Nature of the work
Respiratory medicine is a hospital-based
specialty concerned with the treatment of all lung diseases.
Together with general internal medicine (acute) and cardiology,
this is one of the three major medical specialties.
Working in respiratory medicine
Respiratory physicians are essential and major
contributors to the acute medical take in all acute hospital
trusts. They are referred patients with a vast range of pulmonary
and non-pulmonary conditions and they deal with a wide spectrum of
- inherited (eg cystic fibrosis)
- infective (eg pneumonia, empyema, opportunist infection
including transplant and HIV-related disorders, bronchiectasis,
- inflammatory (eg eosinophilic lung disease, vasculitis, diffuse
parenchymal (interstitial) lung disease)
- vascular (eg pulmonary embolism, primary pulmonary
- malignant (eg lung cancer, mesothelioma, mediastinal
- allergic, sleep-related, neuromuscular, and
- airway (asthma, COPD, obliterative bronchiolitis).
A large percentage of their outpatient work
involves the investigation, diagnosis and management of patients
referred with the non-specific complaints of chest pain, cough and
breathlessness of unknown cause. For this reason, they often
work with other clinicians when a diagnostic explanation for
non-specific symptoms is proving elusive. They also run early
discharge, hospital at home and pulmonary rehabilitation services
for chronic obstructive pulmonary disease (COPD) and have
considerable skill in the management of terminally ill patients.
Respiratory medicine produces doctors with a
wide range of interests and many different abilities, including
research skills, clinical skills and considerable technical skills.
They undertake bronchoscopy (both diagnostic and, increasingly,
interventional), pleural procedures including pleural biopsy and
chest drain insertion, medical thoracoscopy for the more invasive
investigation of pleural effusion and non-invasive
These specialists have considerable expertise in
cardiopulmonary physiology and run lung function laboratories in
most hospitals for the interpretation of complex lung function
testing, a cornerstone of respiratory diagnosis. In the outpatient
setting, respiratory physicians run the services for lung cancer
and tuberculosis (TB) in most trusts.
Associated sub specialties
There are no formally recognised sub
specialties, but there are a number of important “special interest”
areas: adult cystic fibrosis, pulmonary hypertension, lung
transplantation, domiciliary non-invasive ventilation, lung cancer,
sleep breathing disorders and TB.
Approximately 30 per cent of all acute
admissions are for a primary respiratory problem and respiratory
physicians are major contributors to the acute medical take in all
acute hospital trusts.
The speciality is growing and expanding. It is certain that
there will be a significant demand for respiratory specialists for
the foreseeable future. Technical skills are increasing.
Interventional bronchoscopy is expanding and it is likely that
medical thoracoscopy will become more
Improvements in the management of asthma and COPD are around the
corner, and progress is finally being made in the filed of lung
cancer.Research is also increasing. In the future, it is possible
that some respiratory physicians will become more community