Oxford Special Airway Clinic
The Oxford Special Airway Clinic is based at the Oxford Centre for Respiratory Medicine at the Churchill Hospital.
It provides specialist assessment for patients with more difficult airway problems (severe asthma, chronic cough, severe chronic obstructive pulmonary disease (COPD)). It is set up to deal with local patients and patients referred from other regions. We provide a wide range of diagnostic tests and treatments for severe airways disease.
Who is involved and how does the clinic work?
The clinic is run by Professor Ian Pavord, Dr Mona Bafadhel and Dr Timothy Hinks, who have extensive clinical experience in this area and are active researchers in the field.
The clinic is supported by Radiologists, Lung Function Technicians, Pharmacists, a Clinical Psychologist, Specialist Nurses and a Specialist Chest Physiotherapist.
Patients referred from outside Oxfordshire are generally assessed and investigated in one visit. Typically, specialist breathing tests and an assessment of airway inflammation is done on a Wednesday morning, so that the results are available when patients are seen in the afternoon.
There is inevitably some waiting time, but we hope this will be offset by the travel time saved due to getting everything done in one visit.
Local patients will be asked to attend for tests and clinic on different days.
What do we know about severe asthma and COPD
Most of our patients continue to have unacceptable symptoms or serious attacks despite high intensity treatment. In this setting asthma and COPD can be difficult to tell apart. Our approach is to move away from the labels and concentrate more on identifying patterns of disease associated with treatment responses.
Once treatment has been optimised we do our best to help patients cope more easily with their residual symptoms.
One feature of severe asthma and COPD is that symptoms and tests of lung function become unreliable markers of a likely response to steroids. As a result, patients may be receiving far too much treatment (with associated side effects) or not enough, leaving them at risk of serious attacks.
We have found that objective measures of airway inflammation are much more reliable tests for determining optimum steroid treatment. These tests also identify patients who are likely to respond to some of the newer treatments available or in clinical trial development. Many patients will have the opportunity to participate in clinical trials of new treatment.
What do we know about chronic cough?
A chronic cough is defined as one lasting more than eight weeks. This is a common and distressing condition. It particularly affects women between the ages of 45 and 55. Many report a persistent dry cough with a sensation of throat irritation, particularly after exposure to changes in temperature or irritant fumes. Talking and laughing can also trigger cough. The problem is caused by a heightened cough reflex. Usually a sinister cause for the cough will have been ruled out before referral. Most patients we see have had a cough for more than a year.
Common causes include a side effect of blood pressure tablets (ACE inhibitors such as ramipril, lisinopril, captopril and perindropril), asthma, nasal disease and acid refluxing from the stomach to the gullet and throat. However, in up to 40 percent of patients, none of these conditions are present and the cough is unexplained.
We are usually able to help patients with unexplained cough by reassuring them that they do not have a serious underlying lung condition, and working with them to develop strategies to control the cough. We have an active research programme looking into the cause of chronic cough, and we hope that better treatments will become available in the future. Reassuringly, the longer-term prognosis of all cough syndromes is good.
What tests might be done?
We nearly always need to do further tests assessing your condition and looking into possible causes. These include simple breathing tests, blood tests, simple questionnaires and X-rays. Other tests, which you may be less familiar with include the following.
Tests of airway responsiveness. This test investigates how 'twitchy' your airways are, by investigating whether inhaling (breathing in) a substance called methacholine causes narrowing of your airways. We assess this by asking you to exhale (breathe out) forcefully into a breathing machine. We can usually detect airway narrowing before you become aware of it and the investigation does not cause much discomfort. Patients with asthma nearly always develop narrow airways after inhaling methacholine, so this is a good test for the presence of asthma.
Tests of airway inflammation. We assess this in two ways. First, we ask patients to exhale into a machine that measures the concentration of a gas called nitric oxide. There is more of this gas present in exhaled air from patients with an inflamed airway. Second, we examine the cells and chemicals in a sputum sample (mucous from the lungs) to see whether airway inflammation is present, and determine its nature. We stimulate sputum production by asking patients to inhale a salty mist.
Tests of cough frequency. In some patients, we assess cough frequency using a computerised sound-based cough detection system. We ask patients to wear a microphone attached to a small recording system for 24 hours. The recordings are analysed by computer so no speech or other sounds are detected.
Contact us
If you would like more information about the Oxford Special Airway Clinic, please feel free to contact:
Professor Ian Pavord: ian.pavord@ndm.ox.ac.uk
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