Overview
The Community Respiratory team is a planned care service for Bromley residents who are registered with a Bromley GP and have a confirmed diagnosis of a chronic respiratory disease such as COPD, pulmonary fibrosis and bronchiectasis.
We offer assessment, specialist clinical advice and care, optimisation of medication, education and support. Treatment and advice is provided in clinics and in the community depending on individual needs.
Our overall aim is to enable respiratory patients to feel more confident in managing their condition and to stay in the best health possible wherever possible from diagnosis to end of life.
The Respiratory team is made up of three services:
– Respiratory service
– Oxygen service
– Pulmonary Rehabilitation
Our team of Specialist Nurses, Physiotherapists and Respiratory Healthcare Assistants are on hand to support you.
Cancelling an appointment
If you have a scheduled appointment with us, please contact us as soon as possible on 0300 330 5777 and we will arrange another time for you to see us. Please give us as much notice as possible so that we can give your appointment to someone else.
The current average waiting time for the Respiratory service is 3 weeks.
Calls are recorded for training and quality purposes. To find out more, visit Personal information – Bromley Healthcare.
Respiratory service
The Community Respiratory service offers specialist advice to educate and support people’s knowledge and understanding of their respiratory condition by offering a range of services:
- – An in-depth respiratory assessment.
- – Respiratory Disease Management (with the exception of asthma).
- – Identifying the impact that your condition has on your daily living.
- – Optimise medication.
- – Optimising inhaler technique.
- – Exacerbation review.
- – Holistic care planning.
- – Assisting in goal setting and providing support, advice and specific interventions to achieve these goals.
- – Problem-solving regarding specific challenges to your daily living.
- – Working with you to maintain and / or increase your level of activity.
- – Teaching and advising on energy conservation techniques as part of fatigue management.
- – Teaching and practicing relaxation techniques and advice regarding anxiety management.
- – Develop individual Respiratory action plans.
- – Brief Smoking Cessation advice is given before being signposted to appropriate therapies as required.
Specialist Respiratory Physiotherapy Clinics
Our Specialist Physiotherapists ensure patients are offered a range of treatments appropriate for their condition as well as ensuring their medical management is optimal by providing:
- – Education regarding your condition and advice regarding infection management strategies.
- – A range of sputum clearance techniques.
- – Advice and techniques for breathlessness management.
- – Advice and treatment for chronic cough.
- – Assessment and referral to Pulmonary Rehabilitation.
Take a look at our frequently asked questions below:
What is the Respiratory Service referral criteria?
Inclusion criteria
- Over 18 years old
- Registered with a Bromley GP
- Has a formal diagnosis of COPD, Interstitial Lung Disease/Pulmonary fibrosis, Bronchiectasis. May have asthma as secondary diagnosis but not as primary diagnosis
- May have co-morbidities but respiratory must be primary diagnosis and co-morbidities must be stable.
- +/-MRC3 or above
- Referral for chest physiotherapy/chest clearance
- Repeated hospital admissions for chest complaints
- Reviews post hospital discharge
- Referral for pulmonary rehabilitation
- Where chronic anxiety is a dominant factor this should be addressed prior to referral
- Patient must agree to referral and have a desire to improve their self-management ability
Exclusion Criteria
- No formal respiratory diagnosis
- Asthma diagnosis with no other chronic respiratory condition
- Currently optimised and stable
How can I access the service?
You’ll need a referral from a GP, hospital or any other healthcare professional to the Respiratory team to initially access our services.
Once known to the service you can self-refer back within a year of discharge.
How long will I have to wait for this service?
Whilst we are a planned care service, waiting times can vary. We aim to assess patients within four weeks of receipt of referral.
What can I expect at the appointment?
The service provides support 8am to 5pm Monday to Friday (excluding bank holidays).
Our interactions are usually in clinic either in person or by telephone. We also offer video consultations. Home visits are prioritised for those who are housebound.
Your first appointment
Your initial appointment will be for about 45 minutes. The specialist team member will take a detailed history from you and look at the medication you take. Your inhaler techniques will also be checked. The Community Respiratory team no longer carries out routine spirometry, this will be arranged at your surgery.
We will then discuss the options and work with you to find the best plan of care specifically designed for your needs.
Follow up appointment
Follow up appointments are for 30 minutes.
Changing or cancelling an appointment
If you have an appointment which you are unable to attend please let us know at the earliest opportunity by calling 0300 330 5777. This is so so we can offer the time slot to another patient. Please bear in mind that are appointments are booked quite a long way in advance, so we may not be able to offer you an immediate appointment.
Where are nurse led clinics held?
Our nurse-led clinics are held at three venues across the borough.
Telephone or face-to-face appointments are offered.
Patients are able to select the best location to suit them at either Beckenham Beacon, Biggin Hill, Mottingham or Willows Clinic.
What do I need to bring?
All inhalers currently prescribed.
Calls are recorded for training and quality purposes. To find out more, visit Personal information – Bromley Healthcare.
Home Oxygen Service – Assessment And Review (HOSAR)
Home oxygen is used for the treatment of low levels of oxygen in the blood (hypoxia). It is most commonly prescribed for the management of severe chronic obstructive pulmonary disease (COPD). The oxygen helps protect vital organs from the effects of long term low oxygen levels.
Oxygen may be considered for other respiratory diseases causing hypoxia once all reversible causes have been identified and treated such as interstitial lung disease, morbid obesity causing nocturnal hypoventilation/obstructive sleep apnoea and other rarer respiratory diseases. Other indications for home oxygen may include chronic heart failure. High flow short burst oxygen therapy may be prescribed by neurologists for cluster headaches; this is the only indication for oxygen to be prescribed without co-existing hypoxia.
The service is not an emergency response service for patients who require oxygen therapy for acute episodes of care.
Unfortunately, home oxygen is a poor reliever of breathlessness so is not recommended for this symptom, unless oxygen levels are low. However, there are other ways the team may be able to help, for example, adjusting your inhaled therapy or referring the patient for Pulmonary Rehabilitation.
For more information, please visit Home Oxygen Therapy | NHS.
Take a look at our frequently asked questions below.
What is the Home Oxygen Service referral criteria?
Inclusion Criteria
- Aged 18 and over
- Registered with a Bromley GP
- Has a formal diagnosis of COPD, Interstitial Lung Disease/Pulmonary fibrosis, Bronchiectasis or a secondary diagnosis of polycythaemia/ Cor pulmonale and has serial pulse oximetry ≤92% on 2 occasions (2-3 weeks apart)
- A resting SpO2 of ≤ 94% with evidence of peripheral oedema, polycythaemia (haematocrit ≥55%) or pulmonary hypertension.
- A fall in SpO2 of 4% to below 90% on exertion.
- Cluster Headaches
- Pharmacologically optimised and a period of 8 week stability post exacerbation.
- Patients who currently receive oxygen therapy but do not require follow up in Secondary Care.
- Be in receipt of oxygen therapy without ever having been formally assessed.
- Due to the significant risk of fire and personal injury associated with smoking and the use of Home Oxygen therapy it is recommended that patients referred into the service and other smokers living in the same household must have ceased smoking for at least 8 weeks prior to the referral
Exclusion Criteria
- Current smoker or any smokers within the household
- Not in a stable phase of their disease
- Does not meet criteria if oxygen saturation >92% on pulse oximetry
- Not pharmacologically optimised
- Palliative patients who are normoxic ie Sp02 ≥92% on air
- Oxygen therapy is withdrawn
- Declines interaction from the service
- Patient confused at time of referral
What is the aim of the HOSAR team?
Oxygen is a drug and patients must have a thorough assessment by the specialist team before it is prescribed to ensure that only patients who will benefit from oxygen receive it and the correct dose of oxygen and equipment is ordered.
- Assess and support people who have been identified as possibly needing home oxygen by their GP or a hospital.
- Ensure appropriate prescribing of home oxygen, and achieving optimal therapy benefits
- Reduce harm from trips, falls, smoking, fire and oxygen toxicity
- We take a proactive approach to identifying and supporting high risk patients.
- The service also ensures that oxygen is supplied through the most cost effective route.
What specialist support is available?
The Community Respiratory service offers specialist advice to educate and support people’s knowledge and understanding of oxygen therapy.
Where appropriate the team assesses, prescribes, initiates oxygen and follows up with patients requiring oxygen at home.
We work with patients, sharing decision making and helping patients take care of themselves.
Our team are responsible for assessing and reviewing the oxygen therapy needs of patients indicated as requiring oxygen for their condition, in accordance with British Thoracic Guidelines on the Provision of Home Oxygen.
The HOSAR team remit is to review:
- All patients with a new LTOT prescription within 4 weeks post install
- All patients with a LTOT prescription for respiratory diseases six monthly
- All patients with a LTOT prescription whose hypoxia is caused by non-respiratory conditions yearly
- All patients with ambulatory oxygen will be assessed yearly or as required.
- Home oxygen prescription coded as ‘palliative care’ with cancer with hypoxia or advanced progressive multi-morbidity with hypoxia to be reviewed jointly with palliative care team if required
Patients are also supported to stop using home oxygen therapy where appropriate.
What can I expect at the appointment?
Initial and follow up oxygen assessments are either carried out at home or in a clinic setting.
The respiratory assessment may include capillary blood gas analysis to determine a patient’s oxygen requirements. This involves taking a small sample from an ear lobe.
How can I access the service?
You’ll need a referral from a GP, hospital or any other healthcare professional to the Respiratory team to initially access our services.
How long will I have to wait for this service?
We aim to assess patients within two weeks of receipt of referral.
The service is not an emergency response service for patients who require oxygen therapy for acute episodes of care.
Where are nurse led clinics held?
Oxygen clinics to assess ambulatory oxygen are held at two venues across the borough. Patients are able to select the best location to suit them at either Beckenham Beacon or Orpington Methodist Church Hall.
What do I need to bring
Oxygen equipment. All inhalers currently prescribed
Calls are recorded for training and quality purposes. To find out more, visit Personal information – Bromley Healthcare.
Pulmonary Rehabilitation
Pulmonary Rehabilitation (PR) is an established exercise and education programme designed specifically for people with confirmed diagnosis of COPD, bronchiectasis or intestinal lung disease who experience symptoms of breathlessness.
The idea of exercising may seem daunting especially if you are experiencing breathlessness in your usual daily activities however pulmonary rehabilitation has been extensively researched and evidence shows that by undertaking the course it can:
- – Improved quality of life, increased confidence with self-management due to an increased knowledge on your condition. Helps you to recognise and self-manage future chest infection/flare up’s.
- – Improved muscle strength and endurance enabling you to walk further and feel less tired and breathless when carrying out everyday tasks such as housework or day to day activities.
- – Improves your understanding and technique of taking medications and inhalers.
- – Great way to socialise and meet others.
Videos
The videos on the Pulmonary Rehabilitation page on the South East london ICS website provide some insight into what someone who has been referred to PR experiences during, and after attending a programme, what the benefits are, and what those who have already attended PR, say about the programme.
Take a look at our frequently asked questions below.
Pulmonary Rehabilitation referral criteria?
Inclusion criteria
- Patients must be over 18 and have a confirmed diagnosis of a respiratory condition such as chronic obstructive airways disease, chronic asthma, bronchiectasis or interstitial lung disease.
- The patient is committed and motivated to attend 12 sessions, twice weekly.
- MRC breathlessness score of 3-5.
- MRC breathlessness score of 2 will be accepted if affected by breathlessness and frequent exacerbations due to poor management or deconditioning.
Exclusion criteria
- Unstable cardiac disease
- Recent myocardial infarction (would require cardiac rehabilitation first)
- Unstable aneurysms
- Aortic stenosis
- Unstable angina
- Unstable cardiac arrhythmia
- Uncontrolled blood pressure (diastolic above 100 and Systolic above 180)
- Poorly controlled diabetes
- Unable to walk 10m
- Uncontrolled pain
Other factors to be considered (which may lead to exclusion)
- Very frail, high risk of falls
- Low BMI (under 18)
- Significant and limiting musculoskeletal conditions
- Recent cataract surgery
- Recent surgeries (within last 3 months) which may require restrictions to exercise
- Already attends an intensive exercise class
- Cognitive impairment where unable to follow instruction / be safe in class
What does Pulmonary Rehabilitation involve and what can I expect from a session?
If assessed as suitable for pulmonary rehabilitation you will be invited to attend a six-week course delivered twice a week (12 sessions)
At all sessions you will be supervised and supported by trained staff. Each session will consist of group physical therapy session and an education / information session for small groups of people who all have breathing problems.
Classes are run by specialist respiratory physiotherapists, nurses and rehabilitation assistants. An individualised physical exercise programme will be devised from the start which will be tailored to individuals’ capabilities with the aim of a gradual progression of both aerobic exercise and resistance training over the following six weeks. Agreed goals will be set.
Following an hour of exercise the group will then receive a 30 minute talk on a variety of subjects including lifestyle support / advice on lung condition and self-management techniques. Topics include:
- How the lungs work and overview of lung disease
- Inhaled medication and other medication
- Breathlessness
- Nutrition
- ACBT
- Self-management plans
- Exercise /physical activity
- IAPT
- Relaxation
- Bristol COPD test
The sessions are relaxed, friendly and informal.
You can also bring a spouse or carer for the education sessions.
Interpreters are available.
How can I access the service?
In most circumstances you will be referred by your GP, Practice Nurse or Respiratory Consultant.
Once referred you will initially be assessed in one of the nurse led clinics to assess your suitability.
How long will I have to wait for this service?
Whilst we are planned care service, waiting times can vary. This will be discussed at your initial assessment.
Our aim is to assess patients within three months of receipt of referral and urgent referrals for patients following an infective exacerbation of their respiratory condition or admission will be processed within four weeks.
Where is Pulmonary Rehabilitation held?
Our face to face programme is held twice a week for six consecutive weeks at two venues across the borough.
Patients are able to select the best location to suit them at either Beckenham Beacon or Orpington Methodist Church Hall.
Each session lasts for 90 minutes.
We do not offer home-based or virtual Pulmonary Rehabilitation at this present time. We are unable to arrange transport.
What do I bring?
- GTN spray if you suffer from angina
- Reliever inhaler such as Salbutamol if you have one prescribed
- Ambulatory oxygen if prescribed
- Sensible shoes and loose fitting clothes
- Reading glasses if you need them
- Bottle of water
Do you offer Pulmonary Rehabilitation at the weekend?
Unfortunately not at this stage. Our working hours are 8am to 5pm Monday to Friday, excluding bank holidays.
Calls are recorded for training and quality purposes. To find out more, visit Personal information – Bromley Healthcare.
More information
Leaflets
Home oxygen assessment service
Pulmonary Rehabilitation service
Useful websites
Bromley Well have several useful videos that inform you about their services including What is Bromley Well? and a Long term conditions video
Asthma + Lung UK have produced the following free leaflets that you can read through for extra information:
– Living with Chronic Obstructive Pulmonary Disease (COPD) | Asthma + Lung UK
– First steps to living with COPD | Asthma + Lung UK
– Living with Pulmonary Fibrosis | Asthma + Lung UK
– Idiopathic Pulmonary Fibrosis (IPF) | Asthma + Lung UK
– Living with Bronchiectasis | Asthma + Lung UK
– Breathlessness | Asthma + Lung UK
– Eating well for healthier lungs | Asthma + Lung UK
– How to stop smoking | Asthma + Lung UK
– Home oxygen therapy | Asthma + Lung UK
– RightBreathe provides information and video demonstrations on inhaler prescribing and how to use inhalers correctly.
Heatwave
– Beat the Heat – Staying Safe in Hot Weather | GOV.UK
– Supporting vulnerable people before and during hot weather | GOV.UK
– Adverse weather and health plan | GOV.UK
– Looking after your lungs in hot weather | Asthma + Lung UK
Air pollution
Advice for the general population: Anyone experiencing discomfort such as sore eyes, cough or sore throat, should consider reducing activity, particularly outdoors.
Advice for at risk individuals: Adults and children with lung problems, and adults with heart problems, should reduce strenuous physical exertion, particularly outdoors *, and particularly if they experience symptoms. People with asthma may find they need to use their reliever inhaler more often. Older people should also reduce physical exertion.
Support group
Asthma +Lung Support Group
Meets on the 3rd Tuesday of every month at 2pm to 4pm at the Victor Childs Room, St Paul’s Church, Crofton Road, (A232), Orpington BR6 8JE
You are welcome to join meetings featuring guest speakers and refreshments.
Calls are recorded for training and quality purposes. To find out more, visit Personal information – Bromley Healthcare.
For professionals
Patients can be referred via the Single Point of Entry form on EMIS.
Respiratory Team Lead: Caroline Ryden
For additional information, please email the team Administrators at bromh.cccpod2refs@nhs.net