Chronic respiratory diseases were increasing in prevalence globally from 2005 – 2015 and projected to increase based on the global disease burden study in 2015. The Singapore burden of disease study in 2010 noted a 23.6% increase in chronic respiratory disease burden, 38% increase in disability burden and 4.8% increase in premature mortality burden. We offer a wide range of services in the treatment of chronic respiratory diseases which includes asthma, Chronic Obstructive Pulmonary Disease (COPD), bronchiectasis and interstitial lung diseases.
You would be assessed by a multidisciplinary team, which may include a respiratory specialist, respiratory case managers and allied health professionals e.g. physiotherapists, to determine the appropriate medical therapy for your chronic lung condition.
The services we provide include:
- Medications with inhalers and other oral medications e.g. anti-fibrotic therapy (for interstitial lung diseases), antibiotic prophylaxis(for bronchiectasis)
- Respiratory Case Management
- Smoking Cessation
- Pulmonary Rehabilitation Programme
- Advance Care Planning
- Telemedicine
- Complex Airway Clinic
- Multidisciplinary Interstitial Lung Disease Management
Medications
Inhaler therapy is often required for the treatment of asthma and COPD. There are a wide variety of inhalers (reliever and preventer) available to improve symptoms, reduce exacerbations and possibly improve mortality (especially for treatment of asthma). Anti-fibrotic therapy (e.g. pirfenidone, nintedanib) or immunosuppressive therapy are considered in treatment of interstitial lung diseases (e.g. idiopathic pulmonary fibrosis). Antibiotic prophylaxis may be considered in patients with bronchiectasis and frequent exacerbations.
Respiratory Case Management
Our team of case managers would provide comprehensive patient education on chronic disease management, which includes teaching patients on the use of inhalers and self-management of symptoms including an action plan for exacerbations. They would provide telephonic consults and follow-up with our patients. They facilitate transitions from hospital to home and provide end-to-end care for our patients with asthma and COPD. There are two major programmes that our patients are recruited into – the Singapore National Asthma Program (SNAP) and TAP (The Airway Program – COPD). These programmes have shown to reduce mortality in asthma and COPD and reduce health care utilisation.
Smoking Cessation
Smoking cessation improves survival in patients with COPD and improves symptom control in asthma and COPD. This is an essential part of the management of chronic lung disease such as asthma and COPD.
Pulmonary Rehabilitation Programme
Pulmonary rehabilitation enhances the quality of life for patients with chronic respiratory diseases such as COPD, bronchiectasis and interstitial lung diseases, and may improve exercise tolerance. This programme is run by our physiotherapists who are accredited in pulmonary rehabilitation.
Advance Care Planning (ACP)
We offer advance care planning to patients with advanced chronic respiratory diseases to review their preferences and values in the event of deterioration. We work closely with our ACP coordinator and palliative care team to optimise symptoms for patients with advanced chronic respiratory diseases.
Telemedicine for Asthma and COPD
We provide telemedicine services for our patients with well-controlled asthma and COPD. This service aims to reduce inconveniences of a physical visit to the doctor. Medications could be delivered to the patients’ homes. Our specialists would determine the suitability of the patient for the service.
The Complex Airway Clinic
The complex airway clinic aims to treat patients with difficult to treat or severe airway diseases such as asthma, bronchiectasis and COPD. Our specialists would refer you to this clinic if required. Multidisciplinary consultation is performed with some of our other specialists, including our Ear, Nose and Throat (ENT) specialists and allergists. Further testing of sputum may be required to adopt personalised therapies for optimisation of treatment. Novel treatment with biologics (e.g. mepolizumab and omalizumab) and bronchoscopic techniques (e.g. bronchial thermoplasty) may be explored with patients (severe asthma) if appropriate.
Multi-disciplinary Interstitial Lung Disease Management
Interstitial lung disease is a less common chronic respiratory disease characterised by inflammation and scarring or fibrosis of the lungs. The most common cause is idiopathic pulmonary fibrosis which often affects the elderly and has a median survival of three to five years. The other causes could be related to autoimmune disorders or idiopathic. These cases are discussed among the various specialists including the respiratory specialists, rheumatologist, radiologists and pathologists to confirm the diagnosis via imaging or more invasive strategies such as bronchoscopic biopsy or video assisted surgery such that management strategies could be further advised.