All of our specialists are Melbourne trained and members of the Royal Australasian College of Physicians as well as the Thoracic Society of Australia and New Zealand, so a thorough background in chest and respiratory disease is assured.
A comprehensive initial assessment is undertaken, whereby we usually review any x-rays and CT scans or other imaging, as well as lung function test results. Please bring all of your x-rays, letters, tests and other pertinent results, so we don’t repeat tests unnecessarily.
If there have been no recent lung function tests or chest x-rays, we may organise these prior to the initial assessment so that the most current information is available. A basic chest x-ray enables us to determine if there are any obvious abnormalities which require further investigations, and a lung function test (breathing test) gives us an up-to-date measure of the health of your airways (your lung capacity, control of asthma and effectiveness of oxygen absorption).
Further tests such as CT scans or PET scans may be required and these are usually organised on the first visit. Arterial blood gases are sometimes requested, which sample oxygen and carbon dioxide directly from a small artery. Blood tests often requested at this time are your allergic profile and markers for other inflammatory or respiratory related conditions.
We will occasionally recommend a Bronchoscopy test, which is performed as a day procedure under a light anaesthetic, where we look inside the lungs and take samples if necessary, such as biopsies, washings and brushings. This is similar to a gastroscopy and performed in a major hospital such as Cabrini.
We frequently refer to a specialised chest physiotherapist, who may give you a course of hands-on treatment, inhalational treatment or self-management type breathing exercises.
We work with a number of affiliated specialists to help us look after respiratory illness, such as in the case of lung fibrosis, gastro-oesophageal reflux, unusual chest infections, tumours or cancers. We have a lung cancer multidisciplinary team to coordinate lung cancer treatment. Significant breathlessness and COPD/smokers lung sometimes requires exercise rehabilitation specialists to improve muscle strength and performance. Occasionally we ask a cardiothoracic surgeon to undertake a biopsy or removal of part of the lung, and occasionally we will ask an interventional radiologist to help with a biopsy under x-ray guidance, or remove fluid around the lung with a drainage tube.
If you remain largely well, we aim to enable management through your general practitioner so as to avoid unnecessary visits in the future, such as visits when you are actually well. Our group focuses on providing care when it is needed, i.e. when you are unwell, and providing in-hospital care in an expeditious way.
Breathing tests, otherwise known as lung function testing, are measures of lung capacity and the flow of air, as well as the effectiveness of air getting into the bloodstream. These tests are performed by trained scientists using specialised equipment. Lung function testing is far superior to just basic peak flow measurements.
Testing usually comprises measuring the amount of air that you can breathe out in one second, called the FEV1, and the total amount of air that you can breathe in and out, called the FVC all vital capacity. You will be seated for the test and usually wear a nose peg, so you only breathe through your mouth. You will be asked to breathe in and out quite forcefully at times, so if you have any conditions which may limit your ability to do so, please tell the scientists in advance or come prepared (such as when there is bladder weakness, hernias or recent surgery).
We usually ask you not to take your regular inhalers on the day of testing, however you can bring these along with you to use after the testing. Long acting inhalers which act for 12 or 24 hours should be stopped the night before, unless you are very uncomfortable doing this. Inhalers such as Seretide, Symbicort, Oxis, Serevent, Spiriva or Onbrez should therefore be avoided the night before testing. If your test is in the afternoon, try to avoid taking short acting sprays such as Ventolin, Asmol, Atrovent or Bricanyl on the morning of the test.
Lung function testing is offered at both Cabrini Brighton and Cabrini Malvern and generally takes 15 to 30 minutes to complete. Results are issued within 1 – 2 working days to your referring doctor. We often ask for a lung function test prior to your next visit which can be organised immediately before we see you, for convenience. Sometimes repeated lung function is taken, for example to monitor the progress of asthma or treatments for lung diseases. For those with a long standing lung problem, ongoing lung function testing is used to monitor progress, exacerbations and improvements.
A bronchoscope is a flexible fibre-optic camera which can be used to explore the airways. This day procedure is completed by a respiratory physician and involves a light anaesthetic. Bronchoscopy allows the specialist to view the airways and look for areas of abnormality. The procedure is scheduled in either a public or private hospital.
You are required to fast for at least six hours prior to admission. You will be discharged a few hours after the test is complete and will need to be collected to go home. You are not allowed to drive yourself home. Although a light anaesthetic is used, some general precautions still apply. You should rest for the remainder of the day and avoid any activities that rely on memory, such as complicated banking or making investments!
The anaesthetist inserts an intravenous drip through which sedative medication and then a light anaesthetic is given. You will have no awareness during the test and often people are surprised when they wake up thinking that they haven’t had the test at all! Once you are anaesthetised, we lubricate the bronchoscope with anaesthetic jelly and ease it down the nose and the back of the throat, and then using anaesthetic spray, ease our way down past the voice box and into the windpipe, and thereafter into all of the branches and openings that we can reach. The procedure is usually complete within 15 minutes, but if there is something complicated such as clearing phlegm or taking biopsies, it may take longer. We try to take photographs to show you at a later date, particularly where there is something interesting.
During the procedure we routinely use salty water to irrigate and then suck it back into a container, before sending it off to the laboratory for microbiology and cell analysis. This is called bronchial washings. In addition, we use a microscopic brush to get cellular material (called bronchial brushings). We often use microscopic forceps which pass through the bronchoscope and take biopsies of the airways for analysis under the microscope. This is the standard bronchoscopy procedure for which we ask you to consent. It is common to have some minor irritation in the throat following the procedure and not unusual to cough up some specs of blood over the succeeding 24 hours or experience a slight fever the next day. These affects usually settle within 48 hours.
We may occasionally push the biopsy forceps further and take a small section of lung tissue. This is called a transbronchial biopsy. In this instance, we generally aim to get at least two but usually four and sometimes six pieces of lung tissue. It is not uncommon to have some bleeding and occasionally this may be very major. We therefore ask for your added consent for transbronchial biopsies. There may be a minor leakage of air called a pneumothorax as a result and we may ask for a chest x-ray to check on this as a matter of routine. Transbronchial biopsies are usually performed with x-ray equipment helping us to guide the biopsy forceps into their intended location. Very rarely is there a critical situation with bleeding or air leakage which may prolong your hospitalisation.
Most results are available within five days, but often the washings are left to incubate for a number of weeks in case there are slow growing organisms present. A full report may therefore not be available for up to eight weeks in certain situations.
After the test, you will be moved to recovery and fairly quickly come to your senses, usually within the hour and eat a sandwich within two hours. Most people are out the door after two hours. We will try to speak with you after the test, particularly if there is something that needs to be organised as a result of what was found. Unless we specifically instruct you otherwise, we would expect to see you two weeks after the bronchoscopy procedure to discuss the results in detail.
When oxygen levels in the bloodstream are inadequate, supplemental oxygen can be used as a welcomed treatment for the relief of breathlessness. However oxygen insufficiency has to be determined and there are three measurements required. An appointment for oxygen assessment can be organised, which takes about one hour to complete.
Oxygen can be obtained through a government-sponsored program if the deficiency is severe enough or alternatively via prescription through a community retailer/provider. Oxygen supplies can be in the form of small portable cylinders, larger cylinders that can be attached to 4 pointed frames or put onto wheels, and oxygen machines – the size of a rubbish bin which draws in room air, producing up to 5 litres of oxygen per minute, utilising electricity through a standard electrical point.
Full lung function tests will initially be taken, which take 15 – 20 minutes. Secondly, an arterial blood gas analysis of the actual level of oxygen and carbon dioxide in the bloodstream is undertaken, using a miniature needle to sample arterial blood directly out of the radial or brachial artery. Thirdly, an oxygen walk test is performed, where you are asked to walk at your own pace with and without the use of oxygen.
If oxygen deficiency is found to be severe enough to warrant government sponsorship, standard forms are completed and submitted to the regulatory authority. An approval notification is generally received at least two weeks following. However, oxygen can be prescribed immediately and obtained through a community retailer/provider, with testing and paperwork performed at a later date.
For many people with respiratory illness, the lack of oxygen is present at night but not during the day, and for this a sleep test is organised to measure oxygen levels during the time of sleep. If two thirds of the night is spent with oxygen deficiency, this also qualifies for the supply of nocturnal oxygen through the government program.