Respiratory
The respiratory department offers inpatient and outpatient services to treat adults with conditions affecting the respiratory tract including asthma, chronic obstructive pulmonary disease (COPD), lung cancer, respiratory infections, bronchiectasis, tuberculosis (TB), interstitial lung disease, sarcoidosis and pleural disease.
Diagnostics are carried out for the majority of respiratory conditions at Bedford, however some sleep disorder conditions are investigated at the Luton and Dunstable site.
The respiratory department is supported by respiratory consultant physicians, respiratory specialist nurses, TB nurse specialists, lung cancer nurse specialists, respiratory physiotherapists and respiratory physiologists.
We have a visiting consultant thoracic surgeon from UCLH who holds a clinic on a weekly basis, and have referral links to Papworth Hospital for complex asthma, ILD and cancer patients.
The respiratory department works closely with community services such as the palliative care hub, wellbeing service, smoking cessation service, GPs and community matrons.
Respiratory outpatient clinics are held on the first floor of the Caudwell Centre, located next to the A&E dept.
The respiratory department is an evolving and expanding service to ensure the needs of respiratory patients in Bedfordshire are met.
Services available
- ARAS (Acute Respiratory Assessment Service) – Urgent service for patients with chronic lung conditions who are having a flare up that is not responding to medication
- Virtual Ward / Early Supported Discharge (ESD) – This services allows patients admitted with lung conditions to be safely discharged home from hospital early with the support of the respiratory team (Consultant and nurses). Patients can be discharged home with nebulisers, oxygen and monitoring devices as appropriate.
- Home Oxygen Service (HOS) – Patients who have low oxygen levels are assessed and provided with oxygen if appropriate, they will be followed up both at home and in oxygen clinic. Patients who currently smoke are not eligible for home oxygen due to the high risk involved.
- Pulmonary Rehabilitation – Following assessment, a six-week, twice a week, exercise and education course for respiratory patients at venues in Bedford, Sandy or Ampthill (view Pulmonary Rehabilitation service on the website for more information).
- Respiratory Physiotherapy – Clinics patients with respiratory conditions are assessed and supported by Respiratory Physiotherapists to help with management of symptoms such as breathlessness, dysfunctional breathing, secretion clearance and cough.
- Smoking Cessation – Advice / support and referral to SCS
- Physiology Services – Lung function testing
- Bronchoscopy
- EBUS
- Pleural Aspiration / Biopsy
- Referral for skin prick allergy profiling
- Non Malignant MDT Meeting
- Lung Cancer MDT meeting
Inpatient services
- Pilgrim Ward – A dedicated ward caring for respiratory patients and patients requiring NIV/CPAP ventilation support.
- Respiratory in reach – Respiratory specialist nurses review patients admitted with respiratory conditions within 24 hours of admission.
Staff
The Respiratory department is supported by eight full-time consultants, an associate specialist, four full-time respiratory physiologists, six full-time respiratory nurse specialists, one extended scope physiotherapist and two full-time lung cancer nurse specialists with additional support from two TB nurse specialists. There is also a visiting Cardio-Thoracic Surgeon who comes across from Harefield Hospital every week.
The department also has close links with the community based respiratory nurse specialists, Macmillan palliative care nurses and community matrons. The department is currently expanding with the imminent appointment of additional consultants in order to further improve and expand the services available.
The Luton and Dunstable University Hospital has excellent tertiary links with Mount Vernon, Harefield, Addenbrookes, Papworth and the Royal Free and Royal Brompton hospitals in addition to St Marys Hospital London.
Services we offer
- Acute Respiratory Assessment Service (ARAS) – this is an urgent service for patients with chronic lung disease (COPD/ILD/Bronchiectasis) who are having a flare up that is not responding to antibiotics or steroids. Patients and healthcare professionals can refer into this service
- Early Supported Discharge (ESD) – this service allows patients with chronic lung disease to potentially be discharged from hospital admission earlier with support from the Respiratory team at home for a few days. Patients can be discharged with nebulisers/oxygen if appropriate.
- Home oxygen service – Patients who are found to have low oxygen levels can be assessed to see if they will benefit from home oxygen (please note there are strict criteria around the provision of home oxygen, particularly regarding smoking). Once a patient is started on oxygen, they will be followed up regularly, initially at home and then in clinic/by telephone.
- Sleep Service
- Pulmonary Rehabilitation
- Physiology services:
- Full lung function and exhaled nitric oxide
- Provocation testing
- Sleep Studies
- Flight assessments
- Oxygen assessments
- Manometry studies
- Bronchoscopy with lavage endobronchial biopsies, transbronchial biopsies and transbronchial needle aspiration
- Pleural aspiration and biopsy
- Endobronchial ultrasound transbronchial needle aspiration (EBUS)
- Skin prick testing for allergy profiling
Specialist Clinics
- Lung cancer clinic
- TB clinic
- Interstitial lung disease clinic (consultant and nurse specialist joint clinic)
- Bronchiectasis clinic (consultant and specialist physiotherapist joint clinic)
- Pleural clinic
- Asthma clinic (specialist nurse clinic)
- Community COPD clinic (specialist nurse clinic)
Specialist Multidisciplinary Teams
- Interstitial Lung Disease MDT – Respiratory consultants, consultant radiologists and respiratory nurses meet to discuss and review imaging of patients with suspected or confirmed ILD to determine diagnosis and ongoing management.
- Non-malignant MDT – This is led by one of the Respiratory consultants and involves respiratory nurses from the hospital and community, members of the Keech Palliative Care Centre, psychology/wellbeing services, pulmonary rehabilitation, community matrons and GPs. The team looks at what support and management can be given to those patients who are struggling with symptom management as a result of their progressive chronic lung condition, in order to help improve quality of life and reduce hospital admissions.
- Transition MDT – We are aware that the process of transitioning from paediatric to adult services can be quite daunting, so in respiratory we have set up a transition MDT which involves paediatric and respiratory consultants, paediatric and adult respiratory nurses, as well as the patient and carers. Patients with ongoing respiratory conditions that will need managing by adult services are aimed to be reviewed in the joint clinic from the age of 16 upwards until they have fully transitioned to adult services.
- Sleep MDT
- Lung Cancer MDT
Inpatient Services
- Ward 10 (Respiratory Unit) – we have a dedicated respiratory ward which is covered by two respiratory consultants as well as a respiratory nursing team.
- Respiratory HDU – We have a dedicated respiratory HDU for patients that require non-invasive ventilation. This unit is covered by one of the respiratory consultants.
- Respiratory In-reach – Respiratory consultants will review patients admitted due to respiratory causes on the admission wards – this enables specialist assessment and treatment early on during an admission and allows us to appropriately arrange the transfer of patients to respiratory HDU or the respiratory unit (Ward 10)
- Yellowboard – Other ward areas can ask for respiratory review for patients that they have concerns about.
Conditions we treat
- COPD – Chronic Obstructive Pulmonary Disease
- Asthma
- Interstitial Lung Disease (ILD)/Pulmonary Fibrosis
- Bronchiectasis
- Lung Cancer
- TB