Respiratory

Asthma

Asthma can range from intermittent symptoms of wheeze, chest tightness and cough, to debilitating chronic breathlessness, poor exercise tolerance and reduced quality of life. In recent years the management of asthma has advanced greatly. There are now targeted therapies for some patients with severe asthma. Alex, Lauren and Tom are keenly invested in treating all other diseases which may worsen asthma, including sinus disease, post-nasal drip, reflux disease and allergy.

Chronic obstructive pulmonary disease (COPD)

Even with a remote or no active smoking history it is possible to develop damage to the lungs which can result in COPD. COPD may take the form of chronic airway inflammation with a prominent cough and phlegm production, or damage to the lung tissue (emphysema). Both can lead to breathlessness and poor exercise capacity. It can also be a combination of these two problems. Inhalers, tablets, smoking cessation and pulmonary rehabilitation make up the back bone of its treatment, and we will tailor these components to each patient.

Lung nodules

Lung nodules are small dots that are seen on a CXR or on CT imaging. Often these nodules are discovered incidentally. Reassuringly, the majority of lung nodules are benign and relate to past infection (e.g. Chicken pox). Sometimes the nodules relate to infection. Rarely, lung nodules are due to cancer. Usually nodules are observed with serial CT scans. Rarely a biopsy is required. Dr Ritchie has an interest in nodule evaluation and surveillance.

Lung cancer

Lung cancer is a feared complication of smoking. Fortunately, we are now able to diagnose lung cancer using less invasive techniques. The prognosis for this disease has also improved dramatically. Lung cancer screening (with low radiation dose CT scans) is being established as standard of care in North America and Europe and is expected to be available here in Australia soon.

Shortness of breath (Dyspnoea)

Shortness of breath can be a challenging and distressing symptom. The evaluation of shortness of breath requires a careful and logical approach, teasing out the cause to guide treatment. Accurate lung function is a key element of the assessment.

Lung function testing

When you come for your appointment, you may need to have a lung function test, or breathing test. Lung function testing is used to make an accurate diagnosis and to monitor your lung condition. The testing is non-invasive and is conducted by skilled respiratory scientists in an accredited laboratory.

SPIROMETRY

Spirometry is a basic test of lung function. You will be asked to blow out forcefully into a measuring device before and after a bronchodilator medicine, usually salbutamol (Ventolin™, Asmol™). This test is useful to diagnose and monitor common problems such as asthma or COPD.

COMPLEX LUNG FUNCTION INCLUDING FeNO, TESTS OF RESPIRATORY MUSCLE STRENGTH

Complex lung function provides a comprehensive understanding of lung function and incorporates spirometry but also measures lung size and reserve. The diffusing capacity of the lung is another vital unit of measurement and gives an appreciation of how the lung can perform gas exchange.

Asthma is often driven by exposure to allergens (e.g. dust, pollen, grasses). The cells in the lung make a chemical called nitric oxide when stimulated by allergens. This can be measured with a FeNO (Fraction expired Nitric Oxide) test which also allows monitoring response to treatment.

Respiratory muscle testing may be performed to understand the function of the diaphragm.

BRONCHIAL CHALLENGE TESTS

These tests are performed to understand how reactive, or twitchy, your airways may be. People with asthma tend to have quite reactive airways. An abnormal bronchial challenge test combined with an appropriate history may help make the diagnosis of asthma, even if spirometry is normal.

CARDIOPULMONARY EXERCISE TESTING (CPET)

A CPET is a specialized test performed under medical supervision. You will sit on a bicycle and pedal continuously against increasing resistance until you are unable to go any further. This test gives a very detailed understanding of how well the heart and lungs work together during exercise. The test is performed to investigate shortness of breath, establish fitness levels prior to a training intervention and to determine suitability for surgery.