Respiratory Medicine
Introduction
In Hong Kong, air pollution, low awareness of infectious/occupational disease prevention and unhealthy habits like smoking have increased and induced risks of respiratory diseases, such as asthma, chronic obstructive pulmonary disease, tuberculosis and lung cancer. These, coupled with the affluent yet stressful lifestyle, lack of physical exercise and hence the rising incidence of obesity, have led to more and more cases of obstructive sleep apnoea. Respiratory diseases rank top among common diseases in Hong Kong due to these multiple reasons.
In view of this, the KWH set up a specialised respiratory team in Medicine and Geriatrics Unit , bringing together experienced respiratory specialists, nurses, physiotherapists and occupational therapists. Equipped with state-of-the-art healthcare facilities and the latest high-tech knowledge, they offer a full range of respiratory medical services of high diversity and quality with in/out-patient departments, the Respiratory Medicine Centre and Day Hospital, etc.
Professional Services
1. In-patient Services:At the Medicine and Geriatrics Unit of the KWH, there are a total of 17 beds dedicated to patients in respiratory medicine, mainly those admitted through A&E Department or those requiring further hospitalised treatment after clinical diagnosis. Invasive/non-invasive ventilator-assisted therapy and high dependency unit services are provided there.
2. Out-patient Services:
Specialised out-patient services in respiratory medicine are available at the Medicine and Geriatrics Unit of the KWH every week, headed by experienced specialists.
3. Respiratory Medicine Centre Services:
The Respiratory Medicine Centre is the main department responsible for planning, promoting and enhancing specialist respiratory medicine services at the Medicine and Geriatrics Unit . Recurrent services include:
3.1 Pulmonary Function Test: Test items include:
1. Lung Capacity, Diffusing Capacity of the Lung for Carbon Monoxide and Lung Plethysmography
2. Portable Spirometry
3. Airway Resistance Test Suitable for children, elderly people and patients who cannot undergo ordinary pulmonary function test. Patients only have to breathe naturally during the test without overventilation.
4. Cardiopulmonary Exercise TestingPatients’ response to exercise stress is assessed in a safe, monitored setting, where data such as oxygen/carbon dioxide exchange, electrocardiogram, blood oxygen level and pressure are analysed in order to identify the causes of exercise impairment, evaluate the risk of surgery and draw up an exercise training plan. Data from pulmonary function test can facilitate correct diagnosis and treatment for the respiratory disease concerned.
3.2 Sleep Test:
Mainly used for the diagnosis of obstructive sleep apnoea.
3.3 Positive Pressure Ventilator Titration Test:
Test for the severity of sleep apnoea to help doctors design the appropriate treatment plan for patients with obstructive sleep apnoea.
3.4 Continuous Blood Oxygen Monitoring:
24-hour monitoring of patients’ blood oxygen level to evaluate the treatment efficacy and progress of respiratory patients.
3.5 Endoscopy:
1. Tracheoscopy and Ultrasound Endoscopy:Tracheoscopy allows direct observation of the bronchi and biopsy for testing; if lymph nodes are found outside the bronchi, ultrasound endoscope can guide a fine needle aspiration to classify the tumour for early, suitable treatment.
2. Thoracoscopy:Thoracosopy allows direct observation and biopsy for testing; for patients with recurrent pneumothorax or pleural effusion due to lung cancer, the procedure enables doctors to administer drugs directly, perform pleural adhesiolysis or other treatments.
3.6 Health Education for Respiratory Patients:
Various education talks are organised to raise patients’ awareness of diseases and seek their cooperation to bring the conditions under control. Health education talks provided by the Respiratory Medicine Centre for respiratory patients include:
1. Talks on Respiratory Diseases – patients are informed about their respiratory diseases to enhance their self-care capacity.2. Talks on Drugs/Equipment – patients are informed about how to use different respiratory drugs and equipment properly; accuracy and compliance in medication-taking is promoted to improve treatment efficacy.
3. Smoking Cessation Talks – patients are given encouragement and assistance to quit smoking.
4. Day Hospital Services:
The Respiratory Medicine Centre is the main department responsible for planning, promoting and enhancing specialist respiratory medicine services at the Medicine and Geriatrics Unit of the KWH. Recurrent services include:
4.1 Respiratory Oncology Out-patient Clinic:
The Respiratory Oncology Out-patient Clinic was established by the Medicine and Geriatrics Unit of the KWH in November 2010 to receive internal referrals for patients diagnosed with lung cancer and screen those suitable for targeted therapy.
4.2 Home Care Team
Chronic obstructive pulmonary disease is difficult to treat and prone to recurrence. Patients’ mobility is limited due to impaired lung function with serious implications for their quality of life.
To tackle the restricted mobility, the Respiratory Medicine Unit of the KWH set up a professional team to provide rehabilitative treatment for patients who had been hospitalised for chronic obstructive pulmonary disease with a view to consolidating treatment benefits and reducing recurrence.
The treatment plan includes:
Home assessment, home training and breathing/conditioning training by professional team, as well as regular follow-up consultations by respiratory specialists, in order to enhance patients’ self-care capacity and lower the need for hospitalisation; re-establish their self-confidence and improve their mobility and hence quality of life.
