The Chest Clinic
Symptoms
Respiratory symptoms can have several causes, and more than one may contribute. We assess the pattern, your medical history and examination findings, then agree targeted tests and a plan for treatment and review.
Conditions and treatments | Investigations | Arrange an appointment
When to seek urgent help
Call 999 for severe breathing difficulty, blue or grey lips, collapse, or sudden chest pain that feels tight or heavy or spreads to the arm, jaw or back. Coughing up more than a few spots or streaks of blood, or blood with breathlessness, a fast heartbeat or chest pain, also needs emergency assessment. Do not wait for a routine private appointment. For new or worsening symptoms that are not an emergency, contact your GP or NHS 111.
Cough
A cough lasting more than three weeks should be assessed; in adults, a cough lasting over eight weeks is called chronic cough. Causes include asthma or eosinophilic airway inflammation, nasal disease, infection, reflux in selected patients, smoking and medicines such as ACE inhibitors. Some people have an unusually sensitive cough reflex even after other causes have been treated.
Assessment may include a chest X-ray, spirometry, blood tests and FeNO. Sputum tests, CT or bronchoscopy are arranged for specific indications, rather than routinely for everyone. Treatment is directed at the findings, with planned review if the cough persists.
We work with specialist Speech and Language Therapists for cough-control therapy, including techniques to reduce the urge to cough, breathing strategies and voice or throat care. These approaches can help persistent cough and do not mean the symptoms are imagined.
For selected adults with refractory or unexplained chronic cough, a specialist may discuss gefapixant (Lyfnua), a medicine that acts on cough-reflex signalling. Benefit varies and altered, reduced or lost taste is a common reason for difficulty tolerating it. At The Chest Clinic, gefapixant is currently available only on a self-pay basis after specialist assessment; we discuss suitability, monitoring and costs before treatment. NICE's appraisal was terminated without a recommendation on NHS use.
Our detailed cough guide | BTS cough guidance | ERS patient guide | NICE: gefapixant | Gefapixant patient leaflet
Breathlessness
Breathlessness may develop suddenly or gradually, at rest or on exertion. Lung and heart conditions, anaemia, reduced fitness, breathing-pattern disorders and other causes can contribute. We ask about its timing, exercise tolerance and associated symptoms, and check observations and oxygen levels where appropriate.
Initial tests may include chest X-ray, ECG, blood tests and lung function. Depending on the findings, echocardiography, CT, exercise testing or other investigations may help. Treatment can combine management of the underlying condition, rehabilitation and breathing support. Oxygen is prescribed for particular clinical indications, not simply because someone feels breathless.
Our breathlessness guide | NHS: shortness of breath
Wheeze and chest tightness
A whistling sound when breathing or episodes of tightness may suggest asthma or COPD, but symptoms alone do not establish a diagnosis. Spirometry, bronchodilator testing, FeNO and sometimes peak-flow monitoring help assess the cause. We also consider upper-airway problems when the history suggests them. Treatment depends on the diagnosis, with inhaler technique and response reviewed.
Asthma guide | COPD guide | Asthma + Lung UK: asthma
Chest pain
Chest pain can arise from the heart, lungs, chest wall or digestive system. Sharp pain on breathing can occur with infection, a pulmonary embolism or pneumothorax, and needs assessment according to its severity and context. We establish whether urgent care is needed before arranging outpatient respiratory tests. ECG, chest imaging and blood tests are selected according to the suspected cause.
Our chest pain guide | NHS: chest pain
Coughing up blood
Even a few spots or streaks of blood in sputum should be assessed urgently by a GP or NHS 111. Infection is one possible cause, but we also consider bronchiectasis, blood clots and cancer. Depending on the situation, investigation may involve chest X-ray, CT, sputum samples and bronchoscopy. See the emergency advice above for heavier bleeding or associated breathing difficulty or chest pain.
Our coughing-up-blood guide | NHS advice
Snoring, breathing pauses and daytime sleepiness
Loud snoring, witnessed pauses in breathing, waking choking, unrefreshing sleep and daytime sleepiness can suggest obstructive sleep apnoea. Assessment includes sleep history and usually a home sleep study. Snoring alone does not establish sleep apnoea, and further assessment may be needed if a home test is inconclusive.
Treatment may include changes to sleep habits and weight management where relevant, CPAP or selected alternatives. CPAP treatment is usually arranged through a GP referral to the patient's local NHS sleep clinic. We can provide our assessment and test results to support that referral. Do not drive if sleepy or if your alertness is impaired; discuss the relevant DVLA requirements with your clinician.
Our sleep apnoea guide | NHS: sleep apnoea | NICE sleep guidance
Fatigue and reduced exercise tolerance
Fatigue means a lack of energy; sleepiness means a tendency to fall asleep. They can overlap but need different questions. Sleep-disordered breathing, persistent respiratory disease and recovery from infection can contribute, while anaemia, thyroid disease, medicines, mood and many other non-respiratory causes also need consideration. Assessment is guided by your history and may involve blood tests, sleep testing or exercise assessment, with your GP and other specialists involved when appropriate.
Recurrent chest infections or troublesome sputum
Repeated infections, a persistent productive cough or a change in sputum can occur with bronchiectasis, COPD and other conditions. We review previous infections, antibiotics and imaging, and may arrange sputum cultures, lung function, blood tests and CT. Treatment may include targeted antibiotics, physiotherapy for airway clearance and measures to reduce future infections. Antibiotics are not appropriate for every cough or viral infection.
Bronchiectasis guide | Chest infection guide
Nasal symptoms, throat irritation and voice changes
A blocked or runny nose, sneezing and post-nasal symptoms may accompany allergy or nasal inflammation and can contribute to cough. We consider triggers and examination findings, with selected allergy tests. Persistent hoarseness, swallowing difficulty or symptoms suggesting an upper-airway disorder may need ENT assessment or Speech and Language Therapy alongside respiratory care.
An abnormal scan, weight loss or unexplained symptoms
We also assess abnormal chest X-rays or CT scans, lung nodules and unexplained respiratory symptoms. Unintentional weight loss, persistent fever or night sweats, a changing cough or repeated infections in the same area should be discussed promptly with a clinician. Previous scans and reports help us decide whether comparison, follow-up imaging or further investigation is needed.
Arrange an assessment
Our main clinics are at The Wellington Hospital in London and The Clementine Churchill Hospital in Harrow. Bring a medicines list and any previous results available to you. We will explain the proposed tests, review the results and agree the next steps.
Appointment contacts and booking | Meet our consultants
General information for adults. Your clinical team will tailor assessment and treatment to you.