Conditions
We assess and manage a wide range of respiratory conditions in adults. This guide brings together the main diagnoses, how we investigate them and the treatments that may help. Detailed guides and trusted external information are linked throughout.
Symptoms | Investigations | Appointments
Asthma and severe asthma
Asthma causes variable airway narrowing and inflammation, leading to wheeze, cough, chest tightness or breathlessness. Diagnosis combines a clinical history with objective tests such as FeNO, blood eosinophils, spirometry with bronchodilator testing and sometimes peak-flow monitoring or specialist challenge tests.
Treatment includes inhaled anti-inflammatory medicines. Depending on your needs, an appropriate inhaled corticosteroid/formoterol inhaler may be prescribed as an anti-inflammatory reliever (AIR), or for maintenance and relief (MART). Not every combination inhaler is suitable for these roles. Technique, adherence, triggers and a written action plan are reviewed.
People with severe asthma despite optimised treatment may be assessed for biologic injections. The choice depends on the pattern of inflammation, attacks and other eligibility criteria. Most patients who need biologic treatment transfer to an NHS specialist service for this care; that team confirms eligibility, prescribing and monitoring.
Detailed asthma guide | Asthma + Lung UK | BTS/NICE/SIGN asthma guidance
COPD, emphysema and chronic bronchitis
COPD is a long-term condition with persistent airflow obstruction. Emphysema describes damage to the air sacs; chronic bronchitis describes a pattern of ongoing cough and sputum. Assessment includes symptoms, smoking and exposure history and post-bronchodilator spirometry, with imaging and other tests where appropriate.
Treatment may include smoking cessation support, vaccinations, long-acting inhalers, pulmonary rehabilitation and a plan for flare-ups. Some patients need inhaled steroids, selected additional medicines, oxygen assessment or evaluation for lung-volume reduction. Treatment is individualised and inhaler technique is checked.
Biologics for COPD: selected adults with ongoing exacerbations despite optimised treatment and raised blood eosinophils may be eligible for add-on biologic injections, including dupilumab or mepolizumab under current NICE guidance. These medicines target particular inflammatory pathways; they are not suitable for everyone and do not treat an acute attack. We can assess whether specialist referral is appropriate. Most patients requiring biologics transfer to NHS specialist care, where the team confirms current eligibility, access and follow-up.
Detailed COPD guide | NICE COPD guidance | NICE: dupilumab | NICE: mepolizumab
Bronchiectasis
Bronchiectasis means abnormal widening of the airways, often causing daily sputum and recurrent infections. CT establishes the structural changes; sputum cultures, lung function and blood tests help identify infection, severity and possible causes. Investigations may look for immune problems, allergic bronchopulmonary aspergillosis or other underlying conditions.
Care centres on individually taught airway-clearance physiotherapy, exercise, vaccinations and prompt treatment of appropriate infections. Selected patients need long-term antibiotics or other specialist treatment after careful assessment and monitoring.
Detailed bronchiectasis guide | Asthma + Lung UK: bronchiectasis
Interstitial lung disease (ILD) and pulmonary fibrosis
ILD is an umbrella term for disorders affecting the lung tissue around the air sacs. Some predominantly cause inflammation, others scarring (fibrosis), and some cause both. Subtypes behave differently, so establishing the most likely diagnosis matters.
Assessment usually includes high-resolution CT, lung function with gas transfer, oxygen assessment and a detailed review of medicines, work, home exposures and autoimmune symptoms. Blood tests and multidisciplinary discussion help refine the diagnosis. Bronchoscopy or biopsy is considered only when the expected benefit justifies the risks.
Idiopathic pulmonary fibrosis (IPF): progressive lung scarring without an identified cause. Eligible patients may receive antifibrotic treatment to slow progression, alongside rehabilitation, symptom support and assessment for oxygen or transplantation when appropriate. A usual interstitial pneumonia (UIP) scan pattern can also occur in other diseases, so it does not automatically mean IPF.
Hypersensitivity pneumonitis (HP; previously called extrinsic allergic alveolitis): an immune reaction to inhaled material, for example from birds or mould. It can be non-fibrotic or fibrotic. Identifying and reducing the responsible exposure is central; selected patients need anti-inflammatory or antifibrotic treatment.
Connective tissue disease-associated ILD: lung involvement associated with conditions such as rheumatoid arthritis, systemic sclerosis or inflammatory muscle disease. Respiratory and rheumatology teams work together; treatment may include medicines that modify immune activity and, in selected progressive fibrotic disease, antifibrotic therapy.
Non-specific interstitial pneumonia (NSIP): a pattern of inflammation and/or fibrosis that may occur with autoimmune disease or without a clear cause. Management depends on its cause, severity and behaviour, with monitoring and selected immune-modifying treatment.
Organising pneumonia, including cryptogenic organising pneumonia (COP): an inflammatory repair pattern that can follow infection, medicines or other illness, or occur without an identified cause. It differs from a straightforward bacterial pneumonia. Infection must be considered before steroid treatment; some patients need a monitored course of anti-inflammatory therapy.
Occupational, drug-related and smoking-related ILD: examples include asbestosis, silicosis and smoking-related interstitial disorders. We assess the exposure or medicine history and coordinate removal or alteration of the cause where possible. Do not stop prescribed medicines without advice.
Other or unclassifiable ILD: some people have overlapping or less common patterns. Regular review of symptoms, lung function and imaging helps guide care. Progressive pulmonary fibrosis describes worsening fibrosis in some non-IPF conditions, rather than one single diagnosis.
Treatment may involve observation, avoiding exposures, immune-modifying medicines or antifibrotics according to the subtype. Rehabilitation, vaccination, oxygen when indicated and symptom support are also important. These treatments are not interchangeable and established scarring is not simply reversed by medication.
Our ILD guide | Our IPF guide | European Lung Foundation: ILD | Asthma + Lung UK: HP | COP information | ERS/EULAR patient guidance
Sarcoidosis and eosinophilic lung disease
Sarcoidosis causes clusters of inflammatory cells and can affect the lungs, lymph nodes and other organs. Diagnosis may require imaging, organ assessments and a biopsy, while excluding other causes. Some people need monitoring alone; others need steroids or additional immune-modifying treatment depending on symptoms and organ risk.
Eosinophilic lung disorders involve a type of white blood cell called an eosinophil. Assessment considers asthma, medicines, infection and systemic disease, using blood tests, imaging and selected sampling. Treatment depends on the specific diagnosis and may include steroids or other specialist medicines.
Sarcoidosis guide | Asthma + Lung UK: sarcoidosis
Sleep apnoea and obesity hypoventilation
Obstructive sleep apnoea causes repeated upper-airway narrowing during sleep. Sleep history and a sleep study establish the diagnosis and severity. CPAP supplies pressurised air through a mask to keep the airway open; APAP adjusts pressure within a prescribed range. Selected alternatives include a mandibular advancement splint or positional treatment, alongside measures such as weight management where relevant.
Our usual CPAP pathway: most patients transfer to NHS care for CPAP. Their GP usually refers them to their local NHS sleep clinic, with our assessment and sleep-study results available to support the referral. The sleep service confirms treatment, supplies equipment and arranges follow-up. Mask fit, leaks, dryness and comfort should be reviewed if treatment is difficult to use.
Obesity hypoventilation involves inadequate breathing with raised carbon dioxide and requires specialist assessment, sometimes including blood-gas testing and additional ventilatory support. It is not the same as uncomplicated snoring. Do not drive when sleepy or if alertness is impaired; your clinician can advise on DVLA requirements.
Detailed sleep guide | NICE sleep guidance | NHS: sleep apnoea
Respiratory infections, pneumonia, TB and NTM
Assessment of chest infections considers severity, underlying lung disease and whether antibiotics are likely to help. Pneumonia may require chest imaging, blood or sputum tests and hospital treatment when severe. Follow-up imaging is arranged where clinically indicated rather than automatically for every infection.
Tuberculosis (TB) needs specialist testing and a combination of antibiotics, with public-health support where appropriate. Non-tuberculous mycobacteria (NTM) can be found in sputum without always causing disease; diagnosis considers repeated cultures, symptoms and imaging. Treatment decisions require specialist review and may involve prolonged combinations of antibiotics.
Respiratory infections guide | Pneumonia guide | TB guide | BTS clinical resources
Pleural disease: effusion and pneumothorax
A pleural effusion is fluid around the lung. Ultrasound and, when appropriate, fluid sampling help identify its cause; treatment may involve drainage and management of infection, heart failure, cancer or another underlying condition. A pneumothorax is air around the lung, which can cause sudden pain and breathlessness. Management ranges from observation to drainage or surgery according to symptoms, stability and the clinical situation.
Pleural effusion guide | Pneumothorax guide
Pulmonary embolism and pulmonary hypertension
A pulmonary embolism is a blood clot in the lungs and may need urgent hospital assessment. Diagnosis uses clinical probability and selected blood tests and imaging; anticoagulant treatment is usually needed. Follow-up reviews recovery, treatment duration and persistent breathlessness.
Pulmonary hypertension means raised pressure in the lung blood vessels. Echocardiography can suggest it, but specialist tests are needed to establish the cause and confirm the diagnosis. Treatment is cause-specific and some patients need a specialist pulmonary hypertension centre.
Pulmonary embolism guide | NHS: pulmonary hypertension
Lung nodules, lung cancer and mesothelioma
A lung nodule is a small abnormality on imaging; many are benign. Previous scans, nodule features and individual risk guide surveillance or further investigation. Suspected cancer may require CT, PET-CT and tissue sampling by bronchoscopy, EBUS, image-guided biopsy or surgery, chosen for the safest useful information.
Lung cancer and mesothelioma are managed through specialist multidisciplinary teams. Treatment depends on the diagnosis, stage, fitness and, where relevant, tumour biomarkers, and may include surgery, radiotherapy, systemic medicines and supportive care.
Lung cancer and MDT guide | Mesothelioma guide | NHS: lung cancer
Allergic rhinitis, nasal disease and persistent cough
Nasal allergy and inflammation can coexist with asthma and contribute to cough. Diagnosis is based on symptoms and triggers, with selected allergy testing. Treatment may include trigger reduction, nasal treatment and antihistamines where appropriate.
Persistent cough can continue after identifiable causes have been treated. We use specialist Speech and Language Therapy for cough control and consider selected medicines after assessment. Gefapixant is currently self-pay through The Chest Clinic; suitability, taste-related side effects and follow-up are discussed before prescribing.
Rhinitis guide | Symptoms: cough, gefapixant and further information
Treatment, review and ongoing support
Good inhaler technique, airway-clearance physiotherapy, pulmonary rehabilitation, vaccination and smoking cessation can be important parts of care. Oxygen is prescribed following assessment of low oxygen levels, rather than routinely for breathlessness. We agree how treatment benefit and side effects will be monitored and coordinate with your GP, NHS services and other specialists when needed.
Inhaler technique videos | Asthma + Lung UK condition library | European Lung Foundation and ERS patient guidelines
Call 999 for severe breathing difficulty, collapse or severe sudden chest pain. Do not wait for an outpatient appointment in an emergency. This is general information for adults; investigation and treatment are tailored to you.