Specialty spotlight – respiratory medicine

Introduction to respiratory medicine

Respiratory medicine is concerned with the diagnosis, treatment and continuing care of adults of all ages with a wide range of respiratory and related conditions. It is an exciting and diverse specialty, blending a grounding in general medicine with expert respiratory knowledge and interventional skills. It draws together elements of many other specialties including:

• oncology 
• infectious diseases and public health 
• immunology
• sports medicine
• palliative care.

Every subspecialty area involves a multidisciplinary team, which may include doctors (including respiratory physicians, oncologists, thoracic surgeons, pathologists and radiologists), specialist nurses, physiologists, physiotherapists, dietitians, smoking cessation advisers and psychologists.

Respiratory physicians have varied roles and deliver care from tertiary centres, acute hospitals, day centres, outpatient clinics, community clinics, and, with the growth of integrated care, the patient’s own home. You will deal with everything from airway emergencies to chronic care of patients over many years. There are research opportunities to work with stem cells and immunotherapy, genomics, pleural procedures, and breathlessness interventions. In addition there are roles in education, training and quality improvement.

There is something for every trainee. If you love a practical challenge you can become an expert in bronchoscopy, endobronchial ultrasound and thoracoscopy. If you are excited about imaging and diagnostic challenges you may find satisfaction in interstitial lung disease (ILD) and, for those of you who value connecting with patients and forming long-lasting relationships, you will be well suited to caring for those with chronic obstructive pulmonary disease (COPD).

Respiratory physicians around the UK are working on interesting and innovative projects to improve respiratiory care and services. Some examples of this can be found on the Future Hospital Tell us your story webpage. The RCP Future Hospital Programme is currently also improving respiratory services on two different development sites: Central and South Manchester and Sandwell and West Birmingham.

Training and working in respiratory medicine

Five key facts about training in respiratory medicine from the Specialty Advisory Committee (SAC) for Respiratory Medicine:

1. Almost all respiratory trainees also train in internal medicine and complete their training with a CCT in each specialty. The basic ST programme is 5 years but many trainees spend additional time during their training 'out of programme' either doing research for a higher degree or gaining extra experience and training in a specialist area.
2. A typical training programme will include placements in district general hospitals and teaching hospitals and will also include a 3–4 month placement in an intensive care unit. There will also be attachments to highly specialised teams treating patients with cystic fibrosis, pulmonary hypertension and lung transplants.
3. All trainees will become skilled in bronchoscopy and pleural ultrasound together with the use of non-invasive ventilation to treat respiratory failure.
4. The curriculum is flexible and able to be modified to accommodate less than full-time training (LTFT and academia). Currently, 12% of respiratory trainees are in LTFT training.
5. General medicine is a key part of the job as our patients often have a number of co-morbidities. In addition, some diseases such as COPD and tuberculosis are more common in those with social problems such as poverty and poor housing. Respiratory physicians take pride in being able to care for the whole patient, not just one organ system.

You can find more information on the training pathway from the Joint Royal Colleges of Physicians Training Board. Learn more about the recruitment and interview process by visiting the ST3 recruitment page.

Respiratory medicine resources

• Organisations:
  • British Thoracic Society
  • European Respiratory Society
  • American Thoracic Society
  • British Lung Foundation.
• Careers:
  • BMJ Careers - respiratory medicine
  • British Thoracic Society. A career in respiratory medicine. London: BTS, 2016.
  • Health Education England - Health Careers: Respiratory medicine.
• Education:
  • Respiratory Futures
  • Resp NET
  • Cochrane Airways
  • Bronchoscopy International
  • WikiJournalClub - Landmark papers in respiratory medicine
  • CHEST trainee resource hub.

RCP resources

• Medical Care: respiratory medicine
• Specialty career profile: respiratory medicine
• National Lung Cancer Audit reports:
  • Royal College of Physicians. National Lung Cancer Audit annual report 2016 (for the audit period 2015). London: Royal College of Physicians, 2017. 
  • Royal College of Physicians. Lung cancer clinical outcomes publication 2016 (for the 2014 audit period). London: RCP, 2016.
  • Royal College of Physicians. National Lung Cancer Audit: Pleural mesothelioma report 2016 (for the audit period 2014). London: Royal College of Physicians, 2016.
• National Chronic Obstructive Pulmonary Disease (COPD) Audit reports:
  • Primary care:
    • Baxter N, Holzhauer-Barrie J, McMillan V, Saleem Khan M, Skipper E, Roberts CM. COPD in England – Finding the measure of success. National Chronic Obstructive Pulmonary Disease (COPD) Audit Programme: Primary care report for England 2014–15. London: RCP, November 2016.
    • Baxter N, Holzhauer-Barrie J, McMillan V, Saleem Khan M, Skipper E, Roberts CM. Time to take a breath. National Chronic Obstructive Pulmonary Disease (COPD) Audit Programme: Clinical audit of COPD in primary care in Wales 2014–15. National clinical audit report. London: RCP, 2016.
  • Secondary care:
    • Stone RA, Holzhauer‐Barrie J, Lowe D, Searle L, Skipper E, Welham S, Roberts CM. COPD: Who cares matters. National Chronic Obstructive Pulmonary Disease (COPD) Audit Programme: Clinical audit of COPD exacerbations admitted to acute units in England and Wales 2014. National clinical audit report. London: RCP, February 2015.
    • Stone RA, Holzhauer‐Barrie J, Lowe D, Searle L, Skipper E, Welham S, Roberts CM. COPD: Who cares? National Chronic Obstructive Pulmonary Disease (COPD) Audit Programme: Resources and organisation of care in acute NHS units in England and Wales 2014. National organisational audit report. London: RCP, November 2014.
  • Pulmonary rehabilitation:
    • Steiner M, Holzhauer-Barrie J, Lowe D, Searle L, Skipper E, Welham S, Roberts CM. Pulmonary Rehabilitation: Steps to breathe better. National Chronic Obstructive Pulmonary Disease (COPD) Audit Programme: Clinical audit of Pulmonary Rehabilitation services in England and Wales 2015. National clinical audit report. London: RCP, February 2016.
    • Steiner M, Holzhauer-Barrie J, Lowe D, Searle L, Skipper E, Welham S, Roberts CM. Pulmonary Rehabilitation: Time to breathe better. National Chronic Obstructive Pulmonary Disease (COPD) Audit Programme: Resources and organisation of Pulmonary Rehabilitation services in England and Wales 2015. National organisational audit report. London: RCP, November 2015.
• Clinical Medicine articles:
  • Mason C, Dooley N, Griffiths M. Acute respiratory distress syndrome. Clin Med 2016;16:s66–s70. 
  • Reynolds DJ, Andersen CA, Hoskote S et al. Lesson of the month 1: Lobar pulmonary consolidation in an immunocompromised host. Clin Med 2016;16:595–8.
  • Liu Yu-Jing, Zhao J, Tang H. Non-invasive ventilation in acute respiratory failure: a meta-analysis. Clin Med 2016;16:514–23.
  • Sunderland N, Camm CF, Glover K, Watts A, Warwick G. A quality assessment of respiratory auscultation material on YouTube. Clin Med 2014;14:391–5.
  • Payne B, Bellamy R. Novel respiratory viruses: what should the clinician be alert for? Clin Med 2014;14:s12–s16.
  • Sutherland TJT, Dwarakanath A, White H, Kastelik JA. UK national survey of thoracic ultrasound in respiratory registrars. Clin Med 2013;13:370–3.
  • Boland J, Boland E, Brooks D. Importance of the correct diagnosis of opioid-induced respiratory depression in adult cancer patients and titration of naloxone. Clin Med 2013;13:149–51.
  • Hull JH, Ansley L, Robson-Ansley P, Parsons JP. Managing respiratory problems in athletes. Clin Med 2012;12:351–6.
  • Brill SE, Lim WS, Brown JS. Respiratory tract infections: uncommon pathogens and misleading presentations. Clin Med 2011;11:567–70.
  • Wolstenholme RJ. Community respiratory services (editorial). Clin Med 2010;10:429–30.
  • Hardy AB, Jones L, Kastelik J. Development of a web-based training programme for respiratory physicians in Yorkshire. Clin Med 2010;10:344–8.
  • Moxham J, Jolley C. Breathlessness, fatigue and the respiratory muscles. Clin Med 2009;9:448–52. 
• Clinical Medicine CME respiratory medicine (2012):
  • Wise MP (ed). Influenza-related pneumonia. Clin Med 2012;12:67–70.
  • Wrightson JM, Maskell NA. Pleural infection. Clin Med 2012;12:82–6.
  • Shrikrishna D, Hopkinson NS. Chronic obstructive pulmonary disease: consequences beyond the lung. Clin Med 2012;12:71–4.
  • Mandal S, Hart N. Respiratory complications of obesity. Clin Med 2012;12:75–8.
  • O'Driscoll BR, Murphy P, Turkington PM. Acute monitoring of patients with chronic respiratory disease during hospital admission. Clin Med 2012;12:79–81.
• Future Hospital Journal articles: 
  • Partridge M, Baxter N. Integrated care: respiratory medicine ready and waiting. FHJ 2016;3:37–9. 
  • Patel I, D'Ancona G, Baxter N et al. The future hospital: integrated working and respiratory virtual clinics as a means of delivering high-value care for a population. FHJ 2016;3:s28.
  • Kumar S, Gittus M, Cracknell A, Miller S. Learning from total 2222 calls and leading to an improvement work for quality patient care: a respiratory experience. FHJ 2016;3:s35.
  • Achaiah A, Babu S. Improving discharge advice given to patients with spontaneous pneumothorax in accordance with British Thoracic Society (BTS) guidelines. FHJ 2016;3:s20.

Historical highlights from the library, archive and museum collection

There have been many distinguished specialists in respiratory medicine among the RCP fellowship. However, a report produced by the RCP in 1962 might be able to claim more benefit to the country’s lungs than all their individual efforts. You can read more about the respiratory health of the nation on the library, archive and museum blog.