Respiratory Medicine

St. James's Hospital

St James Respiratory Medicine consists of five Respiratory Consultants who provide SJH with the following services

Patient Care

1. Two acute medical services, on a 1:9 on call
2. A dedicated in-patient Respiratory Consult service
3. Daily bronchoscopy service for diagnostic studies, including fluoroscopy, argon-plasma photo coagulation, brachytherapy and endobronchial ultrasound for accurate lung cancer staging.       
4. Pulmonary function laboratory, including cardiopulmonary exercise stress testing, mannitol challenge testing and routine PFT’s
5. Non-invasive Ventilation “unit” for management of unstable chronic lung disease patients
6. Sleep Disorder clinics and full Polysomnography by dedicated Respiratory technicians
7. Multi disciplinary lung cancer clinic
8. National Referral Centre for Tuberculosis operating both an in-patient and out-patient settings.
9. Respiratory Outreach service dedicated to maximizing patient performance and well being and minimizing in-patient admissions in advanced lung disease.
10.  Interstitial Lung disease out-patient clinic
11.  Asthma out-patient Clinic
12.   Pleural disease evaluation including Pulmonary delivered ultrasonography to provide safe and efficient management of both benign an malignant pleural diseases, seldinger placed Cook catheters for chest tube placement with minimal pain, and Abrams pleural biopsy.

Undergraduates who spend time in our department can expect to get first hand experience of management of such diseases as tuberculosis, lung cancer, COPD, asthma, sleep-disordered breathing and interstitial lung disease. For example, we see up to 100 TB cases a year and in excess of 400 cases of lung cancer per year, so the service is very busy. We follow over 200 sarcoidosis patgints in the OPD setting.  This makes St James's Hospital an outstanding place for the undergraduate to get hands-on experience.  Our undergraduates are encouraged to integrate themselves into our clinical teams and involve themselves in patient management during post-call ward rounds and in the out-patient suite. Those who are so inclined are encouraged to become involved in both clinical and basic science research endeavors. 

Tallaght University Hospital

The Professorial Respiratory Centre at Tallaght University Hospital treats and cares for adult patients with all forms of breathing related difficulties including, but not limited to

• Asthma
• Chronic Obstructive Pulmonary Disease
• Lung infection
• Pulmonary Fibrosis
• Disorders of sleep and ventilation, and
• Patients with lung cancer

Our team of consultants, specialist respiratory nurses, specialist respiratory physiotherapists and Pulmonary Technologists work hard to enable those with respiratory disease lead as normal a life as possible.

We care for many of our patients within Tallaght University Hospital, but also manage a 25 bed specialist Respiratory Rehabilitation Unit at Peamount Healthcare in Newcastle Co. Dublin.

We are proud to be the home of Ireland’s first National Centre for the treatment of Pulmonary Fibrosis. Lead by Professor Seamas Donnelly, this state of the art medical unit provides specialised care for patients. Its Specialist Nurse Service offers assistance and advice to GPs, patients, and to their families.

The Professorial Respiratory Centre offers specialised treatment for a wide range of breathing related disorders.

1. Severe Asthma and allied allergic and vasculitic respiratory disorders
   We have a special interest in caring for patients with severe asthma, respiratory allergy and pulmonary vasculitis. Our team of doctors, clinical nurse specialists and pulmonary physiologists treats a large cohort of patients with the main asthma phenotypes such as allergic asthma, eosinophilic asthma and aspirin-exacerbated respiratory disease. We have a therapeutic interest in Monoclonal Antibody Therapy, Bronchial Thermoplasty, and Allergen Immunotherapy. The Professorial Respiratory Centre is a member of the Tallaght Vasculitis & Allergy Group (TVAG). This interdisciplinary grouping of consultants is involved in the management of rare vasculitis and allergic lung conditions such as Churg Straus Syndrome, Wegener’s Granulomatosis, Hypereosinophilic syndrome, Anaphylaxis and Immunodeficiency. We run an active clinical research unit and are involved in multiple ongoing investigational studies into these conditions.
2. Pulmonary Fibrosis
   In our National Pulmonary Fibrosis Centre, we care for patients with Pulmonary Fibrosis referred nationally from Consultant and GP colleagues. One of the largest in Europe, we have a multidisciplinary team of specialist nurses, physiotherapists, pulmonary function specialists, pharmacists and medical doctors who look after referred patients. In addition, the Centre runs joint clinics with our Rheumatology and Nephrology colleagues. It supports the cutting-edge research which is ongoing within the Professorial Respiratory Centre and Trinity College Dublin, seeking to discover why people get Pulmonary Fibrosis, and trying to develop potentially novel therapies to treat the disorder.
3. Disorders of Sleep and Ventilation
   We help and treat patients with respiratory symptoms of Obstructive Sleep Apnoea (snoring, witnessed apnoeas, nocturnal arousals and daytime sleepiness). We investigate using inpatient full or limited sleep studies, or home overnight oximetry studies. We manage patient treatment with nocturnal continuous positive airway pressure (CPAP) in our 25 bed Respiratory unit in Peamount Healthcare. This includes therapy setup, titration, and monitoring.
   We also assist patients with ventilatory failure caused by a variety of conditions including obesity hypoventilation disorders, OSA/ COPD overlap syndrome, Kyphoscoliosis, Muscular dystrophies and Motor Neuron Disease.
4. COPD
   We provide acute management of patients with Chronic Obstructive Pulmonary Disease through the Emergency Department and the Acute Medical Unit in Tallaght University Hospital. We assist and support patients with Early Supported Home Discharge from Tallaght University Hospital through our special COPD Outreach service.
5. Lung Cancer
   Our Lung Cancer Service operates in conjunction with our sister service at St. James’s Hospital, Naas General Hospital and Peamount Healthcare. The Centre treats c.170 new cases of lung cancer per annum.

Comprehensive Summary of Teaching Undergraduates

Undergraduates are invited to admit patients when we are on-call and present them during post-call ward rounds. In addition, they get an opportunity to work up patients in clinics and discuss them with the attending consultant in the outpatients department. Students are actively involved during our bronchoscopy lists and are given responsibilities with respect to the outpatient work up’s of lung cancer and tuberculosis.

During a typical week with us, the undergraduate will attend a dedicated pulmonary conference (Tuesday), where academic discussion of cases occurs, in addition to a tumour board or multi-disciplinary team meeting on Monday morning. We also have a dedicated PFT interpretation session which the students are encouraged to attend and journal clubs/didactic talks (Thursday).

Curriculum Summary

The teaching goals of the Department of Respiratory Medicine are the development of scientific and clinical knowledge, clinical skills, and professional attitude in all students attached to the service.

Scientific and Clinical Knowledge

• Pulmonary physiology and anatomy
• Atmospheric gases
• Ventilation; Boyle’s Law etc.
• Gas exchange
• Ventilation and perfusion relationships
• Pulmonary pathophysiology
• Failure of ventilation (Type 2 Respiratory Failure)
• Failure of gas exchange (Type 1 Respiratory Failure)
• Pulmonary disease
• Obstructive airways disease
• Lung infection
• Pulmonary malignancy
• Sleep and chronic ventilatory disorders
• Interstitial lung diseases
• Pulmonary vascular disease
• Lung transplantation
• Specific therapies
• Oxygen therapy
• Supportive ventilation, both invasive and non-invasive
• Pharmacotherapy for specific diseases
• Indication for therapeutic procedures
• Interpretation of diagnostic studies
• Pulmonary function testing
• Cardio-pulmonary exercise testing
• Allergy testing
• Sleep studies
• Chest radiology
• Arterial blood gas and pleural fluid analysis

Clinical Skills

• Focused history-taking, with an emphasis on cardinal symptoms, timing of symptoms, and risk factors for respiratory disease.
• Clinical examination with a focus on the application of clinical anatomy, and the elimination of redundancy in examination.
• Interpretation of findings from history and examination to develop a logical pathological differential diagnosis.
• Performance of  diagnostic and therapeutic procedures

Professional Development

• Development of communication skills, relating to interaction with colleagues and patients.
• Awareness of basic medico-legal concepts such as confidentiality and consent.
• Accurate note-taking and record keeping

Students attached to the department of respiratory medicine are expected to take a full and active part in the care of patients under the care of the service.

St James's Hopital

The respiratory department is involved in the training of specialist registrars in respiratory medicine and general internal medicine. We provide a dedicated teaching session in this regard. The consultants are also actively engaged in specific tutorial sessions for all parts of the membership exam. Our unit gives the postgraduate trainee a unique opportunity to acquire skills in invasive bronchoscopy, tuberculosis management, COPD work up and interstitial lung disease. Like most aspects of postgraduate training, self motivation is the key component in taking advantage of the unique environment that SJH provides in developing diagnostic and procedural skills. Although many aspects of SPR training involve documentation, in SJH feedback is given monthly to sPRs as to their performance with each individual consultant. A unique aspect of SJH is that the trainee gets to work with all 5 respiratory physicians and can benefit from their unique skills and different approaches.

Tallaght University Hospital

The Professorial Respiratory Centre is an excellent place to learn. Medics work under the direct guidance of renowned respiratory consultants and are based in Tallaght University Hospital & Peamount Healthcare. They learn how best to treat and care for patients with Asthma, COPD, Pulmonary Fibrosis, Lung Cancer and Respiratory Sleep & Ventilation disorders. They gain experience working in the 10-bed ICU Unit in Tallaght, and in the 25-bed Respiratory Sleep & Ventilation Unit in Peamount.  Those with a special interest in research have the opportunity to seek admission to a three year research programme in Trinity College Dublin under the leadership of Professor Seamas Donnelly, Head of Medicine, Tallaght University Hospital & Trinity College Dublin.

Why did you choose Respiratory Medicine and Tallaght University Hospital?

"I was initially attracted to work in Respiratory Medicine as it is a perfect blend of clinical and practical skills; it is very tangible too. I found working on rotation in Tallaght a great learning experience. Everyone was friendly, and I received great support and guidance from consultant colleagues. Working in Intensive care as a part of the SpR rotation was invaluable, as was working in the Respiratory unit in Peamount Healthcare.It was a great opportunity for me to gain in-depth knowledge and experience in the management of ventilatory and sleep disorders."  

Dr. Chithra Varghese, Registrar

"Tallaght Hospital is a very friendly place to work. The Professorial Respiratory Centre provides a variety of experience and learning opportunities. I began my training in the Intensive Care Unit where I learned under supervision how to perform many practical procedures and care for critically ill patients. Starting off my SpR year in such an important area was a valuable experience.  I look forward to working in the Ventilation Unit in Peamount Hospital.  It will be a good opportunity for me to learn how to treat and care for patients with sleep disorders." 

Dr. Aoife O'Reilly, SpR Respiratory Medicine

St James's Hospital

Tallaght University Hospital

Naas Hospital