Development of Paediatric Respiratory Medicine at BCH

Simon C. Langton Hewer

The Respiratory Medicine service at Bristol Childrens Hospital is based within the Directorate of Acute Medical Services. It comprises 1.0 full time consultant (Dr Simon Langton Hewer) with additional sessions provided by an academic post (Dr John Henderson; 6 sessions) and 2 sessions by Dr Huw Thomas (North Bristol) for support of CF services & allergy. In addition Professor Peter Fleming provides sessional input to the Sleep Laboratory, the management of infants and children with chronic respiratory disorders and ventilation support, and the monthly home ventilation clinic. The main interests of the department are cystic fibrosis, asthma, bronchoscopy, allergy and sleep/home ventilation.

The cystic fibrosis service is led by Simon Langton Hewer. We are able to provide a mixture of hospital and community delivered care with input from a multidisciplinary specialist team of nurses, physiotherapists and dietician. We are the lead centre for CF services within the South West (excluding the peninsula region) and have been running shared-care clinics at the Royal United Hospital Bath for the past 3 years. We are expecting to start similar shared care clinics in Taunton, Cheltenham and Gloucester over the forthcoming year. We have been working with the SW Specialist Commissioning team to encourage investments from Primary Care Trusts and have recently appointed two nurses between the adult service in the BRI and the Childrens Hospital. There is an active research group with papers being presented at the annual European and American CF conferences.

The Childrens Hospital asthma services have recently been boosted by the appointment of a full time asthma nurse specialist (Mrs Deb Marriage) who will aim to improve links between primary and secondary care and improve self-management of asthma of those children who are seen at the Childrens Hospital. She is compiling a database that will be used to generate data on these patients for research studies. She is able to visit children at home, in their schools and to discuss management of difficult patients with their school and practice nurses.

Flexible bronchoscopy in children is a relatively new development. We are performing approximately 100 per annum in children with persistent cough, recurrent pneumonia, stridor and as a support service to cardiac and paediatric intensive care services. The procedure is video-recorded so we can explain the findings more easily to the parents, for teaching purposes and so that we can discuss findings with colleagues in other specialities such as cardiac and thoracic surgery.

The department operates the purpose-built Sebastian Diamond sleep physiology laboratory at St. Michaels Hospital. Over 180 sleep studies are performed annually on patients whose diagnoses include adenotonsillar hypertrophy causing obstructive sleep apnoea, musculo-skeletal weakness (such as spinal muscular atrophy or Duchennes muscular dystrophy) causing sleep hypoventilation and central sleep apnoea. The department is now looking after 27 children who are ventilated at home. Approximately half of these are ventilated through a tracheostomy, the others via a close-fitting face mask. Community nursing support, often including resident overnight carers, for these children is provided by the Lifetime service, based in Bath.

There is a clinical allergy service supported by the consultant staff and with additional input from Dr Joe Unsworth, consultant immunologist at Southmead hospital.

In order to continue to provide a high quality clinical respiratory service we will require further investment in cystic fibrosis to meet the growing demand from neighbouring hospitals sleep medicine/home ventilation to allow monitoring of children with progressive neurological impairment and early implementation of non-invasive ventilation where appropriate allergy/immunology to meet demand for these services and to provide immunotherapy and allow access to novel allergy treatments such as monoclonal antibodies.

March 2003