Respiratory disease refers to chest conditions such as asthma,
allergy, bronchitis, COPD, lung cancer, lung fibrosis as well as
conditions such as allergy and sleep and breathing problems.
Respiratory doctors often deal with symptoms such as
breathlessness, cough, chest infections, and allergies. Many people
who snore or stop breathing at night are also seen by respiratory
doctors. Respiratory medicine has a broad range of conditions and
many types of tests are used to understand and diagnose these
conditions such as breathing tests, x-rays and CT scans and camera
tests in the lungs. These and other tests are available at the
UPMC Beacon Hospital. To talk to a coordinator/schedule an appointment,
please call UPMC Beacon Hospital scheduling department at 293 8652.
Who are we?
We are a team of Consultant specialising in respiratory disease with
training and expertise in the diagnosis and management of respiratory
conditions. We have access to all necessary tests and procedures
at UPMC Beacon Hospital and have backup from other
supporting services such as chest surgeons and other physicians.
Pulmonary Function Tests (PFTs)
PFTs may be used to confirm the diagnosis and track the progression of respiratory disease, as well as enabling clinicians to assess an individual’s response to a given therapy. They are frequently requested by anaesthetists as part of pre-operative assessment of individuals undergoing surgery. PFTs may also be used in healthy individuals who undergo routine health-check and for those undergoing pre-employment screening.
During your initial visit to the Respiratory Lab, a qualified technician
will ask you to perform a series of Pulmonary Function Tests (PFTs).
Spirometry, Gas Diffusion and Lung Volumes are the quickest and
most common basic tests. You may be asked to perform one or all
of these tests during your visit.
1) Basic PFTs
i. Spirometry
Spirometry testing is quick, non-invasive and painless. If you
regularly experience breathlessness, have difficulty breathing, or
otherwise suspect you have a lung disease, spirometry should be
performed. The patient will be asked to quietly breathe in and out
through a mouthpiece. The technician will then instruct the patient
to rapidly fill the lungs with air and immediately blast this air out
as quickly as possible back into the mouthpiece and continue the
blast out until the lungs are completely empty. They will rapidly fill
the lungs again to complete the test.
ii. Gas Diffusion (DLCO)
Diffusing capacity is used to measure the ability of the lungs to
transfer gas from inspired air to the red blood cells in the pulmonary
capillaries.
DLCO is particularly used to evaluate various fibrosing diseases such
pulmonary fibrosis or asbestos exposure but is also used to evaluate
emphysema, CF, cardiovascular diseases and the effects of
chemotherapy agents or other drugs.
The patient will inhale maximally and hold this air in their lungs for
10 seconds, after which they will gently exhale the air back into the
mouthpiece. The expired air is analyzed by the computer.
iii. Lung Volumes by Body Plethsmography
Inspired and expired lung volumes are useful for detecting,
characterising and quantifying the severity of lung disease.
It is primarily useful for diagnosing and monitoring restrictive lung
diseases such as sarcoidosis, asbestos exposure or pulmonary fibrosis.
The patient will gently "‘pant"’ into a mouthpiece against a closed
shutter for a few seconds.
Depending on your query or symptoms, more involved testing
can be performed. Including the above, we also offer the
following services:
2) Sleep Studies
Sleep studies are tests that watch what happens to your body
during sleep. The studies are done to find out what is causing your
sleep problems. The most common respiratory sleep disorder would
be sleep apnoea. If you suffer from the following symptoms, you
may have sleep apnoea that can be diagnosed from a sleep study:
(ref: www.isat.ie)
Loud, frequent and irregular snoring
Your spouse/partner indicates that you periodically stop breathing
or appear to be choking during your sleep, or gasp for breath
Excessive daytime sleepiness and/or falling asleep when you
don't intend to. This could be almost anytime you are sitting down,
such as during a lecture, while watching TV, while sitting at a desk,
and even while driving a vehicle. Even if you don't literally fall asleep,
excessive fatigue/tiredness could be a positive indicator.
Body movements often accompany the awakenings at the end of
each apnoea episode, and this, together with the loud snoring, will
disrupt the spouse/partner"’s sleep and often cause her/him to move
to a separate bed or room.
Forgetfulness (short term memory), difficulty in concentrating,
focusing and completing repetitive tasks. Bouts of irritability and
depression are common. If working, a disimprovement in
performance over a period of time.
3) Bronchial Challenge Testing
Methacholine and/or Exercise challenge testing are used to determine
degrees of airway responsiveness (e.g. Airway narrowing), either
triggered by an aerosol solution (e.g. asthma) or by exercise (exercise
induced bronchospasm).
i. Methacholine challenge testing involves inhaling various
concentrations of an aerosol that is known to tighten the airways
in responsive patients. Generally, it is used to exclude a diagnosis of
asthma or to test the relative risk of its future development.
ii. Exercise challenge testing involves exercising for 4-6 minutes at
your target heart rate. You will then perform a basic breathing test
every few minutes to assess the response of your airways from the
exercise.
4) Cardiopulmonary Exercise Testing (CPET) A CPET provides information regarding the integrative responses of
the pulmonary, cardiovascular and muscular systems during maximal
exercise. We can use this test to evaluate exercise tolerance or
intolerance as well as respiratory or cardiovascular disease.
5) Six Minute Walk Test (6MWT) The distance walked by the patient in 6 minutes wearing an oxygen monitor on there finger, is used to assess sub maximal level of response of pulmonary system.
6) Allergy Skin Prick Test An allergy is abnormal immune responses to commonly occurring substances (that are not harmful in themselves). These include foods, inhalants (pollen, dusts, and animal dander), insect bites and drugs. Skin tests have been proven to be of benefit in the diagnosis of allergy and have been proven to be more sensitive than a blood test (RAST). It also has another advantage of providing results almost immediately. Regular antihistamines should be discontinued prior to the test.
The technician applies the allergens to the skin on your forearm or back, and then a gentle scratch is applied by lancet over each allergen (See Figure). Readings are taken after 15 mins. Sample allergens available include: Egg, Peanut, Dust Mite, Grass Pollen, Tree Pollens, cat, dog, aspergillus funnigatus, cladosporium etc.
7) Maximum Inspiratory & Expiratory Pressure (MIP & MEP) The maximum inspiratory pressure is the highest atmospheric pressure developed during inspiration against an occluded airway (MIP). The maximum expiratory pressure is the highest pressure developed during expiration against an occluded airway (MEP). These are a useful measure of the power of the inspiratory and expiratory muscles. Often used in conjunction with other test in the diagnosis of neuromuscular disease.
Lung Clinic:
UPMC Beacon Hospital provides a Rapid Access Lung Clinic. This service offers a one stop evaluation, diagnosis and comprehensive treatment options in a very short time frame and seamless manner. The service is used to detect and treat patients referred by their GP with symptoms, allowing immediate treatment for patients and ruling out malignancy in some cases.
The service is run by a team of two Consultants – Mr Maher Shuhaibar (Cardiothoracic Surgeon) and Dr Deirdre O’Riordan (Respiratory Medicine). As well as a multidisciplinary team including Consultants in Oncology, Radiotherapy, Radiology and Pathology. Allowing this team to provide a rapid diagnostic service and facilitate access to appropriate therapies.
If the initial assessment indicates further investigation, diagnosis will be established within a week (allowing for tissue diagnosis results) and definitive treatment will follow suit.
Early detection is instrumental to patient outcome. Eighty percent of patients with lung cancer present to specialist services with advanced incurable lung cancer. It is evident that early detection of lung cancer and expedient therapy will have a survival advantage, because patients diagnosed with earlier stage disease will be suitable for curative treatment, and patients with more advanced disease will be offered optimal chemo-radiotherapy with benefits for symptom control and better quality of life.
To contact the Rapid Access Lung Clinic for an appointment please call 01-293-6666 or fax the referral form or letter to 01-293-6653. Also we can be contacted using our email at lungclinic@beaconhospital.ie. The cost for a consultation and CT of lung is €500. This is currently not directly covered by any health insurers either at UPMC Beacon Hospital or indeed at any other private Irish hospital.
