Care at NUH

Respiratory and Critical Care Medicine

2024/07/04

Established in 1987, the division of Respiratory and Critical Care Medicine (RCCM) at NUH specialises in respiratory medicine (treating lung disorders) and intensive care medicine (caring for critically ill patients). Our mission is to deliver world-class clinical care, lead in research and cultivate future healthcare leaders. We offer an extensive range of clinical programmes aimed at improving patient outcomes in respiratory and critical care medicine. Our innovative approaches have garnered prestigious accolades, including the National Medical Excellence Awards and Asian Hospital Management Awards. Notable achievements include advancements in non-invasive ventilation for chronic obstructive pulmonary disease (2010), management of severe community-acquired pneumonia (2014), improving value-driven outcomes in community-acquired pneumonia (2017) and improving patient safety in the medical intensive care unit (2017).  

Our active involvement in clinical research underpins our commitment to improved patient care, focusing on developing new diagnostic and treatment and quality improvement initiatives. Our research, encompassing areas such as pleural disorders, lung infections (including tuberculosis), airway diseases, interventional pulmonology, sleep disorders, critical illnesses and medical education, has been published in medical journals. 

We are dedicated to educating the next generation of clinicians, offering comprehensive training programmes at both undergraduate and postgraduate levels. Our structured curriculum is centred on the core competencies of patient care, medical knowledge, practice-based learning and improvement, systems-based practice, professionalism, and interpersonal skills and communication. Our enthusiasm for medical education is reflected in the numerous teaching awards we have received.

Our Team
Our Services

Our clinical services encompass both inpatient and outpatient care in respiratory and critical medicine.  

Click here to view the list of programmes and services. 

Our Facilities

For contact details, operating hours and directions, please click the respective facility link. 

Wards 

Clinic 

Laboratories 

  • Lung Function Laboratory and Sleep Laboratory

Division of Respiratory and Critical Care Medicine 

Division Secretary 

Ms Nor Hudah Binte Ramli 

Division of Respiratory and Critical Care Medicine 

National University Hospital 

1E Kent Ridge Road, NUHS Tower Block, Level 10 

Singapore 119074 

Tel: (65) 6772 6312 

Patient Education

Respiratory Medicine 

Infections 

Pneumonia 

Common symptoms include cough, yellowish or green phlegm, and fever. Chest X-rays typically show lung opacities. Antibiotics are the standard treatment for this condition. 

 

Pulmonary Tuberculosis (TB) 

Still prevalent in Singapore, symptoms include a persistent cough (usually over two weeks), fever, night sweats and weight loss. Treatment requires specific anti-TB antibiotics for a minimum of six months. 

 

Acute Bronchitis 

A benign condition where the airways are infected, leading to cough, sometimes accompanied by fever and shortness of breath. Symptomatic relief is generally adequate for treatment. 

 

Obstructive Lung Disorders 

Asthma 

A common condition affecting individuals of all ages, characterised by highly sensitive small airways. Symptoms include cough, shortness of breath and wheezing. Lung function tests typically reveal variable airflow limitation and responsiveness to bronchodilators. Treatment involves a multi-faceted approach, including inhaled steroids. 

 

Chronic Obstructive Pulmonary Disease (COPD) 

Often caused by prolonged tobacco smoke exposure (and less commonly, air pollution), COPD damages the lungs. Symptoms include recurrent cough, phlegm and breathing difficulties. Lung function tests show a fixed airflow limitation. Treatment focuses on reducing exacerbations and improving quality of life through medications and rehabilitation, but smoking cessation is crucial for enhancing survival and slowing lung damage progression. 

 

Bronchiectasis 

This condition involves dilated, inflamed airways due to repeated infections, leading to progressive damage. Causes include past tuberculosis or severe lung infections, idiopathic disorders, immunodeficiency or genetic disorders. Symptoms are cough, recurrent yellow sputum and breathing difficulties. Treatment typically includes antibiotics and inhalers.  

 

Pleural Disorders 

Pneumothorax 

Characterised by spontaneous air leakage into the pleural space, it can occur in individuals with or without prior lung problems. Symptoms include sudden chest pain and breathlessness. Diagnosis requires a chest X-ray and immediate treatment typically involves draining the air using a needle or chest tube. 

 

Parapneumonic Effusion and Empyema 

This condition involves the accumulation of infected fluid in the pleural cavity, potentially as a complication of pneumonia. Symptoms include fever, cough, chest pain and shortness of breath. Treatment starts with antibiotics and usually drainage of the fluid, confirmed by chest X-ray. Severe cases may require surgical intervention. 

 

Tuberculous Effusion 

Sometimes, tuberculosis primarily infects the pleural space, causing symptoms like cough, fever, breathlessness, chest discomfort with weight loss and loss of appetite. Treatment involves with anti-tuberculous medications for at least six months. 

 

Malignant Effusion 

Fluid in the pleural cavity can also result from lung cancers or cancers from other body parts. Symptoms include chest discomfort and shortness of breath, in addition to underlying cancer symptoms. Treatment may start with draining the fluid and could involve other therapeutic approaches. 

 

Tumours 

Lung Cancer 

Common symptoms of this prevalent cancer include cough (sometimes with bloody sputum) and breathlessness. Diagnosis may involve chest X-rays, lung scans, sputum tests, bronchoscopies or lung biopsies. Treatment typically requires a multi-disciplinary approach and may include symptomatic relief, surgery, chemotherapy and/or radiotherapy. 

 

Malignant Mesothelioma 

This relatively rare tumour affects the pleural cavity, often in individuals with asbestos exposure. Symptoms include vague chest discomfort, weight loss, shortness of breath and a dry cough. Treatment options vary based on the disease stage.  

 

Benign Tumours 

Several types of benign lung tumours exist, often asymptomatic and incidentally discovered. 

 

Pulmonary Vasculature Disorders 

Pulmonary Embolism 

Blood clots can sometimes obstruct the blood vessels supplying the lungs. Common risk factors include cancer, prolonged immobility and post-surgical conditions. Symptoms may include breathlessness, chest pain and sometimes swelling in the lower limbs. Severe cases can lead to low blood pressure and reduced oxygen levels. Treatment typically involves anticoagulants to prevent clot progression. 

 

Pulmonary Hypertension 

This condition is characterised by high blood pressure in the lung’s blood vessels and can arise from various causes. Symptoms include easy breathlessness and low blood oxygen levels. Treatment options vary based on the underlying cause. 

 

Sleep Disorders 

Obstructive Sleep Apnoea 

This occurs when the upper airways are during sleep, often by the tongue or other structures. It leads to disrupted sleep and reduced oxygenation. Symptoms include daytime sleepiness and night-time snoring. Diagnosis is confirmed through sleep studies. Continuous positive airway pressure (CPAP) therapy is typically effective. 

Central Sleep Apnoea 

In this condition, the brain’s regulation of breathing is disrupted during sleep, causing abnormal breathing patterns. Though symptoms are similar to obstructive sleep apnoea, it is not due to physical obstruction. Investigations and treatments are akin to those for obstructive sleep apnoea, but a different mode of machine is used. 

Diffuse Parenchymal Lung Diseases (DPLD) 

Idiopathic Pulmonary Fibrosis 

Commonly affecting older individuals, this disorder involves lung scarring and degeneration. Symptoms include progressive breathlessness and dry cough. Chest X-rays and lung scans typically reveal scarring. Treatment focuses on symptomatic relief and supportive measures, such as oxygen therapy and antibiotics when necessary. 

 

Other Idiopathic Interstitial Pneumonias 

These conditions involve lung degeneration, scarring and inflammation, often without a definite cause. Treatments and investigations, including lung scans, scopes, biopsies and steroids, vary depending on the specific condition. 

 

DPLD related to Collagen Vascular Disease 

Collagen vascular diseases, such as lupus, can affect the lungs, causing various forms of interstitial pneumonia. Treatment may involve steroids and other immune-targeting drugs. 

 

Pneumoconiosis 

Long-term exposure to certain dusts in specific occupations can damage the lungs. Examples include silicosis (silica inhalation) and asbestosis from cement piping and shipbuilding (asbestos fibre inhalation). Chest X-rays typically show characteristic patterns of damage. Treatment is supportive, focusing on symptomatic relief. 

 

Other Restrictive Lung Disorders 

Restrictive Lung Disorders 

These disorders involve restricted lung expansion due to issues with the lungs, respiratory muscles or nerves, or chest wall. 

 

Neuromuscular Weakness 

Dysfunction in breathing muscles or the nerves controlling them can disrupt breathing, potentially causing respiratory failure or recurrent chest infections. Treatment varies based on the underlying cause. 

 

Chest Wall Disorders 

Severe deformities of the spine, ribs or sternum can impede breathing and lead to respiratory failure. Treatment may include oxygen supplementation and the use of breathing masks. 

 

Miscellaneous 

Chronic Cough 

Defined as a cough persisting for more than eight weeks, it can stem from various causes such as upper airway cough syndrome, asthma, or gastro-oesophageal reflux. Treatment depends on the underlying cause and may require several basic investigations. 

 

Mediastinal Disorders 

The mediastinum, located between the lungs, includes lymph nodes, various glands, the oesophagus, nerves, blood vessels and the heart. Disorders affecting this area, including tumours, require treatment tailored to the specific diagnosis. 

 

Drugs and Inhalational Injuries 

Lung injury can result from ingesting certain drugs or inhaling noxious gases, leading to breathing difficulties and low blood oxygen levels. Treatment is scenario-dependent and may involve oxygen, antibiotics and/or steroids. 

 

Critical Illnesses 

Sepsis 

A severe infection affecting any part of the body, sepsis is a common cause for intensive care unit admission. It can lead to multi-organ failure and is a significant cause of death. Treatment includes antibiotics and artificial life support. 

 

Acute Respiratory Distress Syndrome (ARDS) 

Characterised by severe lung inflammation and scarring, ARDS results in critically low blood oxygen levels. This life-threatening condition often requires ventilator support. 

 

Multi-Organ Failure 

Severe infections and other disorders can cause multiple organs to fail,  including the brain, heart, lungs, kidneys, liver, gut and blood clotting system. Intensive and dedicated care in the ICU or high dependency unit is crucial for organ support. 

 

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Our Education

RCCM Fellowships 

We accept applications for two types of fellowships: the Basic Pulmonary & Critical Care (PCC) Fellowship (12 months) and the Advanced Pulmonary & Critical Care Fellowship (12 months). The Basic PCC Fellowship provides training to manage common Respiratory and Critical Care conditions under supervision, including basic to intermediate level procedures like conventional bronchoscopy. For those aiming to become independent specialists, the Advanced PCC Fellowship is essential. It offers the ability to manage all Respiratory and Critical Care conditions independently, including rarer conditions like pulmonary arterial hypertension, and to perform a full range of procedures, such as endobronchial ultrasound. The combined duration of 24 months for both Basic and Advanced PCC Fellowships aligns with the typical two-year U.S. Accreditation Council for Graduate Medical Education (ACGME) accredited Pulmonary Medicine programmes. 

 

Minimum entry requirements include: 

  • Completion of General Internal Medicine training and full qualification in a recognised tertiary hospital in one’s home country 
  • Proficiency in English, with a TOEFL or IELTS equivalent qualification 
  • Positive references from one’s training hospital
  • Preference is given to Fellows from teaching or university hospitals  

For more information, please contact Dr Low Seow Ping at [email protected]. 

 

Achievements of RCCM Senior Residency Programme 

Several of our current senior residents and graduates have distinguished themselves in the Singapore Chief Residency Programme. Notable individuals include Dr Serene Wong (Associate Consultant, Division of RCCM, 2015), Dr Ronnie Tan (Senior Resident, Division of RCCM, 2016) and Dr Tan Ze Ying (Senior Resident, Division of RCCM, 2017). Additionally, Dr Chua Joo Wei and Dr Tan Ze Ying were recipients of Special Recognition Awards, serving as role models for their graduating class at the National University of Singapore (NUS) teaching awards in 2016. 

Our Research
Awards, Events and Talks

Awards 

Our clinical programmes have achieved recognition both nationally and internationally, winning awards such as the Asian Hospital Management Awards and the National Medical Excellence Award. Noteworthy achievements include:  

Additionally, we have received the NUH Prestige Awardsfor quality improvement projects, such as: 

  • Total team liberation in the MICU (2017)  
  • Implementation of an advanced practice nurse (APN) led delirium screening education programme in the MICU (2017) 
  • The PEACE (Palliative approach and advance care planning conversation enhancement) project (2017) 

Our clinicians have also been honoured with individual awards at the National Medical Excellence Awards in 2011 and international awards for research and interventional pulmonology, underscoring their significant contributions to respiratory medicine in Singapore and globally. 

Events 

Our team is committed to educational outreach in the region. The Critical Outreach Programme (CROP), launched in 2013, has facilitated visits to Myanmar in 2013 and Nepal in 2016, where we provided educational talks and workshops to medical teams, receiving positive feedback from host institutions. Moreover, our team of senior residents clinched victory at the annual Singapore Thoracic Challenge in 2016. CROP 2013 - Myanmar

CROP 2016 - Nepal

Singapore Thoracic Society 2016 Team Challenge Champions

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