Do you like breathing and sleeping? If so, this could be the specialism for you…Hopefully this post will provide some useful insight into what the Respiratory & Sleep specialism involves.
What is Respiratory & Sleep Science?
Breathing and sleeping – two of my favourite hobbies, and arguably two of the most important things that a human requires in order to survive…
Unfortunately, however, my job is not just simply getting paid to breathe and sleep, but instead involves assessing and trying to help other people breathe and sleep better…(I do thoroughly enjoy doing this too!).
As respiratory physiologists we play a key role in the diagnosis, treatment, and monitoring of a variety of respiratory related disorders. This includes things such as asthma, COPD, pulmonary fibrosis (lung scarring), neuromuscular disorders, pulmonary vascular disorders and musculoskeletal disorders (e.g. kyphosis/scoliosis). We also assess cancer patients prior to and during chemo/radiotherapy to assess/monitor the potential impact of treatment on the lungs, as well as providing pre-operative testing to assess fitness for surgery. Finally, we are also involved in the diagnosis and treatment of respiratory related sleep disorders such as sleep apnoea. We mainly see outpatients in our department, but we do also visit wards (e.g respiratory wards, ITU, Acute Medical Unit (AMU)) to perform inpatient spirometry, particularly for those with conditions that can cause respiratory muscle weakness, such as Guillan-Barre Syndrome, Myasthenia Gravis and other neuromuscular disorders.
What tests do we perform?
The most common tests we do are full pulmonary function tests (PFTs). This essentially involves telling patients to breathe in various ways whilst they are sat in a large glass box/tardis/time machine (ominously named the ‘bodybox’), breathing into a mouthpiece and wearing a nose clip.
PFTs consist of 3 main parts:
- Spirometry – measures maximal volume of air you can breathe in/out and how fast, i.e., how ‘open’ the airways are
- Lung volumes – calculates total lung capacity and residual volume using Boyles’ law and the relationship between volume/pressure
- Gas transfer – calculates how well lungs transfer oxygen from lungs to the blood by measuring alveolar volume (surface area available for gas exchange) and efficiency of gas exchange
We also do more specialist tests, such as respiratory muscle strength testing, skin prick allergy testing, bronchial challenge testing and ‘fitness to fly’ assessments to assess whether patients require oxygen to fly.
Life as a respiratory physiologist…
We start day with calibration/verification of machines. This includes the use of a giant syringe (pictured below) as well as performing full PFTs on ourselves (biological controls) on the machines each week. I like to see how quickly I can complete a full PFT – our patients are given a 45 minute appointment, however my personal record is just under 6 minutes (I’m definitely not competitive…). We will then spend most of the day carrying out tests with patients, interpreting the results and writing clinical reports to send to the consultants.
Patient interaction is an essential part of our role and is one of the aspects of the job that I most enjoy. The high level of patient interaction is what really appealed to me about respiratory and is one of the main reasons why I chose this specialism. The nature of our tests means that they are heavily reliant on patient effort. Therefore, it is important that we establish a rapport with the patient and provide them with support and encouragement throughout to ensure we get the best results out of them to aid accurate diagnosis. We may often have to adapt our approach depending on the patient – some need a gentler approach with high levels of encouragement and praise, whilst others respond better to a sterner approach. Some patients you can have a laugh and joke with, whilst for others a more serious approach may be more suited. It is important to be able to read people in order to try and ascertain the best approach for them.
A standard PFT appointment is 45 minutes and I really enjoy how this gives us the opportunity to get to know the patient and I often end up having very interesting and sometimes eye-opening conversations with patients. Also, I think these conversations can often be valuable for the patients, particularly at the moment, as many of them have been isolating during covid due to being clinically vulnerable, and as such many of them have had very little social interaction. It is so heart-warming to see how much a conversation can mean to someone. I believe these interactions have reciprocal benefits for both myself as a clinician, and for the patients, as I have certainly found on numerous occasions, when I have been in a bad mood or struggling with my mental health, that interacting with the patients can instantly boost my mood and I like to think that some of the patients may benefit similarly.
Working in Respiratory during COVID times…
Obviously, our specialism is becoming increasingly important given the COVID pandemic and the resultant ‘long COVID’. It has had significant impacts on the capacity and level of service our department can provide as sufficient time must be left between patients to ensure sufficient ‘air changes’ in our rooms and this meant when I first started working at my trust towards the end of 2020, we were having to wait three hours between patients initially at one of our sites!! Due to the nature of our tests and the vulnerability of our patients we have also been required to wear LOTS of PPE, which can get very hot and sweaty! This has definitely been one of the things that I have not enjoyed so much…
Not only has COVID limited the number of patients we have been able to see, but also increased the number of people requiring tests due to their ongoing respiratory symptoms post covid. We are having increasing numbers of people referred to us with ‘long covid’. The range and severity of symptoms really varies, with some people experiencing minimal long-term impact whilst for others the effects have been completely life changing. It really is very eye opening, and often upsetting, seeing and hearing the experiences of previously healthy people who are so debilitated by the impacts covid has had on their body. The number of patients who have told me their families were told to ‘expect the worse’ and that they ‘may not wake up’ or described their experiences of seeing people around them dying in hospital or losing loved ones, is heartbreaking. It has become very apparent that the ongoing symptoms are not just physical, but psychological too, with many of them experiencing high levels of distress. Whilst hearing their stories is understandably upsetting, I am also truly inspired by the strength and determination so many of them have shown to fight back from the brink of death and the gratitude so many of them have for the care they received and for being alive. I feel lucky to have crossed paths with these patients and to be part of their journey. Yes, it may sound cliché, but it does make you appreciate how precious life is.
Rotations and structure of STP for Respiratory & Sleep
As with all specialisms on the STP, the first year is spent undertaking rotations in different departments. For us, this involves spending time completing rotations in Cardiology, Vascular and Clinical Investigations (Pathology and Radiology), in addition to Respiratory & Sleep.
There is some overlap between specialisms and often our patients will be undergoing investigations within these other areas too. I have found these rotations help give a good overview and broader understanding of how different specialisms interact, and provide different diagnostic assessments which, when taken together, allow a much better overview/picture of what is going on, e.g., bloods, x-rays/CTs, PFTs etc all help to make a definitive diagnosis together, but if taken on their own this would be difficult.
Second and third year are focussed solely on respiratory and sleep and learning some of the more specialist techniques within the specialism, including non-invasive ventilation, supplemental oxygen assessment and performing and analysing more specialist sleep investigations.
It is definitely a very interesting/exciting time to be working in the respiratory field given the current COVID pandemic and the uncertainty/unknowns regarding the long-term impact this may have on our population/society. Our role as respiratory physiologists/scientists will likely continue to become increasingly more important in assessing the true impact of the pandemic and long covid over the coming years. Undoubtedly the demand for respiratory physiologists will only continue to increase as we deal with the devastating effects of COVID-19. If you enjoy lots of patient interaction and working with patients to get the best out of them then respiratory and sleep may well be a great fit for you!