Clinical Practice

My NHS practice at the Royal Brompton Hospital is principally tertiary, meaning that patients are referred to me by other hospital consultants, usually general and emergency paediatricians, but also Ear Nose & Throat specialists, allergists, gastroenterologists and dermatologists. I also see a smaller number of children referred by their general practitioners (secondary referrals).

At Chelsea & Westminster hospital, the majority of referrals are from GPs but there are also a number of referrals from the other paediatricians and specialists within the hospital.

The majority of my private work (Royal Brompton Hospital) comes from GP referrals as well as other paediatricians, but sometimes parents refer themselves.

Clinical Practice

At Chelsea & Westminster hospital, the majority of referrals are from GPs but there are also a number of referrals from the other paediatricians and specialists within the hospital.

The majority of my private work (Royal Brompton Hospital) comes from GP referrals as well as other paediatricians, but sometimes parents refer themselves.

Tertiary referrals

• Unexplained respiratory symptoms e.g. noisy breathing, cough, breathlessness, chest pain, exercise intolerance.
• Difficult / severe asthma
• Severe infant wheezing
• Cystic fibrosis
• Recurrent pneumonia
• Chronic lobar collapse
• Empyema
• Obstructive sleep apnoea and other sleep disturbances
• Congenital thoracic malformations

Secondary referrals

• Unexplained respiratory symptoms e.g. noisy breathing, cough, breathlessness, chest pain, exercise intolerance
• Infant wheezing
• Asthma
• Chronic cough
• Recurrent chest infections

Diagnostic services

Simple tests that can be carried out in clinics include –

• Chest x-ray
• Lung function (children aged 6 and over)
• Allergy skin tests (children aged 3 and over)
• Sweat testing for cystic fibrosis

More complex investigations are carried out at Royal Brompton Hospital and may involve an overnight stay –

• Chest CT scan
• Formal lung function testing including exercise tests, bronchodilator responsiveness
• Lung clearance index
• Flexible bronchoscopy including airway brushings, bronchoalveolar lavage and endobronchial biopsy (all under general anaesthesia)
• 24-hour dual probe pH study or impedance study for gastro-oesophageal reflux
• Sleep studies – level 1 (oxygen and carbon dioxide monitoring), level 2 (polysomnography – includes respiratory movement, nasal airflow, and video)
• Video fluoroscopy assessment by speech therapist for aspiration
• Nasal ciliary brushings and nasal nitric oxide (for primary ciliary dyskinesia)
• Blood testing for allergy and immune function, CF genotyping
• Non-invasive markers of inflammation (exhaled nitric oxide, induced sputum cytology)
• Open lung biopsy
• Assessment by physiotherapist, dietitian, speech therapist, clinical psychologist

International services

Referrals are accepted from abroad.

In addition I am Honorary Consultant to Mater Dei Hospital, Malta where I visit once a year (Autumn) and conduct cystic fibrosis and respiratory clinics with a full multidisciplinary team (physiotherapist, nurse specialist and dietitian). We also conduct a videoconference clinic in March each year.