Inside Medicine - the asthma doctor

In a series focusing on medical specialisms, the BBC News website meets Andrew Menzies-Gow, a consultant in respiratory medicine, who talks about managing asthma.

Asthma is a chronic, inflammatory lung disease characterised by recurrent breathing problems. People with the disease suffer attacks when the air passages in their lungs narrow and breathing becomes difficult.

Attacks are caused by the airways over-reacting to certain environmental factors. The airways then become inflamed and clogged.

Dr Menzies-Gow's CV

WHAT IS YOUR JOB?

I am a consultant in respiratory medicine at the Royal Brompton Hospital, London, with a particular interest in patients with severe, or difficult to control, asthma.

I am part of a team that specialises in the diagnosis and management of patients who have been sent for a second opinion from their local hospital.

Unravelling what has been happening can be very difficult, but it is crucial if we are to ensure that the patient receives the correct treatment Dr Andrew Menzies-Gow

I am also setting up an active research programme to look at the causes of and potential new treatments for asthma.

WHAT IS THE MOST COMMON CONDITION?

It is difficult to treat asthma.

Over five million people in the UK suffer from asthma.

The majority of patients have their symptoms well-controlled with inhaled treatment and are looked after by their GP practice.

However between 5-10% of asthmatics still have symptoms, despite standard therapies.

They need more help from clinicians and are more likely to require hospital admission.

WHAT IS THE MOST COMMON PROCEDURE?

We perform a variety of procedures to find out what is causing a patient's symptoms.

These include allergy tests, lung function tests and a computer tomography (CT) scan of the lungs.

In selected patients we also perform a bronchoscopy, which is when we look at the airways using a long flexible camera and take tissue samples to determine the nature of any inflammation within the lungs.

WHAT IS THE HARDEST THING ABOUT YOUR JOB?

It can be very difficult to determine whether a patient has severe asthma - currently there is no gold standard test available to confirm the diagnosis.

Many patients have been given a diagnosis of severe asthma and then treated with high-dose therapy for many years prior to referral to our centre.

Unravelling what has been happening can be very difficult, but it is crucial if we are to ensure that the patient receives the correct treatment. So we encourage early referral.

WHAT DO YOU FIND THE MOST SATISFYING CASES?

Patients with severe asthma often have a poor quality of life due to a combination of respiratory symptoms and side effects from their treatments.

The most satisfying cases involve patients for whom we are able to discover a clear cause for their symptoms that responds to our treatment.

This could be removal of something causing an allergic reaction or a trial of a new drug, either of which may improve patients' symptoms and mean they need less medication.

WHY DID YOU CHOOSE THIS SPECIALTY?

During my training as a junior doctor I had the opportunity to work for excellent chest physicians at St George's hospital who inspired me to follow a career in respiratory medicine.

More than five million people in the UK suffer from asthma

I was able to train at the Royal Brompton and complete a PhD at Imperial College's National Heart and Lung Institute, which nurtured my interest in patients with severe asthma.

IF YOU HAD YOUR TIME AGAIN WOULD YOU CHANGE YOUR SPECIALTY?

Fortunately I am very happy with my career choice.

I find respiratory medicine very stimulating and challenging.

I am lucky to have the opportunity to pursue a career in my chosen field of interest at the Royal Brompton as it is a national centre of excellence.

WHICH SPECIALTY WOULD YOU HAVE GONE INTO IF NOT YOUR OWN?

I would probably have gone into allergy treatment.

It is a very interesting area of medicine where doctors can significantly improve the quality of life for individual patients and links well with my immunology research background.

HOW DO YOU SEE THE ROLE DEVELOPING IN THE FUTURE?

My aim is to improve the quality of life for patients with difficult asthma by providing a first-class diagnostic and treatment service.

To achieve this it will be necessary to raise awareness of our service within the health service, to encourage doctors to refer patients to us earlier, and to give more people the opportunity to use our service.

In addition, I intend to continue my research into the causes of and novel treatments for severe asthma.

CV - Andrew Menzies-Gow

1994: Graduated and started work at St George's Hospital in Tooting

1999: Began to specialise in respiratory medicine

2006: Started working at Royal Brompton Hospital as a locum

2007: Became a respiratory consultant at Royal Brompton Hospital

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