Respiratory medicine is concerned with the diagnosis, treatment and continuing care of patients with a considerable range of diseases. They include asthma, chronic bronchitis / emphysema (COPD), pulmonary fibrosis, asbestos related conditions including mesothelioma, tuberculosis, sleep disordered breathing, pneumonia,chronic respiratory failure, Cystic Fibrosis and lung cancer. A brief description of these conditions follows with useful links. East Kent Hospitals University NHS Foundation Trust does not accept any responsibility for the information within these websites. Patients who need further information should contact a professional.
Asthma is a common condition that can occur in up to one in five people. Patients with asthma experience wheezing, coughing and breathlessness upon exposure to certain triggers (most commonly allergens such as grass pollen). The condition is treated with a wide range of medications including inhalers and tablets. For the vast majority of patients this brings their condition under control, however there is a small subset who have long term difficulties and recurrent symptoms.
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Chronic Bronchitis and emphysema is one of the common respiratory diseases worldwide and within the UK. It is also known more commonly as Chronic Obstructive Pulmonary Disease or COPD. Patients with COPD have long term difficulties with breathlessness, coughing, wheezing and excess sputum production. These problems reduce their ability to do many household tasks. The condition is treated with a range of inhalers and tablets but many patients experience long term symptoms.
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Pulmonary fibrosis is a disease caused by scarring within the lung. This scarring occurs for a number of reasons including exposure to certain materials including asbestos. Patients with this condition usually experience worsening breathless and cough. Treatments for this condition are difficult but tablets can be helpful.
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Lung cancer affects about 35,000 patients per year in the UK. The condition is usually seen in people who are current smokers or who have previously smoked. Symptoms of lung cancer can be variable but include new onset of persistent coughing, hoarse voice, worsening shortness of breath and coughing up blood. Treatments include surgery, radiotherapy and chemotherapy. Unfortunately lung cancer remains a very serious condition and long term survival rates are small.
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Tuberculosis is a lung infection caused by a bacteria called mycobacterium tuberculosis. The number of patients being diagnosed with tuberculosis is beginning to increase. Patients can be affected by exposure to tuberculosis or by reactivation of previous tuberculosis. Characteristically patients experience fevers, uncontrollable sweating and coughing blood with weight loss. Treatment consists of a six to 12 month course of tablets which cures patients in over 99% of cases.
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Many patients experience sleeping difficulties and the department deals with a wide variety of patients. Sleep-breathing clinics are held at both Ashford and Canterbury and whilst majority of referrals are for patients with Obstructive Sleep Apnoea (OSA), patients with other disorders like Narcolepsy, delayed Sleep Phase syndrome, Parasomnias are also assessed in the joint Neuro-sleep clinics at Ashford.
Obstructive Sleep apnoea is a very common condition where the airway narrows whilst patients are asleep causing loud snoring interspersed with episodes when patients appear to stop breathing (apnoeic episodes). Patients often have disrupted sleep patterns and often fall asleep when watching television or driving. The condition is diagnosed by recording the breathing activity during sleep (Sleep Study) and is usually treated with a mask (CPAP) or less often a surgical procedure. Dental splints are also an option. Narcolepsy is a rarer disorder and is also characterised by sleepiness, though usually in the form of “sleep attacks” and needs a more specialised form of sleep study for diagnosis. Treatment is usually with medication.
Parasomnias (sleep walking, sleep talking, night terrors) and delayed sleep phase syndromes are quite common but patients rarely seek advice unless they impact on their quality of life. These also require sleep study for diagnosis and usually the treatment is a combination of life style changes, sleep hygiene and in some cases medication.
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Most patients develop Respiratory failure as a result of a chronic Respiratory illnesses. Many of these will have a high level of Carbon Dioxide (PCO2) in their blood in addition to a low level of oxygen(PO2), resulting in Hypercapnic Respiratory failure. This can be a gradual process in most patients. They develop symptoms of early morning headaches, lethargy, shakes and when severe become very confused and comatose.
Patients who are overweight, have chest wall problems (kyphoscoliosis), neuro-muscular diseases (MND, Muscular dystrophy) or COPD are prone to develop this. If untreated, they will progressively deteriorate and die. This progressive deterioration can be halted or slowed down by initiating treatment with portable ventilators which can be used at home.
The Respiratory department provides this service across east Kent with a service base at William Harvey Hospital. Patients referred to this service are assessed and if found suitable established on the ventilator. A contract with the ventilator company ensures 24 hour cover for all patients and an innovative electronic smart card system enables remote monitoring. The patients are reviewed bi-annually in the specialist clinic. This is the only centre in the south east (outside London) to provide this service.
The Sleep and Mask Ventilation Team were the WINNERS of the British Thoracic Society Silver Jubilee Award For Innovation in Secondary Care (Sleep) in December 2007.
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Cystic Fibrosis is a genetic disorder, characterised by repeated chest infections, bowel and liver problems in childhood along with a predisposition towards developing Diabetes, Osteoporosis and reduced fertility as adults. With improved treatment of infections in childhood and good nutrition, the median survival has improved and many are surviving into adulthood. As a result of this, there is a major need for adult Respiratory departments to provide care for this group of patients who have very specific needs.
The Respiratory Department at East Kent Hospitals provides shared care for these patients along with the tertiary centres in London. Specialist clinics are held at Ashford and the adult physicians work closely with the Paediatric Cystic Fibrosis team to provide smooth transition of care for these patients.
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Asbestos was widely used in the 1960’s as an insulator. Unfortunately exposure to its fibres may result in lung conditions which can occur up to 40 years later. These diseases include asbestos plaques, asbestosis, lung cancer and mesothelioma.
Asbestos pleural plaques are a benign (non-cancerous) condition of the lining of the lung. These are usually not of any clinical significance although sometimes the thickening can be widespread.
Asbestosis is scarring of the lung which results in progressive shortness of breath. Mesothelioma is a cancer of the lining of the lung and patients may experience chest pain and breathlessness. Many of these conditions except pleural plaques can be eligible for compensation.
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