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 conditions:

• inherited (eg cystic fibrosis)
• congenital
• infective (eg pneumonia, empyema, opportunist infection including transplant and HIV-related disorders, bronchiectasis, TB)
• inflammatory (eg eosinophilic lung disease, vasculitis, diffuse parenchymal (interstitial) lung disease)
• vascular (eg pulmonary embolism, primary pulmonary hypertension)
• malignant (eg lung cancer, mesothelioma, mediastinal tumours)
• 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.  

Common procedures/interventions

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 ventilation.

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.  

Future vision

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 widespread.   

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 based.