Respiratory medicine is a high-volume specialty, being one of the busiest outpatient services and a major reason for acute hospital admission, with up to a third of admitted patients admitted having an underlying respiratory problem. There is a marked seasonal variation with an 80% increase in respiratory admissions during the winter, contributing to ‘winter bed pressures’. |
The specialty actively uses all of the diagnostic pillars of imaging, pathology, endoscopy and physiological science, with genetics less used. These pillars are used to not only aid diagnosis but also in monitoring and in a therapeutic approach, depending upon the underlying respiratory condition. |
Within respiratory medicine there are numerous sub-specialties/conditions that use different diagnostics and in different settings (in primary or community care, outpatients and inpatients); for example, lung cancer and pleural diseases are very dependent on imaging through chest X-ray, computed tomography and pleural ultrasound, the latter now being routinely performed by respiratory physicians. A diagnosis is then confirmed by biopsy/cytology that may require further imaging or endoscopic (bronchoscopy) procedures. Patients admitted with pneumonia may require pathological sampling to identify the infecting agent. |
Many of the diagnostic and monitoring aspects in respiratory medicine revolve around the wide number of physiological science tests that can be used to monitor function, as opposed to imaging to define ‘structure’. For asthma and chronic obstructive pulmonary disease (COPD), the National Institute for Health and Care Excellence requires tests for confirming the diagnosis, whereas for pulmonary fibrosis, detailed lung function tests define function and trigger treatment options. |
Chronic breathlessness is a common problem in primary care and warrants a new approach to diagnosis, where either respiratory or cardiac disease could be the underlying problem. This is discussed under community diagnostic centre (CDC) opportunities. |
Diagnosis of sleep disorders requires a detailed history and a range of simple or more complex diagnostic tests (eg polysomnography), some of which could be undertaken in a CDC. Subsequent monitoring of progress for patients with sleep apnoea treated with continuous positive airways pressure (CPAP) is also needed. |
COVID-19 has had a particularly significant impact with variable restoration. Given it is a respiratory virus transmissible by aerosol spread, infection prevention and control (IPC) procedures have needed to be robust to protect staff and other patients during diagnostic tests. The impact has been significant in primary care where there is limited infrastructure to support IPC measures leading to a marked reduction in spirometry with a halving of the number of new diagnoses of COPD over this period. |