Respiratory Medicine Centre

Respiratory Medicine Centre

About Us

Respiratory Medicine CentreThe centre provides comprehensive services to all patients who suffer from respiratory diseases and promotes prevention of these illnesses.

Our Services

Common Respiratory Diseases
Symptoms and Treatment

Bronchitis
Bronchitis can be classified as acute and chronic types, and is characterised by coughing with excessive sputum. Acute bronchitis is mostly caused by viruses. Whether the pathogen is viral or bacterial, symptomatic treatments are usually given and most patients will recover in a week. Chronic bronchitis is more prevalent in current or ex-smokers. Antibiotics are usually needed for patients with acute exacerbation of chronic bronchitis, and smokers are strongly encouraged to quit smoking.  

Bronchial Asthma
Bronchial asthma more frequently occurs in allergy-prone individuals who might have already had their onset of asthma in childhood. Clinical presentations depend on the severity . In mild cases, patients may suffer from a persistent cough after catching a cold or flu. Coughing is often worse at night when it is compared to day time, and can also be triggered by doing exercises. In those with moderate bronchial asthma, patients may experience bouts of coughing, chest tightness and reduced exercise tolerance. In severe cases, patients may complain of shortness of breath on exertion even with activities of daily living, and audible wheezing may be heard when they are breathing out.  

Treatment of asthma depends on the severity of the disease and patient’s drug compliance. Inhalers are the mainstay of asthma treatment. Short term inhaled corticosteroids and long-acting bronchodilators are prescribed for patients with mild symptoms as triggered by seasonal weather changes or viral infections. Asymptomatic patients with impaired lung function require the use of long-term maintenance inhaled medications or oral leukotriene receptor antagonists. If patients are under suboptimal control with high dose of inhaled steroids, they will be advised to have a blood test for eosinophil counts or Immunoglobulin E (IgE) level, and to consider targeted biologic treatments. Asthmatic symptoms may be more difficult to control if patients also suffer from allergic rhinitis and gastroesophageal reflux disease (GERD) at the same time.    

Chronic Obstructive Pulmonary Diseases (COPD)
Smoking is the major cause of Chronic Obstructive Pulmonary Diseases (COPD) in Hong Kong, as around 50% of current or ex-smokers will develop COPD symptoms at some stages. Patients with COPD usually present with productive or non-productive cough and shortness of breath.  

Inhaled therapies are commonly used in COPD patients, including combined long-acting bronchodilators and steroids. An oral anti-inflammatory medication may also be added to reduce infective exacerbations and improve lung function in these patients.  

COPD patients may benefit from pulmonary rehabilitation for improving their exercise tolerance. For selected COPD patients, bronchoscopic lung volume reduction procedures may also be an alternative treatment to improve their lung function and quality of life.  

Bronchiectasis
Bronchiectasis is a condition in which some parts of the bronchial trees are dilated resulting in impairment of mucus clearance, and hence, sputum impaction seen in the airways. Common symptoms include coughing with copious amount of thick sputum, and occasionally with blood stained sputum.  

Sputum impaction could lead to infective exacerbations. Chest physiotherapy is usually helpful, in particular, with postural drainage. Patients with excessive sputum are prescribed with mucolytics to remove sputum more effectively. Antibiotics are required in infective exacerbations to speed up recovery.  

Lung Nodules
The common use of low-dose CT scan of thorax for screening has significantly increased the chance of detecting lung nodules. Lung nodules are defined as radiological opacities in the lungs measuring up to 3cm in diameter. They can be classified as solid, semi-solid and ground glass nodules on CT scans.  

Upon detection of lung nodules, their size and nature as seen on CT scans, i.e. solid or ground glass, are important features to be assessed for further evaluation. For patients with no risk for lung cancer, i) no follow-up is required if the nodules are less than 6mm in size; ii) repeat CT thorax examination is necessary 6 months later if the nodules are 6 to 8mm in size; iii) biopsy will be considered if the nodules are above 8mm in size.  

PET-CT is not helpful if the nodules are 8mm or smaller in size, the glucose consumption is too low for these nodules to become positive on PET-CT scans, it will likely give a false negative result. Given the discrepancy in tissues biopsied, follow-up is required even though the tissues are tested non-cancerous by the biopsies. No routine monitoring is required for solid nodules if there are no changes on imaging (or if any, merely scar tissues) after two years, however,it would be advised to undergo radiological surveillances for 5 years for ground glass nodules due to their slow growth over time.    

HKSH Lung Nodules Programme  
HKSH Lung Nodules Service multidisciplinary team staffed by experienced pulmonologists, thoracic surgeons, radiologists and respiratory nurses offer concerted effort and seamless care to minimise patient anxiety and stress.



The team works together to evaluate the radiological imaging and risk factors of every patient. Service package consists of doctors’ fees for the initial consultation and input from radiologists/ thoracic surgeon at the MDT meeting. After reviewing patient’s health condition, family history and lifestyle, patient would be given the recommendation report on their follow-up consultation. The expert team provides the best guidance to patient and family to navigate for monitoring or treatment options.  

Lung Cancer Screening
In the past decades, lung cancer has long been the leading cause of cancer mortality in Hong Kong and worldwide. The poor prognosis is largely due to late presentation to the doctors. Recently, large-scaled researches in the USA and Europe have shown that the mortality rate of lung cancer can be reduced by 20 to 30% in the high-risk population groups with CT lung screening. Therefore, low-dose CT thorax screening is recommended for the following high-risk individuals:       

Longtime smokers and ex-smokers (who have quitted smoking for less than 15 years) and aged 50 or above
  • People with a family history of lung cancer (parents or siblings)
  • People with a past history of head and neck cancer
  • People with a past history of lung cancer
  • People with silicosis
  • People with COPD  

Sleep Medicine
Sleep apnea is one of the most common sleep-related disorders. Patient’s breathing might become shallow or even stop during sleep, causing fluctuations in blood oxygen level, blood pressure and heart rate. Not only sleep apnea causes fragmented and poor sleep but it also increases the risk of cardiovascular and cerebrovascular diseases. Common adverse outcomes include hypertension, arrhythmia, impaired glucose and lipid metabolism and ischemic heart disease. Reduced short term memory is also noted in patients with sleep apnea due to reduced percentage of REM (Rapid Eye Movement) sleep.  

Therapeutic options are considered based on the types of Sleep Apnea: Obstructive / Mixed Sleep Apnea (OSA / MSA) or Central Sleep Apnea (CSA). A suitable treatment regimen is formulated according to the severity, risk of vascular diseases and underlying causes of sleep apnea after having clinical assessment done. Common treatments include the use of Continuous Positive Airway Pressure (CPAP) devices, oral appliance, positional therapy, weight management, etc. Surgical treatment is also a viable option for selected patients.  

Pulmonary Function Test
For a comprehensive examination of lung function, the Pulmonary Function Test (PFT) will be done to see how severe the airways are blocked or narrowed, as well as to identify any reversible factors. It also provides information related to the causes of reduced exercise tolerance, whether it is attributed to the lungs, airways, respiratory muscles or factors related to organs other than the lungs.  

Bronchoscopy
Bronchoscopy is an endoscopic procedure for diagnostic and therapeutic purposes (when necessary), using an optic device, i.e. a bronchoscope of about 3 to 5mm in diameter is inserted into the airways through the nose or mouth. The procedure is “painless” as it is carried out under monitored anaesthesia care or by intravenous sedation.   As supported by the Endoscopy Centre, we provide a full range of respiratory endoscopy services, ranging from conventional bronchoscopy to different interventional procedures:  

Diagnosis
  • Autofluorescence Bronchoscopy : for the diagnosis of early-stage lung cancer in the airways
  • Endobronchial Ultrasound (EBUS) : for the diagnosis of lesions in the trachea or mediastinum, and it is especially important for the staging of lung cancer
  • Navigation Bronchoscopy: for planning the optimal airway routes leading to peripheral airway lesions based on CT scan imaging reconstruction, and for precise guidance for tissue extraction during biopsy
  • Radial Probe Bronchoscopy: for locating the lesion accurately with endoscopic ultrasound before taking biopsy, thereby enhancing the detection and diagnostic rate
  • Fiberoptic Endoscopic Evaluation of Swallowing (FEES): for direct visualisation of swallowing assessment with the assistance of a speech therapist on-site  

Treatment
  • Cryotherapy: for treatment of lung cancer in the airways or removal of foreign bodies in the airways
  • Laser Surgery, Argon Plasma Coagulation (APC), Stent Placement and Brachytherapy: for treatment of tumours obstructing the trachea or major airways
  • Bronchial Thermoplasty: suitable for certain patients with severe asthma by reducing frequency of asthmatic attacks and improving quality of life
  • Bronchoscopic Lung Volume Reduction Surgery (BLVR): by using one-way endobronchial valve or endobroonchial steam/vapour to shrink the damaged lobe/segment thereby enhancing lung function and quality of life
  • One-way Endobronchial Valves: for treatment of pneumothorax with persistent air leak
  • Bronchoscopic Placement of Fiducial Markers: for guiding CyberKnife radiotherapy to cancerous spots in patients with lung cancer or metastatic lesions  

Diagnosis of Pleural Diseases (Primary and Secondary Spontaneous Pneumothorax, Pleural Effusion and Empyema)
Lung pleural layers are membranes that cover the lungs and attach to the thoracic cavity. Between the two pleural layers is a fluid-filled space called the pleural cavity. The presence of excess fluid in the pleural cavity, i.e. pleural effusion, can compress the lungs and cause difficulty in breathing.  

The causes of pleural effusion can be localised (due to pulmonary or pleural) or systemic (associated with heart failure or liver/kidney dysfunction).  

As a standard procedure, pleural fluid is commonly aspirated under local anaesthesia for analysis. Thoracoscopy, an endoscopic procedure performed under local anaesthesia or monitored anaesthesia care, may be necessary if the cause of pleural effusion is still unknown after simple aspiration for analysis. It is carried out by inserting a thoracoscope into the pleural cavity through a small incision of about 1cm on the chest wall, through which all pleural fluid is removed by suction and then the whole pleural cavity can be examined under direction visualisation via pleuroscope. Pleural lesions will be biopsied for further evaluation. This procedure can also be used for therapeutic purposes, e.g. thoracoscopic pleurodesis for treating pneumothorax and recurrent malignant pleural effusion.

Contact Us
For enquiries and appointments, please contact us at:
 
Respiratory Medicine Centre
Address:10/F, Li Shu Pui Block
Hong Kong Sanatorium & Hospital
2 Village Road, Happy Valley, Hong Kong
Tel: 2835 8673
Fax:2892 7430
Email:respmc@hksh-hospital.com

Common Respiratory Diseases

Symptoms and Treatment