each week and patients are examined under conscious sedation with topical airway anaesthesia. Diagnostic procedures include endobronchial and transbronchial biopsy as well as wedged bronchoalveolar lavage (BAL) to retrieve alveolar inflammatory cells for differential leukocyte profiling in cases of suspected interstitial lung disease.

Rigid Bronchoscopy and Large Airway Intervention

This service, one of the largest of its kind in Europe, has designated theatre lists and a specialist team of highly trained physicians, anaesthetists, theatre nurses and associated staff. Patients with diverse malignant and benign large airway pathologies are treated. Procedures are performed under general anaesthesia and include biopsy of proximal airway tumours, Nd:Yag laser debulking therapy, dilatation of airway strictures, foreign body removal, closure of bronchopleural fistulae, endobronchial stent deployment, application of glue to seal airway defects and investigation and management of massive haemoptysis. The service has an international reputation, an excellent clinical outcome with very low complication rates and is actively engaged in research and teaching. Referrals are accepted from local, national and overseas sources and may be made directly to Professor Madden or his team for assessment and prioritisation within the day of receipt.

Lung Function Testing

Comprehensive lung function testing (measurement of spirometry with bronchodilator reversibility, lung volumes using plethysmography, gas transfer and small airway indices) is available. Skin prick tests, basic exercise tests and six-minute walk test are also performed. Overnight sleep tests are conducted as initial home sleep studies and CPAP titration studies. A full CPAP setup and monitoring service is provided as part of the Sleep Disorders Clinic.

Oxygen Assessment and Nebuliser Trials

A weekly outpatient service to assess supplemental oxygen requirement is run by specially trained senior nurses. Outpatient follow-up, domiciliary reviews and evaluation for portable oxygen devices are also undertaken. A separate weekly service to assess the need for and response to nebulised bronchodilator therapy, including the provision of a compressor and nebuliser chamber, is available for patients with chronic airways diseases.

Pulmonary Rehabilitation

Many patients with long-term respiratory conditions who attend a structured pulmonary rehabilitation programme can make significant improvements in walking distances, activities at home and in their general health status. At St George's, we provide a seven-week exercise and education programme that takes place twice a week. We welcome enquiries and referrals from the Respiratory team, general practitioners, therapists and PCT practice nurses.

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