At the Royal Free London, we diagnose and treat a range of lung conditions and breathing problems.
Your treatment will depend on the nature of the respiratory disease. For example, asthma treatment ranges from teaching patients to manage their condition, through to treating a severe asthma attack.
We also provide chronic obstructive pulmonary disease (COPD) treatment.
If your symptoms may be related to lung cancer, it is likely you will meet our specialist lung cancer nurse, who co-ordinates tests and care and provides support.
All cancer patients are discussed at a weekly meeting so the most appropriate lung cancer treatment can be recommended.
Royal Free Hospital
Enquiries: 020 7794 0500 ext 23331 or 23359
Lung function: 020 7472 6848 or 020 7794 0500 ext 22466 (Monday to Friday, 9am to 5pm)
Sleep and ventilation/respiratory physiotherapy team: 020 7472 6623, or
Thoracic medicine secretaries: 020 7794 0500 ext 23359
Philips pespironics sleep support team: 0800 650 0303
Clinical nurse specialist: 020 7794 0500 ext 38883
Urgent respiratory referrals
You will be urgently referred because your GP feels your symptoms need further investigation.
There are many common conditions that these symptoms could be linked to, including the possibility of cancer.
Because your referral is urgent, you will be offered an appointment within two weeks.
Having an urgent referral does not mean you have cancer. However, you have been referred because you need to see a specialist or have some investigations quickly to help find out what is wrong with you.
If our investigations determine you do have cancer, early diagnosis means treatment is likely to be more effective and this is why it is important you are seen within two weeks of the referral being made.
You will be contacted by phone to arrange an appointment and some investigations before being seen in the clinic. This may be offered at short notice (the following day) or at any time within the next two weeks.
Should you choose not to attend the clinic please call 020 7794 0500 ext 23331. This enables us to use the urgent appointment for somebody else.
This appointment has been arranged to find out the cause of the problems you are having with your chest. You may like to bring a friend or relative with you for company.
The full medical history and physical examination may give your doctor enough information to discuss the findings with you by the end of this first visit. Sometimes, your doctor may wish to have the results of the CT scan before telling you exactly what is wrong.
Once you have had your investigations, you may be given another appointment to come back to see the doctor to discuss the results and any treatment that may be necessary.
Sometimes, your doctor will write to you and your GP about the result when no further appointment is required.
Our asthma team is made up of specialist doctors, nurses, physiotherapists, physiologists, and health psychologists.
Most adult patients who come to hospital with an asthma attack are reviewed by the clinical nurse specialist (CNS).
Asthma CNS services
Our asthma CNS’ provide:
- telephone and email support
- asthma management plans and education
- medication advice
- reviewing patients in the emergency department to enable safe discharge
- anti-IgE (Xolair) therapy
- specialist asthma clinics
- inpatient review and education
- training for ward nurses and primary care nurses
Anti-IgE (Omalizumab/Xolair) service
Omalizumab (Xolair) is given in injection form to reduce the symptoms of asthma.
It is offered to patients who have severe allergic asthma and do not respond to inhaled or oral asthma therapies, including high oral corticosteroid use. It works by reducing the effects of inflammatory cells which cause asthma symptoms.
The Xolair clinic runs on every Wednesday on 2 North PITU (planned investigation treatment unit) ward at the Royal Free Hospital.
Patients must complete a 16-week assessment of the therapy, during which objective measures of symptom improvements are reviewed and a clinical decision is made in conjunction with the lead consultant before continuation of the lifelong treatment.
Our chronic obstructive pulmonary disease (COPD) team is made up of specialist doctors, nurses, and physiotherapists, who work closely with local community services in the London boroughs of Barnet and Camden to provide care across the severity of COPD.
This ranges from early disease, through to those needing more advanced treatments such as non-invasive ventilation.
The Royal Free Hospital hosts the London alpha-1 antitrypsin deficiency service, providing multi-professional care to people affected by alpha-1.
Non-invasive ventilation: helping your breathing problems
Some patients require assistance with breathing, either because of breathing problems or because of the nerves and muscles that control breathing.
This involves a technique called ‘non-invasive ventilation’, which is a machine to help you breathe.
People living with bronchiectasis need access to appropriate diagnosis and management tailored to their individual needs, and this is the ethos of our bronchiectasis service.
We provide care for all types of bronchiectasis, except for cystic fibrosis.
The multi-professional team, who recognise the key role respiratory physiotherapy plays in managing bronchiectasis, have a particular interest in bronchiectasis in people with immunodeficiency and run a joint respiratory-immunology clinic.
The Royal Free London is a specialist centre for the diagnosis and management of interstitial lung diseases (ILD).
As a specialist centre with strong academic links to University College London Hospitals (UCLH) and the Royal Brompton Hospital, we are also able to offer:
- Diagnostic tests using a multidisciplinary approach, including minimally invasive lung biopsy and novel imaging to ensure accurate diagnosis and management.
- Referral to UCLH for National Institute for Health and Care Excellence-approved specialist treatments, including pirfenidone and nintedanib for idiopathic pulmonary fibrosis.
- Bronchoscopy with EBUS and bronchoalveolar lavage to aid diagnosis and treatment of patients with ILD.
- Open lung biopsy, if required.
- Early review for lung transplantation and referral if appropriate.
- Assessment for oxygen (at night or ambulatory).
- Shared care of patients with underlying collagen vascular diseases (with rheumatology colleagues).
- The opportunity to take part in national and international research studies.
- Specialist respiratory nurse involvement and support.
Bronchoscopy is telescopic examination of the lungs. We use state-of-the-art equipment to perform diagnostic bronchoscopy and endobronchial ultrasound (EBUS) for the investigation of suspected lung cancers, haemoptysis (coughing blood), pulmonary infections (including tuberculosis), sarcoid and ILD.
Bronchoscopy is performed as a day-case procedure for outpatients. This means you go home from hospital the same day as the examination.
Bronchoscopy is performed with local anaesthetic to the airways and often an intravenous sedative.
Lung function refers to how well a person's lungs and respiratory system are working.
We use lung function tests to assess diagnose breathing problems, such as shortness of breath.
Lung function test
We might ask to you to take a lung function test if you are suffering from shortness of breath.
Doctors can use the results of these tests to determine whether your lungs are functioning optimally and within the limits expected and to help diagnose conditions such as asthma, pulmonary fibrosis (scarring of the lung tissue), and COPD (chronic obstructive pulmonary disease).
We also provide several specialist tests. These include:
- hypoxic challenge testing (also known as a “fitness to fly” assessment)
- skin allergen testing
- six-minute walk test
- bronchial challenge testing
- sleep studies
Additional specialist tests are performed at the Royal Free Hospital. These include:
- airways resistance using plethysmography
- capillary ear lobe blood gases including long term oxygen (LTOT) assessments
- mouth and nasal pressures to measure the strength of the respiratory muscles
- anatomical shunts
- overnight transcutaneous carbon dioxide (tcCO2) monitoring
We use several different tests to help us assess you and decide on the best treatment options for you. This might include:
- transcutaneous CO2 monitoring
- sniff nasal inspiratory pressure (SNIP)
- capillary blood gas (CBG)
- gas transfer factor testing
- static lung volumes
- chest X-ray and CT scan
- blood tests
Bronchodilator reversibility is to test whether a patient’s spirometry results improve after taking an inhaler.
Sleep studies are offered to diagnose and assess the presence of sleep disordered breathing (snoring, apnoea) and nocturnal hypoventilation. This may lead to symptoms such as headaches and excessive tiredness during the day.
If your doctor has referred you for a sleep study, you will be required to take some equipment home to monitor you while you sleep. You will need to return the equipment the following day (or the Monday if collected on a Friday). A friend or relative can do this for you.
You will be asked to complete and sign a patient declaration form at the time of your appointment to confirm you agree to return the equipment.
Patients experiencing breathlessness and/or a respiratory illness can be affected in multiple ways.
You may develop negative feelings such as stress, worry, anxiety and/or low mood. These feelings may make it more difficult to manage your health and can lead to an exacerbation of respiratory conditions such as asthma.
Our respiratory psychologist works with you to explore any unhelpful thoughts, feelings and problems that can arise from living with a respiratory illness and/or experiences of breathlessness.
Some of the reasons you may be referred to a psychologist include:
- Difficulty in coming to terms with and managing a respiratory condition.
- Learning to adapt to limitations caused by your condition.
- Helping you to cope better with emotional triggers of asthma, such as stress, low mood, and anxiety.
- Helping you to cope with health anxiety regarding your condition, including managing panic attacks.
- Modifying unhealthy lifestyle behaviours that impact on your breathing.
Respiratory psychology clinics run on Thursday afternoons at the Royal Free Hospital. If you would like to be referred, please discuss this with your respiratory doctor or specialist nurse.
We undertake our own research projects, in addition to taking part in local, national, and international studies.
If you are interested to hear more about our research projects, please ask a member of the team who will be happy to give you more information.
Our sleep and ventilation team see, diagnose, and treat people who have problems with their sleep and in particular people who have trouble with their breathing when they are sleeping.
We look after patients with long-term breathing problems who may need assistance with their breathing overnight, including:
- chronic obstructive pulmonary disease
- neuromuscular disorders
- motor neurone disease
- respiratory failure due to obesity such as obesity hypoventilation syndrome
Continuous positive airway pressure (CPAP) is a machine used to treat obstructive sleep apnoea (OSA).
The treatment works by blowing air into the upper airways, providing a small amount of pressure during sleep, to keep the upper airways open and stop them from closing.
Some patients benefit from using a type of breathing machine called a non-invasive ventilator (NIV).
People using NIV need to wear a cushioned mask that either fits over their nose alone, or over both their nose and mouth. A strap holds the mask firmly in place, but it can easily be removed.
Some patients, especially those with neuromuscular conditions such as motor neurone disease, will have difficulty coughing and getting rid of their phlegm.
Making phlegm is a normal part of the way our lungs work, but when we cannot get rid of the phlegm it causes problems, such as chest infections.
We can offer a specialist physiotherapy assessment to help you cough up your phlegm.
We use Actiwatch devices, which are wrist-worn activity data recorders that look like a watch and record data relevant to your sleep and activity levels, and light levels.
The Actiwatch tells us information about your activity levels, sleep schedules, naps, wake episode and sleep quality and quantity.
We use actigraphy as part of our assessments and we use the information to help us decide a diagnosis.
If you have been issued with a Philips Respironics RemStar auto or Dreamstation CPAP machine, it will work with DreamMapper.
DreamMapper is an app which works with your CPAP machine to tell you information about how much you have used your machine and how well it is working.
The following websites have information and support you may find useful: