he Leeds Difficult Asthma clinic is undertaken at Leeds Chest Clinic all day every Tuesday. The aim of the service is to provide a detailed assessment and individualised approach to the treatment of people with difficult asthma. The service provides this through the multi-disciplinary approach of our staff
Dr Ian Clifton – Consultant Physician
Dr Tim Sutherland – Consultant Physician
Jane Slough – Clinical Nurse Specialist Respiratory Medicine
Toby Capstick – Lead Respiratory Pharmacist
Dr Philip Wood – Consultant Immunologist
Jo Kelly – Liaison Mental Health Nurse
Dr Richard Barton – Clinical Mycologist
The list below provides information about some of the investigations (tests) that maybe undertaken while attending the Leeds Difficult Asthma Service
We undertake a number of blood tests examining allergy status and also for conditions that may exacerbate or mimic asthma.
A CT scanner is a special kind of X-ray machine. CT scans are far more detailed than ordinary X-rays and can provide two- and three-dimensional images of the internal organs.
The scanner looks like a large doughnut. During the scan the patient lies on a bed, with the body part under examination placed in the round tunnel or opening of the scanner. The bed then moves slowly backwards and forwards to allow the scanner to take pictures of the body, although it does not touch the patient. We would only consider doing a CT in a small minority of cases when we are looking for structural lung damage
Lung function testing
Lung function testing provides information on how well people can breathe in and out as well as examining the ability of the lungs to get oxygen into our blood, and carbon dioxide out.
The patient blows into a machine which measures how much air they can blow in and out. We will usually have to do this several times to ensure we get accurate results. The patient also will be asked to sit in a transparent booth get more detailed results.
The Mannitol challenge is a test that measures the degree of responsiveness of the airways. Inhalation of mannitol powder can result in constriction of the airways that is suggestive of a diagnosis of asthma. In our experience the test is safe, although a minority of people (<5%) are unable to tolerate inhaling the mannitol powder. This test may help confirm the diagnosis of asthma.
Bronchodilator response testing
This test measures the effect of a bronchodilator such as salbutamol on the airways of the patient. An improvement in lung function of greater that 15% is consistent with a diagnosis of asthma.
Peak flow diary
Patients are asked to monitor and record their peak flow twice daily. Examination the pattern of peak flow values can be helpful in confirming the diagnosis of asthma and also assessing the degree of asthma control.
Where there is a concern about the possibility of asthma related to the person’s occupation examination of more detailed peak flow diaries can be helpful, particularly when combined with analysis by computer software.
Full multi-disciplinary assessment
Access to allergy, ENT and physiotherapy review
Blood levels monitoring of prednisolone and cortisol
Full pulmonary function tests (PFT) and bronchodilator reversibility (BDR).
Airways hyper-reactivity challenge.
Induced sputum cytology
High resolution computed tomography (HRCT) thorax.
Skin prick testing
Bone densitometry (DEXA)
Full Blood Count (FBC), Immunoglobulin E (IgE), Aspergillus IgE and Immunoglobulin G (IgG), anti-neutrophil cytoplasmic antibody (ANCA). Totalimmunoglobulins and vaccine responses.
Access to upper airway clinic
Oesophageal pH studies