Services
- The Respiratory Physiology Service is located across the 3 sites; RIE, WGH and SJH
- All referrals should be made on SCI gateway
- The service offers a diagnostic service for COPD and Asthma for Primary Care.
- The service offers exhaled nitric oxide (FeNO) measurements and bronchial challenge tests where appropriate to assist in the diagnosis of Asthma.
- Routine spirometry should be performed in the community by nurses and doctors in general practice.
- Respiratory Physiology staff are happy to help with interpretation of spirometry results done in the community where the results are not clear or easily understood
For further advice please contact the service on 0131 242 1806
G.E & J. MacL 25-02-20
Who can refer:
- Any practice within Lothian.
Who to refer:
Patients with:
- Equivocal results after spirometry has been done in the community
- Uncertain respiratory diagnosis e.g. distinguishing between COPD and asthma
- A GP practice which does not own a spirometer, to confirm the diagnosis
- Possible COPD, to confirm diagnosis (patients: > 40 years of age, with increasing shortness of breath, chronic cough, repeat chest infections, who have exposure to toxic factors e.g. smokers)
- Possible asthma; (patients with variable PEFR, nocturnal breathlessness/cough, repeated chest infections, wheeze/breathlessness on exertion or exposure to cold air).
Who not to refer:
- Patients with known COPD for an annual check – spirometry should be done in primary care
- Patients under 16 years of age. They should be referred to Children’s Services (RHSC / RHCYP)
- Patients with suspected interstitial lung disease. They should be referred to Respiratory Medicine.
- Patients with a chest infection – wait until they are more clinically stable (at least alert the lab to the presence of active infection so that an appropriate appointment can be offered)
How to refer:
- Use SCI gateway:
- RIE/WGH/SJH >> Respiratory Physiology >> Primary Care Spirometry
- Include useful investigations and history.
For patients with a potential asthma diagnosis it is useful to perform PEF monitoring over 3 weeks to assess diurnal variation. For these patients please rule out other causes of cough before referring for diagnostic Spirometry e.g. rhinitis causing post nasal drip, acid reflux or medication inducing cough etc. The additional tests (FeNO and Bronchial Challenge tests) can be used to assist with a new diagnosis but for existing Asthma patients who are poorly controlled a Respiratory Medicine referral should be made.
For younger patients (< 40yrs) with symptoms in keeping with COPD please consider testing for Alpha 1 Antitrypsin deficiency.
