Respiratory Medicine

Our respiratory medicine service diagnoses and treats a wide range of respiratory diseases and problems. We see patients from South West London and sometimes further afield. Our mission is to deliver outstanding and accessible clinical services that are continually developed and refined in response to the needs of the people we serve and our team includes respiratory specialists, nurses, physiotherapists and physiologists.

Further information about each service component is provided below.

• Asthma
• Chronic obstructive pulmonary disease
• Interstitial lung disease and sarcoidosis
• Lung cancer*
• Pleural disease and ambulatory procedures clinic
• Bronchiectasis and lung infections
• Tuberculosis (TB)
• Sleep-related disorders and domiciliary CPAP service
• Domiciliary non-invasive ventilation service
• Occupational and environmental lung diseases
• Pulmonary hypertension
• Flexible bronchoscopy, endobronchial ultrasound and rigid bronchoscopy
• Full lung function testing including bronchodilator reversibility
• Nurse-led respiratory clinics including Oxygen assessment, Nebuliser trial service and hypoxia altitude simulation test (‘fitness to fly’)
• CDC clinics

Safety Notice regarding ResMed magnetic masks (Issued 4 December 2023)

ResMed has issued an urgent warning to patients currently using Continuous Positive Airway Pressure (CPAP) therapy with masks equipped with magnetic clips.

ResMed has expressed concerns that masks with magnetic clips may pose a threat to individuals with metallic medical implants, including patients, bed partners, and caregivers involved in the fitting of the masks. The magnetic clips, when near certain medical implants, could adversely affect their functionality, leading to serious health implications.

The affected medical implants include, but are not limited to, pacemakers, implantable cardioverter defibrillators (ICD), neurostimulators, and various magnetic metallic implants and devices placed in different parts of the body. A comprehensive list of the implants at risk can be found on the ResMed website.

Patients who are currently using masks with magnetic clips and have metallic medical implants are urged to take immediate action. They are advised to contact the Respiratory Physiology Service at St George’s University Hospitals NHS Foundation Trust by calling 020 8725 2909 or emailing Resp.External@stgeorges.nhs.uk. The hospital will facilitate the transition to an alternative interface within the next three months to ensure patient safety.

In the interim, affected individuals are advised to maintain a minimum distance of six inches between the magnetic clips and their metallic implants, including those of bed partners and caregivers. Alternatively, if patients possess an older mask with non-magnetic clips, they are encouraged to continue using it until a suitable replacement is provided.

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. We have a service for severe asthma patients on injectable biologic therapies wo are reviewed regularly in our severe asthma clinic and are discussed in our regular MDT

Lead consultant – Dr Jane Evans

Chronic Obstructive Pulmonary Disease

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 running a once monthly MDT 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 has an active clinical research programme that aims to improve care for COPD patients.  We also run a severe COPD MDT to assess patients for surgical intervention for emphysema, such as lung volume reduction surgery or endobronchial valve insertion.

Our COPD clinics are in St George’s Hospital and Nelson Health Centre.

Lead consultant –  Dr Sachelle Ruickbie

Interstitial Lung Disease (ILD) & Sarcoidosis

The dedicated Sarcoidosis and ILD twice 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 EBUS, full lung function and exercise testing, echocardiography, right heart catheterisation and thoracic surgical biopsy.  We run regular rheumatology ILD clinics for management of patients with complex  Connective Tissue disease associated ILD and vasculitis. Patients with multi system sarcoidosis have access to Cardiac MRI, and we provide joint cardiac sarcoidosis clinics in association with cardiologist. Complex Neurosarcoid patients are managed jointly with expert neurologists and  discussed in regular neuro sarcoid MDT.  We have access to specialist ILD MDT at St Mary’s Hospital Imperial healthcare NHS Trust. Patients have access to antifibrotics (Nintadib and Pirfenidone) in collaboration with St Mary’s Hospital if required.

Lead consultant – Dr Raminder Aul

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 consultant-led Rapid Access Lung Shadow Clinic. We have access to CT scans, PET scans, image-guided biopsies, flexible and rigid bronchoscopy and EBUS (endobronchial ultrasound sampling). Our weekly MDT meets every Monday morning to discuss cases prior to a specialist joint oncology clinic with thoracic surgeons, medical and clinical oncologists. In addition, CT scans and clinics are conducted at Queen Mary’s Hospital and patients are brought to St George’s for more specialist diagnostic tests and treatment as needed.

Lead consultant – Dr Adrian Draper

Pleural disease and ambulatory procedures clinic

We have a specialist nurse 5 day/ week ambulatory service, managing procedures and diagnostic investigations such as trucut biopsy, pleural aspirations, drain placement and indwelling pleural catheters. There is a weekly consultant led clinic, Dr H Meredith, and pleural MDT to review the patients seen.

Referral to the pleural CNS is currently via bleep 7809 and/or via e mail to Farinaz Noorzad, Pleural CNS, and Dr Helen Meredith via trust email

Lead consultant – Dr Helen Meredith

Bronchiectasis and lung Infections

Patients with bronchiectasis are prioritised to the bronchiectasis clinic.  Our services provided include diagnosis, education and self-management plans, management of severe or complex bronchiectasis (including nebulised hypertonic saline and nebulised antibiotics for recurrent exacerbations, palliative care), nebuliser and oxygen assessment as well as access to structured pulmonary rehabilitation. We work closely with the respiratory physiotherapists to provide care. Blood tests for infective markers including fungal serology, sputum induction, diagnostic bronchoscopy, HIV testing and immune function testing are available.

Lead consultant – Dr Anne Dunleavy

Tuberculosis Service

The TB service at St Georges Hospital provides specialist inpatient and outpatient services and care for the clinical diagnosis and management of TB patients. We are the tertiary referral centre for multi-drug resistant TB and provide specialist care for patients with TB meningitis and co-infection across South- West London.

The medical team is lead by Dr Anne Dunleavy alongside Dr Angela Houston, Dr Catherine Cosgrove,  Dr Amber Arnold and the Respiratory and Infectious Disease Consultants.

The TB specialist nursing team consists of 5 specialist nurses and an outreach worker and they deliver a number of services for TB patients; nurse led clinics for patients receiving treatment for active and latent TB, screening clinics for contacts of TB (adult and paediatric), occupational health contacts, new entrant screening clinics and screening for patients prior to receiving biologic treatments. We have a rapid access clinic for patients with symptoms of active TB who are referred from the community or other tertiary services. We work with inpatient teams to support the care of inpatients on TB treatment.

Patients with cavities on their chest x-ray should be seen withing 24hours of referral and those with suspected pulmonary TB within 5 days.

Lead Consultant- Dr Anne Dunleavy

Domiciliary Non-invasive Ventilation Service

The domiciliary non-invasive ventilation service is a multi-disciplinary team that runs a clinic on 3 days of the week providing assessment of patients, planning of further investigations and commencement with NIV treatment when indicated. The frequency of review depends on the underlying condition and is required to ensure the treatment is effective and symptoms are managed. We will assess and treat patients with obesity hypoventilation syndrome, neuromuscular, musculoskeletal and sleep disorders as well as respiratory disease.

Referrals to the NIV team can be made via internal referrals or for urgent review please contact the respiratory StR on call.

Lead consultant – Dr Nicola Walters

Sleep Disordered Breathing

There are clinics three days 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 Hypopnoea Syndrome (OSAHS). For those in whom the diagnostic sleep study is positive, they may be offered continuous positive airway pressure (CPAP) therapy and follow up is provided within the department. Close links with the Ear, Nose and Throat (ENT) team, orthodontists and bariatric surgeons ensure that alternative therapeutic options are made available where such approaches are more appropriate. The sleep service is supported by the respiratory physiologists.  The sleep service at St George’s Hospital is predominantly for sleep disordered breathing.  We are also able to investigate central sleep apnoea and periodic limb movement disorder.

Other sleep disorders such as narcolepsy and parasomnias cannot be assessed here and should be referred to other local services (usually Guy’s Hospital, Royal Brompton Hospital or Queen Victoria Hospital in East Grinstead).  Insomnia referrals should go to either Royal London Hospital for Integrated Medicine, Great Ormond Street, London or Queen Victoria Hospital in East Grinstead.

Lead consultant – Dr Nicola Walters

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 are 2-3 out-patient clinics per week and a weekly right heart catheterisation service. All referrals and requests for inter-hospital transfers can be made directly to Professor Madden or his team. There are joint MDT meetings with the pulmonary hypertension service at the Royal Brompton Hospital to offer expert care to a large cohort of patients.

Lead consultant – Prof Brendan Madden

Flexible bronchoscopy, endobronchial ultrasound and rigid bronchoscopy

For flexible Bronchoscopy or EBUS the referral process for inpatients is via Respiratory Spr on call, the procedure list runs on a Monday afternoon

Endobronchial ultrasound bronchoscopy runs every week Wednesdays and Fridays. Any admin or clinical queries will be responding to Monday – Friday 9am – 5pm

For external referrals for EBUS please use email: ebus@stgeorges.nhs.uk  or Tel: 020 8725 1956 (please leave a voicemail)

Lung Function Testing

The lung function service is part of respiratory physiology and provides a broad range of diagnostic investigations for adults experiencing symptoms that may indicate a breathing condition. These include full pulmonary function testing (flow volume loop, gas transfer and body plethysmography), bronchodilator reversibility, muscle strength testing, impulse oscillometry, skin prick allergy testing, field exercise testing and bronchial challenge testing. Procedures are performed on outpatient and inpatient adults. The physiology service is active in teaching and training and will have clinical physiology students for large periods of the year, therefore a student may observe or perform the test under supervision (consent is obtain prior to undertaking the test).

Oxygen Assessment, Nebuliser Trials and Hypoxia Altitude Simulation Testing

There are regular nurse led clinics to assess whether patient require domiciliary oxygen and / or ambulatory oxygen therapy.  Evaluation for portable oxygen devices can also be undertaken. The Respiratory Nurses can also assess the need for and response to nebulised antibiotic therapy, including the provision of equipment.

The Hypoxia Altitude Simulation Test is for patients who are due to go on holiday and there is a concern about their oxygen levels during the flight.  The test simulates flight conditions and the need for supplementary oxygen can then be assessed.  The test should be booked at least 8 weeks in advance.  Please note, the hospital does not provide oxygen therapy for the flight or for overseas.  This needs to be arranged with the airline and local medical facilities.