The Community Respiratory Service in Enfield incorporates respiratory nurse and physiotherapy management, home oxygen and pulmonary rehabilitation. The team is supported by respiratory consultant physicians at Royal Free Hospital NHS Trust (Barnet and CFH sites) and North Middlesex University Hospital via weekly multi-disciplinary meetings.

The Respiratory Service provides the following service elements:

• complex review and management of patients with COPD, including sputum clearance and breathlessness management
• COPD acute exacerbation management and intervention for patients known to the service in the form of a telephone advice line for patients
• pulmonary rehabilitation
• home oxygen assessment and follow up.

Nebuliser assessment (see specific inclusion criteria below)

Please note: this is not a diagnostic service.

The service supports patients in various ways, including:

• assessment in clinic or their home and planning for their future needs in accordance with patient wishes and service guidelines. Care is given according to national guidance (NICE, GOLD, BTS)
• professional support, advice and education to patients and their relatives to enable them to effectively manage their illness and return to their normal status wherever possible
• assessment, monitoring and titration of drug therapy to optimise treatment
• liaison with the palliative care team and support for patients and relatives who require palliative care and those experiencing deterioration in their quality of life about physical, psychological, social and spiritual element of care
• training to healthcare providers for people with respiratory disease where necessary

Eligibility Criteria

Inclusions

• over 18
• lives in the borough of Enfield
• confirmed diagnosis of COPD, asthma or bronchiectasis, where symptoms cannot be managed in primary care
• frequent exacerbations (two or more per year)
• recent attendance to A&E or admission to hospital due to exacerbation of respiratory condition

Other respiratory patients such as those with Interstitial Lung Disease (ILD) may be seen by the team to maintain symptom control with secondary care input.

Nebuliser assessment

Patient already on optimised respiratory medication but is not adequately controlled:

• Using full dose of combination therapy
• Anticholinergic
• Mucolytics
• Using short acting Beta² inhaler more than four times a day, appropriately
• If patient has severe COPD as per the NICE guidelines
• Concordance with current therapy has been verified 
• If possible, should have had pulmonary rehabilitation

Exclusions

• cystic fibrosis
• difficult/brittle/severe asthma - please refer to secondary care 
• unconfirmed respiratory diagnosis or undiagnosed breathlessness
• breathlessness as a result of a cardiological condition (e.g. LVF), musculoskeletal disorder (e.g. kyphoscoliosis)
• respiratory problems secondary to neuromuscular conditions
• lung cancer.

Please note: this is not a diagnostic service.

How to Refer

Locations

Forest Primary Care Centre

Lincoln Road Medical Practice

St Michael’s Site