SPECIALIST RESPIRATORY REFERRALS
This page provides quick access to subspecialty referral routes across South London, including key tertiary centres. Each link outlines who to refer, when to refer, and important clinical considerations to keep in mind before referral. Aimed at respiratory trainees and clinicians, these guides ensure timely and appropriate access to specialist services.
Severe Infection, NTM and TB Clinic
Trusts: Royal Brompton Hospital / King’s College Hospital
Contacts:
-
For bronchiectasis with NTM, fungal infections, or complex recurrent infections
-
Include: Microbiology, CT, treatment history
Contacts: Dr Perrin (KCH/GSTT) & Host Defence Team (RBH)
TB
-
Local TB teams at all South London trusts
-
Complex/extrapulmonary or MDR TB discussion with MDR TB Centre
Contacts: Dr Perrin (KCH/GSTT) & Dr Baker (Lewisham)
COPD
Trusts: Guy’s & St Thomas’ / Royal Brompton Hospital
For complex COPD or consideration for lung volume reduction (LVR)
Include: Spirometry, CT chest, smoking history, exacerbation frequency, previous pulmonary rehab
Contacts: Dr A. Dewar / Prof N, Hopkinson (RBH)
Tuberculosis Services
This training opportunity allows trainees to shadow respiratory physiologists during routine and advanced lung function testing. Sessions are available at all major sites and can be arranged by contacting the lead physiologist or lung function laboratory manager. Trainees will gain experience in the technical aspects and clinical interpretation of spirometry, DLCO, FeNO, and bronchial challenge testing.
Pleural Service
Trusts:
GSTT: comprehensive pleural diagnostics and intervention
Oxford University Hospitals (OUH) – home to the National Pleural MDT (quarterly) for complex case discussion
Referrals for patients with complex or unexplained pleural disease, recurrent pleural effusions, suspected or confirmed pleural malignancy, and trapped lung.
Services include medical thoracoscopy, indwelling pleural catheter (IPC) insertion, advanced imaging review, and surgical input where appropriate.
Tips on referral:
-
Relevant imaging (CXR, CT, PET-CT if available)
-
Cytology and histology results
-
Microbiology and biochemistry
-
Prior interventions and response (e.g. aspiration, IPC, thoracoscopy)
ILD
Trusts: Royal Brompton/ GSTT
-
Refer new suspected ILD or complex progressive disease
-
Include CT chest, PFTs, autoimmune screen, and MDT notes alongside PACS transfer (will speed things up)
Contacts: GSTT Dr Lams / Dr West / Dr Myall
Chemo/immunotherapy related toxicity: Prof Santis
Bronchiectasis
This training opportunity allows trainees to shadow respiratory physiologists during routine and advanced lung function testing. Sessions are available at all major sites and can be arranged by contacting the lead physiologist or lung function laboratory manager. Trainees will gain experience in the technical aspects and clinical interpretation of spirometry, DLCO, FeNO, and bronchial challenge testing.
BRONCHIECTASIS
Trusts: St George’s / Kings College / Royal Brompton
Contacts:
-
Refer patients with ≥3 exacerbations/year, resistant organisms, or worsening CT findings (or need for further specialist care)
Include recent HRCT, sputum results, and exacerbation history.
Contacts:
SGH: Dr H Burgess
Kings: Dr P Macedo & Dr Waller
RBH: Prof M Loebinger Host Defence Team
Genetics in ILD or Familial Lung Disease
Trusts: GSTT / RBH / Kings
Contacts: GSTT Email: gst-tr.geneticsreferrals@nhs.net / Phone: 020 7188 1364
Include: CT, family history, autoimmune screen, consent from patient
Genetic counselling arranged via clinic
NB referral would usually be via ILD route – TIP: would be best to call via telephone to discuss patient first as they fall under catchments relevant to postcode and if fit criteria
See https://www.genomicseducation.hee.nhs.uk/genotes/knowledge-hub/clinical-geneticsdepartments-map/
Asthma
Trusts: Guy’s Hospital (Asthma/EGPA)
Refer patients:
-
Severe/difficult to treat asthma in South London
-
Multiple admissions
-
Non ‘classical asthma’ presentation
-
Any ITU admission with asthma
-
Eos > 1.5 and asthma for ?EGPA.
Tips to include: ACT, IgE, eosinophils, FeNO, spirometry, and exacerbation history.
Include how quickly they feel better with steroids and if you have access to their local care record (add up how many ICS containing inhalers they’ve picked up in last year as this speeds process up).
Contacts: Prof D Jackson
Lung Transplant
Trusts: RBHT
Contacts: (see below)
-
Refer patients with end-stage ILD, CF, bronchiectasis, or pulmonary hypertension.
-
Include CT chest, spirometry, 6MWT, ABG, and psychosocial assessment.
Platform:
Refer a Patient – Lung Transplant
NB This may not open on certain internet browsers
Supporting Information (Selection Criteria):
📄 Royal Brompton Candidate Criteria PDF
Tip: Raise early with your supervising consultant—referrals take time.
Sleep & Ventilation
Trusts: GSTT / Lane Fox Unit
Patients with chronic hypercapnic respiratory failure due to: MND/OHS/COPD with T2RF + complex trache wean
GSTT Sleep Service
Patients with suspected sleep-disordered breathing (e.g. obstructive sleep apnoea) and complex non-respiratory sleep disorders, including parasomnias, narcolepsy, and hypersomnolence. GSTT has a multidisciplinary team with neurology, respiratory, and psychology providing integrated care.
Breathing Pattern Disorder
Contacts: Physiotherapy-led services for breathing pattern disorders
Include: Normal imaging/lung function, symptom history
-
Describe breathlessness pattern (air hunger, sighing, exertional mismatch)
-
Confirm normal lung function/imaging
-
Rule out asthma, cardiac, PE, ILD
-
Any psychological factors, long COVID history, or panic symptoms
Useful for: BPD, PVFM, anxiety-related dyspnoea
Pulmonary Hypertension
Trusts: GSTT (ILD) / Royal Brompton
Contacts:
GSTT: Dr B Mukherjee & Dr A Brame
Royal Brompton: Dr LPrice & Dr J Wort & Dr C McCabe
Refer patients with suspected PAH or CTEPH
-
PH on echo without clear left heart or lung disease cause
-
Suspected PAH, CTEPH, or CTD-associated PH
-
Disproportionate PH in chronic lung disease (e.g. DLCO <40%, severe hypoxia)
-
Patient may be eligible for advanced therapy
-
Attach echo, BNP, ABG, CTPA, 6MWT, and lung function + CTPA/VQ
Primary Ciliary Dyskinesia (PCD)
Trusts: RBHT
Contacts: Dr Siobhan Carr / Dr Claire Hogg,
-
Refer patients with recurrent chest infections, sinusitis/otitis, or situs anomalies.
-
Consider nasal NO test before referral, sputum cultures +- ENT review. Obtain fertility history.
-
Any imaging (HRCT), ENT findings, or family history
[Adult PCD Service – Royal Brompton Hospital](https://www.rbht.nhs.uk/our-services/lung/primary-ciliary-dyskinesia-service-for-adults#:~:text=Phone%3A 020 7352 8121%2C extension,made to this email address.)
Respiratory Muscle Service
Trusts: GSTT (LFU) > discuss with consultant
Contacts:
-
Overview: Offers diagnostic workup and management of suspected diaphragm or respiratory muscle weakness.
-
Common referrals: Unexplained dyspnoea, orthopnoea, raised bicarbonate, suspected neuromuscular disease
Think about it in patients with:
> Orthopnoea not explained by heart failure
> Restrictive spirometry with a normal CT chest
> Known or suspected neuromuscular disease (e.g. MND, MG, myopathies)
> Elevated hemidiaphragm on chest X-ray
> Recurrent hypercapnic respiratory failure (especially in “non-typical COPD”)
> Sleep-related hypoventilation without OSA
> Check: FVC (upright & supine), MIP/MEP, SNIP, ABG, overnight oximetry, consider USS diaphragm
Consider co-referral to Neurology if suspecting Neuro origin
Alpha-1 Antitrypsin
Trusts: Royal Free
-
Early-onset emphysema (esp. panacinar type) > COPD diagnosed before age 45, especially if non-smoker or light smoker
-
Lower lobe emphysema on CT (vs upper lobes in typical COPD)
-
Family history of emphysema or lung disease
-
Poor response to standard COPD treatment
-
Recurrent respiratory infections
-
Liver disease
-
Other systemic manifestations (vasculitis, panniculitis)
Referral inclusion of: serum AAT level (and full LFT panel), phenotype/genotype (if available locally, HRCT chest to assess emphysema pattern, Lung function (spirometry, TLCO), Family history.