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Respiratory medicine

The respiratory medicine training programme in Wales is now split between north and south Wales. The north Wales programme incorporates training through the three sites within Betsi Cadwaladr University Health Board (Bangor, Wrexham and Glan Clwyd) and with the north west Lung Centre at Wythenshawe Hospital in Manchester.

The south Wales programme, incorporates training through all south Wales sites from west Wales to south east Wales. Candidates applying to the Respiratory programme are not expected to rotate between North and South Wales, but will remain in either north or south Wales for the duration of the training.

The beauty of Respiratory Medicine is its broad scope. There are many different primary pulmonary diseases, and the lung is also involved in many other systemic diseases. In addition, research areas are also diverse, encompassing both the clinical arena and basic immunology and molecular biology. Lung pathology is diverse and ranges from airways disease, to cancer to infective disease and inflammatory / vasculitic processes.

There is the opportunity to indulge one's yearning for practical procedures in the bronchoscopy list and for the high tech in the ITU, with which Respiratory Medicine is developing closer links. This is definitely a specialty that can offer something for everyone.

What is respiratory medicine

Respiratory Medicine is one of the two major specialties of acute General (Internal) Medicine (G(I)M). Approximately 30% of all acute admissions in G(I)M are for a primary respiratory problem, similar figures to Cardiology, and Respiratory Physicians are essential and major contributors to the acute medical take in all acute hospital Health Boards. Respiratory Medicine has a close relationship with Critical Care Medicine.

Most Respiratory Physicians supervise non-invasive ventilation in the support of patients with acute respiratory failure in the High Dependency Unit environment, and many have sessions helping to run Intensive Care services and expertise in the management of the Adult Respiratory Distress Syndrome. Respiratory Physicians have considerable technical skills. They undertake bronchoscopy (both diagnostic and, increasingly, interventional), pleural procedures (including pleural biopsy and chest drain insertion), medical thorascopy for the more invasive investigation of pleural effusion and non-invasive ventilation. They 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 in most Health Boards. Patients are referred with a vast range of pulmonary and non-pulmonary conditions, the latter since the lung is involved in many non-pulmonary systemic conditions. A large percentage of outpatient work involves the investigation, diagnosis and management of patients referred with non-specific complaints of chest pain, cough and breathlessness of unknown cause such that most Respiratory Physicians have considerable expertise in dealing with diagnostic uncertainty. For this reason, they are often a port of call for other medical practitioners when there are other more general non-specific symptoms for which a diagnostic explanation is elusive.

They also run early discharge, hospital at home and pulmonary rehabilitation services for COPD and have considerable skill in the management of terminally ill patients. Some Respiratory Physicians run services for lung transplantation. Among specific disease areas that are the principal remit of Respiratory Physicians are a vast array of inherited (e.g. Cystic Fibrosis), congenital, infective (e.g. pneumonia, empyema, opportunist infection including transplant and HIV -related disorders, bronchiectasis, TB), inflammatory (e.g. eosinophilic lung disease, vasculitis, interstitial lung disease), vascular (e.g. pulmonary embolism, primary pulmonary hypertension), malignant (e.g. lung cancer, mesothelioma, mediastinal tumours), allergic, sleep-related, neuromuscular, and airway (asthma, COPD, obliterative bronchiolitis) diseases.

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