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Oxford Special Airway Clinic

The Oxford Special Airway Clinic is based at the Oxford Centre for Respiratory Medicine at the John Radcliffe Hospital.

It provides specialist assessment for patients with more difficult airway problems, for example severe asthma, chronic cough and 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.

Our team

The clinic is run by:

They are active researchers in the field have extensive clinical expertise and experience.

The clinic is supported by:

  • Radiologists
  • Lung Function Technicians
  • Pharmacists
  • Specialist Nurses
  • Specialist Speech and Language Therapist.

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.

Breathing pattern disorder and ILO

There are other conditions that can mimic the symptoms of asthma, such as breathing pattern disorder and induced laryngeal obstruction (ILO).

It is not uncommon for these conditions to be incorrectly labelled as asthma, or to occur alongside asthma, and for inappropriate treatment to be given that is ineffective and may cause more harm than good.

If we believe patients are suffering from these conditions, we have alternative treatment pathways that may involve assessment by allied health professionals, such as physiotherapists or speech and language therapists.

For more information please visit:

Physiotherapy for Breathing Pattern Disorders

Rapid Assessment Clinic

Sometimes it is unclear what is causing a patient's symptoms and therefore what the best treatment options are for them. In this situation we ask patients to contact our Rapid Assessment Clinic when their symptoms are worsening (or exacerbating).

We usually invite patients up for a face to face appointment to try and better understand what is driving their symptoms and better characterise their airways problem.

This helps us to provide individualised care and ensure patients are receiving the right treatment for them.

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.

Tests

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.

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.

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.

Research

Many of our patients are offered the chance to take part in research studies.

For more information please visit:

Respiratory Medicine Unit (RMU) - Experimental Medicine Division

Occasionally we offer the chance to participate in a research bronchoscopy:

Tom's Bronchoscopy [as a research volunteer] - YouTube

Contact us

If you would like more information about the Oxford Special Airway Clinic or are interested in participating in clinical research, please contact us.

Email: orh-tr.severeasthmaclinic@nhs.net

Tel: 01865 227242

Links

Research

Respiratory Medicine Unit (RMU) - Experimental Medicine Division

Video

Tom's Bronchoscopy [as a research volunteer] - YouTube

Last reviewed:21 November 2023