Clinical Information

Asbestos-related lung diseases include asbestosis (scarring of the lung), pleural plaques and mesothelioma, a particular form of cancer of the lining of the lung (pleura). The predicted peak in the number of cases of asbestos lung disease has yet to occur due to the long time interval between exposure and disease. Prompt recognition and accurate diagnosis are crucial.

Asthma is a common condition that affects nearly one in every 12 adults. Inflammation of the airways accounts for its’ symptoms of wheeze, chest tightness, cough and increased expectoration of phlegm. Whilst many patients experience mild symptoms, the condition is often chronic and thus gives rise to poor symptom control. This in turn may lead to prolonged or recurrent exacerbations that may not be particularly serious but are sufficient to interfere with lifestyle and work activities. The cornerstone of effective asthma treatment is the prevention of such episodes (thus also preventing the need for emergency care) by a combination of prophylactic measures, symptomatic relief and allergen avoidance. Although classical asthma is the allergic (atopic) form, exercise-induced and workplace-related asthma are variants within the larger group of diseases and are managed using specific measures once the diagnosis is secured.

Breathlessness (or dyspnoea) is one of the commonest symptoms in medicine. Unexplained breathlessness, particularly when experienced at rest or with low-intensity physical activity may indicate an abnormality within the respiratory tract (airways and lungs), the cardiovascular system (heart and associated circulation) or even pathology outside the chest.

Bronchiectasis is abnormal and often permanent widening (dilatation) of the airways. Its cause is not always clear although it may develop following severe childhood infections or form part of conditions such as cystic fibrosis, certain immune deficiencies, infections due to atypical mycobacteria, gastric acid reflux or ABPA (an allergic condition to fungi). Patients with bronchiectasis often have a chronic cough associated with producing increased amounts of dirty (purulent) sputum or experience more generalised symptoms such as weight loss, fever or tiredness. Effective treatment comprises bronchodilators, instruction on clearing the airways, antibiotics when necessary, immune therapies and rarely, surgery.

Injuries of the chest are very common following a fall, a sports injury or direct impact. They include simple chest wall bruising, fractured (broken) ribs, fail segment (multiple broken ribs), fractured (broken) sternum (breast bone), and problems with the rib joints (connections) to the spine (backbone) and sternum (sternum).  At the time of the injury there is a small risk of internal injuries such bleeding into the chest cavity (haemothorax) or a collapsed lung (pneumothorax) that may require urgent treatment.  Chest wall injuries can be very painful and take weeks or even months to get better. The treatment for simple broken ribs and chest wall bruising is guided restriction in activities, painkillers to allow comfortable breathing and occasionally anaesthetic injections.  In more severe injuries or when recovery takes too long further tests and specialist treatment including surgery may be required.

Chronic heavy smoking gives rise to a number of lung conditions other than COPD and lung cancer. Smokers’ bronchiolitis and a number of interstitial lung diseases have been attributed to the toxic effects of cigarette constituents. Unless specifically sought, early or subtle abnormalities of these conditions may be difficult to identify.

These deformities of the chest usually appear in childhood offend around the child’s growth spurt. There are many different deformities but they are typically divided into two main types; Pectus carinatum (or pigeon chest) where the chest is characterized by a prominence or protrusion of the ribs and breast bone; and Pectus excavatum  (hollowed or funnel chest) where the abnormal ribs and breast bone appear caved-in or sunken.  The deformity is often alone but can be apart of other deformities. Treatment if required can involve both invasive surgical correction of the deformity or non-invasive methods such as bracing.

 COPD stands for chronic obstructive pulmonary disease and is synonymous with the term emphysema. It is the result of excessive smoking which causes limitation of airflow through damaged airways and poor exchange of oxygen due to destruction of alveolar (lung) tissue. Symptoms of COPD include breathlessness, cough, mucus expectoration, chest discomfort, weight loss, frequent infections and lack of energy. COPD is categorised into mild, moderate and severe. In the latter, limitation of both oxygen intake and carbon dioxide expiration may produce life-threatening respiratory failure. The mainstay of COPD treatment is smoking avoidance, improvement of airway function using the right combination of inhaled bronchodilators, mucus-loosening drugs and steroid tablets as well as antibiotics when an infective exacerbation occurs. Pulmonary rehabilitation may be a beneficial form of therapy for many.

Coughs may be acute, subacute or chronic. A common symptom, it may result from an upper or lower respiratory infection, occur following exposure to an irritant or indicate the presence of a more established condition such as asthma, COPD, chronic lung inflammation or scarring, postnasal drip or even gastro-oesophageal reflux disease (occasionally without heartburn). A cough persisting for more several weeks in the absence of infective symptoms warrants investigation.

The lung is susceptible to a range of infections caused by viruses, bacteria and other transmissible agents. Depending on the individual’s systemic (general) and lung-based (local) immunity, both common and unusual agents may cause concern. Viral infections often clear up without requiring treatment but may be complicated by secondary bacterial infections. On the other hand, bacterial infections may produce abnormalities on a chest radiograph which give rise to the term pneumonia. Public health hazards including tuberculosis, new forms of flu and other ‘emerging’ viral infections continue to pose diagnostic and treatment challenges.

Excessive sweating (Hyperhidrosis) is a common problem affecting the palms, armpits, soles of the feet and occasionally the face (flushing). It can be distressing and can have a serious impact on your life. In some cases, affected people avoid social contact with others because of embarrassment about the problem. However, the condition is usually treatable with strong antiperspirant, electrical stimulation (Iontophoresis), Botox injections and surgery.

Interstitial lung diseases (ILD) affect the lung structures that enable oxygen exchange to take place. ILD may be inflammatory or fibrotic, i.e. cause scar tissue to accumulate. Often, one leads to the other. Some important forms of ILD do not have an identifiable cause (idiopathic) but many others may develop following specific exposure (e.g. medical drug, industrial hazard or environmental protein), occur in association with an underlying disease (e.g. rheumatoid arthritis or sarcoidosis) or form part of a rare syndrome. ILD may also be an unwanted effect of important medical procedures such as chemotherapy and radiotherapy. Often, early and appropriate treatment may retard progression to lung fibrosis (scarring). In many cases however, ILD are misdiagnosed or missed entirely because of their propensity to develop insidiously over time.

Lung cancer is one of the commonest cancers in the world, with almost 40,000 cases diagnosed in the UK each year. The vast majority of cases occur in current or ex-heavy smokers, particularly in those over 60. Early detection is associated with better survival. Non-small cell lung cancer (NSCLC) is the commonest form and includes several different subtypes. Small cell lung cancer (SCLC) is less common but more aggressive. Effective management takes into account the cancer cell type, its stage (size and extent of spread) and its likely response to treatment, the last often depending on molecular testing. A complete cure is possible for many early stage lung cancers; for others, treatment with drugs, radiotherapy, radiofrequency ablation or robotic radiosurgery may offer realistic life-prolonging treatment. Holistic lung cancer care must always include a multidisciplinary team comprising Respiratory physicians, Radiologists, Oncologists, Thoracic surgeons, Pain management specialists, specialist nurses, pharmacists and allied professionals.

Pleural effusion is the accumulation of fluid in the pleural space. This space lies adjacent to the outer surface of both lungs and is lined by two layers of pleural lining, namely the parietal (outer) and visceral (inner) membranes. Diseases or abnormalities affecting the pleural linings may give rise to a pleural effusion including infections such as pneumonia or tuberculosis, lung cancer, inflammatory conditions such as rheumatoid arthritis or injury to the ribs. It is vitally important to distinguish benign from cancerous causes of an unexplained effusion. Pain due to a pleural abnormality is known as pleurisy. The investigation of pleural effusion may include a CT scan, ultrasound scan, pleural fluid aspiration, pleural biopsy or a surgical procedure to both visualise as well as to take samples of the pleura (VATS).

The surgical procedure is a keyhole operation (known as VATS, or Video-Assisted Thoracopic Surgery) and can be used to diagnose and treat the underlying pleural disease.

A pneumothorax or collapsed lung is air that is trapped next to the lung in the chest cavity. Most cases occur ‘out of the blue’ in healthy young people. Some develop as a complication from a chest injury or a lung disease. The common symptom is a sudden sharp chest pain followed by pains when you breathe in. You may become breathless. In most cases, the pneumothorax clears without needing treatment. The trapped air of a large pneumothorax may need to be removed if it causes breathing difficulty through removing the air (aspiration) or in some cases a chest drain. A keyhole operation is needed in some cases.

Pulmonary embolism (PE), the formation of blood clot/s in the lungs, may be associated with mild symptoms or less frequently, develop into a life-threatening condition. It may arise remotely, often starting as deep venous thrombosis (DVT) of the lower limbs before moving into the lung circulation. Approximately one in 10 to 15 people with DVT will develop PE. A number of tests can be done to enhance the diagnosis of PE, including a special contrast-enhanced CT scan. Prompt treatment with a blood thinning agent will prevent clot enlargement. Occasionally, a clot-busting drug (thrombolytic agent) may be administered if the clots are exerting a potentially dangerous effect on the circulatory system.

Sleep disorders and sleep disordered breathing is an umbrella term that includes obstructive sleep apnoea (OSA) and central hypoventilation syndrome. Certain risk factors are recognised for sleep disorders including being male, having a large body habitus, having a large collar size or unusual neck anatomy and taking sedative medications. Rare disorders of the central nervous system are also known to cause under-breathing (hypoventilation) particularly during sleep. A special sleep study can be done to identify sleep disordered breathing as well as assess its severity. A number of effective treatment options are available for this condition; non-treatment may lead to restrictions being placed on vehicular driving and other work-related activities.