Doctors Information

Diagnostic Tests

Lung Function Testing – consists of a series of tests todo assess large airway function (spirometry), status of alveolar-capillary membrane (gas transfer), lung volumes (body box plethysmography) and functional assessments (6 minute walk tests).

In order to accurately assess lung function, it is important that the study is conducted in a laboratory with adequately trained staff and well maintained equipment which is regularly calibrated.

Warning – beware of sub-optimally performed spirometry which may incorrectly suggest restrictive lung disease. Although spirometry is widely available it is important to ensure that the provider meets all quality standards.

Sleep Studies – consists of hospital based and home based studies. Hospital based studies are the gold standard and consist of multichannel attended monitoring ensuring optimal signal quality and accurate assessment. Home based studies include home based polysomnography and limited channel studies. As home based studies are unattended they are prone to signal loss and artefact. Studies suggest that up to 20% of home based studies are inadequate to provide accurate diagnosis. Therefore the indication for home studies is in one who is assessed as highly likely to have severe obstructive sleep apnoea.

Warning – all sleep studies can only be interpreted in the context of the clinical assessment. Beware of providers who offer home studies and sell either CPAP or dental devices. In many instances they are not acting in the interests of the patient.

Download Clinical Guidelines for Portable Sleep Monitoring


Respiratory Disorders

Chronic Obstructive Pulmonary Disease (COPD) – current guidelines for the management of COPD is outlined in COPDX. These guidelines are reviewed on an ongoing basis. The diagnosis of COPD is based on lung function testing. CXR may suggest hyper-inflation however lung function should always be performed in order to confirm the diagnosis. Management of early COPD should include smoking cessation, immunisation (yearly Fluvax), salbutamol as needed and an exacerbation action plan. If symptoms are persistent then consider adding tiotropium.

Download COPDX Document

Asthma – the diagnosis of asthma is made based on spirometric evaluation demonstrating airflow limitation with a significant response to bronchodilator. In the setting of a clinical history together with suggestive symptoms consider bronchoprovocation testing. The main limitation in managing asthma is compliance with medication and recognition of warning signs of an impending exacerbation. Asthma education consisting of an action plan and good inhaler technique are vital in the optimal control of this condition.

Download Asthma Management Handbook

Lung Cancer/ Pulmonary Nodules – the comprehensive and timely evaluation and management of lung nodules is important for optimal patient outcome. The availability of interventional bronchoscopy and PET scan has assisted greatly in establishing the diagnosis and staging of lung cancer. All of our physicians are involved with multidisciplinary lung cancer clinics (Royal Melbourne Hospital and Western Hospital) and will ensure assessment within 7 days of referral.


Sleep Disorders

Obstructive Sleep Apnoea (OSA) – approximately 5% of the population have OSA a condition which if severe (Apnoea Hypopnoea Index > 30) is associated with cardiovascular disease, stroke and hypertension. OSA may also play a role in glycaemic control, cardiac arrhythmia and weight gain. The significance of mild-moderate OSA is controversial with few studies suggesting it conveys long term health risk. Therefore the decision to treat mild-moderate OSA is based on clinical assessment. Always consider non sleep apnoea causes for symptoms such as nocturnal awakening, unrefreshing sleep and hypersomnia.

Download Guidelines for the evaluation and management of OSA

Insomnia – is the difficulty initiating or maintaining sleep or early morning awakenings with effects on quality of life. There are a number of possible causes for insomnia which can often be elicited from the medical history. Managing the behavioural/ psychological aspects of insomnia are the first step. Hypnotics in general have little role in the management of insomnia and should be avoided.

Download Guidelines for the Management of Chronic Insomnia in Adults

Driving and Sleep Disturbance – the Ausroads Fitness to Drive Guidelines discusses the risks associated with driving and sleepiness and outlines medical practitioners and drivers responsibilities. This is a very difficult issue in the non-compliant patient and the practitioners must not only consider the importance of the doctor-patient relationship but also the risk the patient poses to themselves and the community.

Download Fitness to Drive Guidelines




Useful Resources

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