Respiratory Medicine

This service provides tertiary level planned and unplanned inpatient and outpatient services for the management of adults with moderate to high complexity respiratory conditions.

Lung cancer

The Respiratory Medicine Service offers a rapid comprehensive service to coordinate the diagnostic and staging workup for patients with suspected thoracic malignancies. Read more about lung cancer (Healthy WA).

It includes a twice-weekly Fast Track Lung Cancer Clinic and a weekly Pleural Clinic that provide a diagnostic and therapeutic service for patients with either early or advanced  thoracic malignancy.

The service team coordinate the patient’s initial journey and arrange the appropriate treatment referrals. They work in close collaboration with other FSH specialities including medical/radiation oncology, cardiothoracic surgery, medical imaging and pathology, and the WA Cancer and Palliative Care Network.

Pleural Medicine Unit

This sub-specialist unit offers a comprehensive range of services to inpatients and outpatients experiencing a range of pleural disorders. The services of the unit include consultation/procedures for:

• investigation of undiagnosed pleural effusion
• diagnostic and therapeutic medical thoracoscopy
• management of malignant pleural effusion including indwelling pleural catheter
• management of pleural infection
• management of primary/secondary pneumothorax
• outpatient imaging guided thoracocentesis.

The unit is also actively involved in clinical research and is an international collaborator for pleural research involving clinical trials for patients with malignant pleural effusion, pleural infection and pneumothorax.

Severe Airways and Bronchiectasis Disease Clinics

These clinics provide a multi-disciplinary service for patients with complex airways diseases such as asthma, chronic obstructive pulmonary disease (COPD) and/or bronchiectasis.

The aim is to provide each patient with an individualised management plan including optimal inhaler therapy, consideration for immunological or non-pharmacological therapy for asthma or COPD and/or participation in clinical trials for new treatments for airways disease.

The clinic also offers medical and nursing support for patients with frequent and/or recurrent exacerbations.

Interventional Bronchoscopy

The use of innovative interventional techniques via flexible or rigid bronchoscopy for management of a variety of pulmonary and airway disorders is provided by a collaborative group of physicians within the Respiratory Medicine Service. These techniques include:

• endobronchial cryotherapy
• endobronchial electrocautery/activated plasma coagulation
• foreign body removal
• endobronchial dilatation
• endobronchial stent insertion/removal
• endobronchial valves for LVRS + bronchopleural fistulae
• parenchymal cryobiopsy.

This specialist program within the Respiratory Medicine Service offers highly specialised care in collaboration with the WA Lung Transplant Unit and WA Pulmonary Hypertension Service. 

The unit provides the following services:

• lung transplantation
• pulmonary hypertension (including pulmonary thromboendarterectomy)
• lung volume reduction surgery (including bronchoscopic lung volume reduction)
• interstitial lung disease.

Lung Transplantation

The WA Lung Transplant Program is a statewide service managed through the Advanced Lung Disease Unit. The program began in 2004 at Royal Perth Hospital before moving to Fiona Stanley Hospital in February 2015.

The program takes referrals from across the State and provides the following services:

• comprehensive lung transplant assessment
• multidisciplinary care comprising physicians, surgeons, nursing, allied health, and pulmonary rehabilitation
• management of severe lung disease in the pre-transplant period
• long term management of lung transplant recipients
• participation in clinical trials, national and international registries.

Pulmonary Hypertension Service

The Pulmonary Hypertension Service is a specialist service within ALDU, providing dedicated twice weekly outpatient pulmonary hypertension clinic, inpatient care and 24 hour on-call access. Consultant physicians and a full-time pulmonary hypertension nurse consultant lead a multidisciplinary team experienced in assessment and long term management of patients with pulmonary hypertension including pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH).

The pulmonary hypertension clinic has access to single, dual or triple combination PAH therapy including the WA state service for continuous intravenous epoprostenol therapy. Within ALDU it is also possible to assess patients for cardiopulmonary transplantation when indicated. Comprehensive assessments performed including cardiac catheterisation, vaso-reactivity testing, exercise testing, and advanced diagnostic imaging such as cardiac MRI. We provide an outpatient pulmonary hypertension exercise training program on site. The unit also continues to participate in multicentre PAH clinical trials.

Interstitial Lung Disease Service

This service provides a specialised clinical service to aid diagnostic and therapeutic decisions and provides streamlined access pathways to:

• diagnostics (including radiology, bronchoscopy, cryobiopsy, and surgical lung biopsy)
• advanced therapeutics
• participation in clinical trials and registries
• pulmonary rehabilitation
• supportive care (including ambulatory oxygen)
• lung transplant clinic.

The Sleep Medicine Service provides a comprehensive range of services for patients suffering a range of sleep disorders, such as:

• sleep apnoea
• narcolepsy
• insomnia
• parasomnias (nightmares). 
• circadian (shift work) disorders. 
• chronic respiratory failure - we manage the non-invasive ventilation service for patients with neuromuscular disorders and other conditions causing chronic respiratory failure.

The service offers the latest sleep study testing, coordinated diagnosis, medical, pharmacological and behavioural treatments and follow-up services to patients, and provides recommended treatment plans to referring GPs and specialists.

This service is an integral part of the Respiratory Medicine Service and offers a wide range of pulmonary physiological testing to both inpatients and outpatients at FSH.

Tests performed include:

• spirometry and flow volume loop
• diffusing capacity (gas transfer) measurement
• lung volume measurement by body plethysmography and helium dilution
• airway reversibility assessment with bronchodilators
• challenge testing with histamine, exercise and mannitol
• cardiopulmonary exercise testing (CPET)
• high altitude simulation testing
• neuromuscular resting
• shunt testing.

The Pulmonary Rehabilitation Service is a comprehensive outpatient pulmonary rehabilitation program involving assessment, exercise and education to eligible patients.

The provision of pulmonary rehabilitation services within the South Metropolitan Health Service (SMHS) is based on the hub and spoke model – FSH acts as a hub providing tertiary hospital based pulmonary rehabilitation and is complemented by secondary spoke and community based programs supporting services close to home unless safety issues dictate otherwise.

We provide educational and training opportunities for basic, advanced and post-fellowship clinical training across a wide range of sub-specialties within respiratory medicine.

We have an active research program including investigator-driven and industry-sponsored research. We also provide research supervision for medical students, basic and advanced trainees. In addition, we can tailor fellowship opportunities on a case-by-case basis.