Dr Jonathen Venkatachalam, Senior Consultant in Respiratory & Critical Care Medicine at Aeden Health, explains the lung and breathing conditions he sees most often: what they are, how they are investigated and what treatment involves. Each section is short by design. Use the contents list to go straight to the condition you are looking for.

Asthma: Beyond Inhalers

Why asthma is not a single disease

We have moved away from thinking that asthma is a single uniform disease. Doctors always knew that this cannot be the case. At one end of the spectrum, patients might have the occasional use of their inhalers once or twice a year whilst at the other end of the spectrum, there are those who visit the emergency department almost every month for their symptoms.

How asthma is identified today

We now know how to better identify our asthmatic patients using imaging, lung function testing and blood tests.

Targeted treatments beyond inhalers and steroids

We now have targeted treatments that include monoclonal antibodies that target specific inflammatory pathways. These medications are well tolerated in most patients. We are no longer in the era of having just inhalers and steroids for those who need more.

COPD: Treatment Beyond Inhalers

Why COPD is still on the rise

Despite decades of public awareness of the ills of smoking, the number of patients with Chronic Obstructive Pulmonary Disease (COPD) is on the rise globally. Patients with COPD are burdened not only with their symptoms, but also with multiple medical conditions such as heart and kidney disease.

COPD treatment beyond inhalers and injections

Newer therapies have shown benefit in a subgroup of patients with COPD. However COPD treatment is beyond just inhalers and injections. Pulmonary rehabilitation and symptom control with tailored strategies that may involve psychologists and nutritionists plays an important role.

Fewer separate appointments

Furthermore, reducing the burden of having to see various doctors for multiple issues offers patients the opportunity to live their lives beyond clinics and the hospitals.

Bronchiectasis: A Tailored Approach

What is bronchiectasis?

Bronchiectasis is a long-term condition in which the airways of the lungs become permanently widened and damaged, so that mucus builds up and chest infections become more frequent.

A condition that varies widely

Often considered the Cinderella of respiratory illnesses, bronchiectasis to some can be a life altering condition. Ranging from a simple description on a radiology report to a crippling illness that can engulf a patient's life. As with most pulmonary conditions, there is no one sized fits all approach to bronchiectasis.

Reassured or alarmed by what you read online?

In the age of internet driven medical information, patients can often be falsely reassured or alarmed when they are told they have bronchiectasis.

Life expectancy and a tailored treatment approach

Thankfully, most patients with bronchiectasis can have a normal life expectancy. A tailored approach involving not only medications, but physiotherapists and airway clearance devices often help patients get their lives back.

Interstitial Lung Disease (ILD): Demystified

What is interstitial lung disease?

Interstitial lung disease (ILD) is not a single illness but a group of conditions in which the tissue between the air sacs of the lungs becomes inflamed and scarred, making the lungs stiffer and making it harder for oxygen to pass into the blood.

A diagnosis many hear for the first time

For many, the term ILD is often a diagnosis they would have heard for the first time when they are told of their diagnosis.

Which specialists manage ILD?

Thankfully rare, most patients often need a team of doctors for the management of their condition. This may include rheumatologists, thoracic surgeons, radiologists and respiratory physicians with an interest in ILD.

Medications that slow progression

Medications such as antifibrotics are able to slow the progression and alleviate the symptoms in the most aggressive forms of this disease.

Lung Cancer: How Treatment Has Changed

How the outlook has changed

Lung cancer is still a serious diagnosis, but the outlook has changed more in the last decade than in the previous fifty.

How lung cancer is diagnosed today: EBUS

Diagnosis is also less invasive than it used to be. With EBUS (endobronchial ultrasound), a thin flexible scope passed through the mouth lets us see and sample lymph nodes in the chest under ultrasound guidance, without any cuts. It is usually done as a day procedure, and it confirms the diagnosis and shows how far the cancer has spread in the same sitting.

Targeted tablets and immunotherapy

The tissue obtained is also used to test the tumour for specific genetic changes, which now allows us to offer targeted tablets that are often better tolerated than chemotherapy. Immunotherapy helps the body's own defences recognise the cancer, and some patients remain well for years.

Surgery, radiotherapy and the team approach

Surgery has become less invasive, and radiotherapy far more precise. Decisions are best made by a team of respiratory physicians, oncologists, surgeons and radiologists, with supportive care alongside treatment from the very beginning. For many patients, lung cancer is now something to be managed over time, and for those diagnosed early, treatment is given with the aim of cure.

Lung Nodules: What to Do Now?

Why nodules are being found more often

With the widespread use of CT scans, small spots in the lung are being found in people who never had a lung symptom.

Are lung nodules harmless?

The vast majority are harmless, often the scar of an old infection.

What decides the next step?

The size, shape and appearance of the nodule, how it behaves over time, and your own risk factors help us decide what to do. Many nodules need nothing more than a repeat scan to confirm they are stable. A few need further tests such as a PET scan, a biopsy or removal.

Neither ignore nor panic

Finding a nodule should neither be ignored nor be a cause for panic, and the right plan is the one that is tailored to you.

Lung Cancer Screening: Where Are We Now?

Why screening matters

Lung cancer often causes no symptoms until it is advanced.

Who is lung cancer screening for?

Low dose CT scanning of high risk individuals, mainly long term smokers, has been shown to find cancers early, when cure is possible, and to save lives. Screening programmes are expanding in many countries.

What about people who have never smoked?

We also know that lung cancer occurs in people who have never smoked, particularly in Asia, and who should be screened is a question that is still being studied.

The downsides of screening

Screening comes with its own downsides, including nodules that turn out to be harmless and need follow up. It is a conversation worth having with your doctor, and it is never a substitute for stopping smoking.

Pneumothorax: Where Do We Go From Here?

What is a pneumothorax?

A pneumothorax, or collapsed lung, happens when air leaks into the space around the lung.

Observation or a drain?

For some patients a small leak settles on its own with observation, while others need a drain placed to let the lung re-expand.

Can a pneumothorax come back?

The more difficult question comes afterwards, as a pneumothorax can come back. For those who have had a recurrence, or who have an underlying lung condition, we discuss definitive options such as keyhole surgery or pleurodesis, in which talc is used to help the lung stick to the chest wall. Stopping smoking lowers the risk of recurrence.

Air travel and diving

We also advise on practical matters such as air travel and diving, which should be avoided until you have been cleared.

Pneumonia: Not Always the Same Outcome

One word, many illnesses

Pneumonia is a common word for a wide range of illnesses. Some patients are treated at home with a short course of antibiotics, while others become critically ill and need intensive care. Age, other medical conditions and the type of germ all influence the outcome.

How long does recovery take?

Recovery can also take longer than people expect, and tiredness and cough may linger for weeks.

Why a follow-up chest X-ray?

In older patients and smokers, we may repeat a chest X-ray after recovery to be sure the lung has cleared, because other conditions can hide behind a pneumonia. Complications such as fluid around the lung may need separate treatment.

Reducing the risk

Vaccination remains one of the simplest ways to reduce the risk.

Coughing Up Blood (Haemoptysis): Do Not Ignore

Always take it seriously

Coughing up blood is frightening, and it should always be taken seriously, even when the amount is small.

What causes coughing up blood?

The causes range from simple infections to bronchiectasis, tuberculosis, blood clots in the lung and lung cancer.

Finding and treating the source

A CT scan and sometimes a bronchoscopy help us find the source. Most bleeding stops with treatment of the cause, but for heavier or recurrent bleeding, we can block the bleeding vessel with a procedure called bronchial artery embolisation.

Chronic Cough: It's Not Just the Lungs

What counts as a chronic cough?

A cough that lasts more than eight weeks can wear a person down, affecting sleep, work and relationships.

Why is the chest X-ray normal?

Many patients have already had several chest X-rays that were normal. This is because chronic cough often arises outside the lungs, from acid reflux, nasal and sinus problems, or from medications such as some blood pressure tablets. In others, asthma is the cause, or the cough reflex itself has become over sensitive.

Finding the answer

A careful and step by step assessment usually finds the answer.

How is chronic cough treated?

Treatment may include speech therapy techniques and medicines that calm the cough reflex, and newer treatments are on the horizon. Persistent cough is treatable, and you do not have to put up with it.

Tuberculosis (TB): It's Still Here

TB has not gone away

Tuberculosis has not gone away, and it remains common in this part of the world.

Is TB curable?

The good news is that TB is curable. Most patients are well again after six months of treatment, provided every dose is taken.

Why finishing treatment matters

Stopping early is the main reason that TB comes back and that drug resistant strains develop, which are much harder to treat.

TB beyond the lungs

TB can also affect the lymph nodes, bones, brain and other organs, not just the lungs.

Symptoms that should prompt a check

A cough of more than two weeks, fever, night sweats and weight loss should prompt a check. Close contacts may need screening, and some people with latent TB benefit from preventive treatment.

Pleural Effusion: Not Just Water in Your Lungs

What is a pleural effusion?

A pleural effusion is fluid that builds up between the lung and the chest wall, causing breathlessness and sometimes chest discomfort.

What causes fluid around the lung?

It is not a diagnosis in itself, but a sign of another problem such as heart failure, infection, liver or kidney disease, or cancer.

Draining and testing the fluid

Ultrasound allows us to drain the fluid safely, and testing the fluid often points to the cause. When the cause is unclear, a small camera examination of the chest, called thoracoscopy, can help.

When the fluid keeps coming back

For fluid that keeps coming back, particularly from cancer, talc pleurodesis, in which sterile talc is introduced into the pleural space to seal it and stop fluid re-accumulating, or an indwelling pleural catheter, a small tube that stays in place to drain it at home, can restore comfort and independence.

When the fluid is infected (empyema)

When the fluid is infected and becomes thick and loculated, as in empyema, antibiotics and a chest drain are often combined with intrapleural fibrinolytics, namely tPA (tissue plasminogen activator) and DNase, placed through the drain to break down the thick fluid and help it drain, which can avoid the need for surgery.

Treat the cause

The key is to find out why the fluid is there and to treat the cause.

Obstructive Sleep Apnoea (OSA): Symptoms and Treatment

More than loud snoring

Obstructive sleep apnoea is far more than loud snoring. The airway repeatedly closes during sleep, leading to broken sleep, morning headaches and daytime sleepiness.

The risks of untreated sleep apnoea

Left untreated, it raises the risk of high blood pressure, heart disease, stroke and road accidents, and it can affect mood and memory.

How is OSA diagnosed?

A sleep study makes the diagnosis.

CPAP and other treatments

CPAP, a gentle flow of air delivered through a mask, remains the mainstay of treatment, and getting the right mask and support makes all the difference. Weight loss, sleeping position, oral appliances and sometimes surgery all have a place. With the right treatment and support, restful sleep and waking refreshed are realistic goals.

Non-Invasive Ventilation (NIV): Explained

What is non-invasive ventilation?

Non invasive ventilation, or NIV, supports breathing through a tight fitting mask, without the need for a breathing tube.

NIV in hospital

In hospital, it is commonly used for flare ups of COPD and for fluid in the lungs from heart failure, often avoiding the need for intensive care.

NIV at home

Some patients with long term breathing failure, from conditions such as COPD, obesity or neuromuscular disease, use NIV at home at night.

Getting used to the mask

It can feel strange at first, and a well fitted mask and a patient coach make a big difference. For the right patient, NIV improves symptoms, sleep and quality of life, and may help patients live longer.

Breathlessness: How to Overcome It

Not just a part of getting older

Breathlessness is not simply a part of getting older.

Finding the cause

We first look for the cause, which may be in the lungs, the heart, the blood, or the muscles, and treat what we can.

Easing breathlessness itself

Even when the underlying condition cannot be cured, the breathlessness itself can often be eased. Breathing techniques, pacing activities, positions that ease the chest, a handheld fan and pulmonary rehabilitation all help.

Breathlessness and anxiety

Anxiety often feeds breathlessness, and addressing it breaks the cycle. In advanced disease, there are medicines that can help too.

Learning to manage it

Patients who learn to manage their breathlessness are able to do more and fear it less.

Pulmonary Embolism: Symptoms and Treatment

What is a pulmonary embolism?

A pulmonary embolism is a blood clot that travels to the lungs, usually from the veins of the legs.

Symptoms that are easily missed

It may cause sudden breathlessness, chest pain or collapse, but sometimes the symptoms are mild and easily missed.

Who is at risk?

Recent surgery, long periods of immobility, cancer, hormone treatments and long haul travel all raise the risk.

Diagnosis and treatment

A CT scan confirms the diagnosis, and treatment with blood thinners is highly effective. For the most severe clots, stronger treatments to dissolve or remove the clot are needed. Some patients remain breathless months later and need further assessment.

Vaccines: What Do I Need?

Why vaccines matter for your lungs

Vaccines are one of the simplest ways to protect your lungs, especially if you have asthma, COPD or other chronic conditions. Infections are a common trigger for flare ups and hospital admissions.

Which vaccines are most often discussed?

The vaccines we most often discuss include yearly influenza, pneumococcal, COVID-19 and, for older adults and those at higher risk, RSV.

Building a plan that fits you

What you need depends on your age, your health and what you have already had. Speak to us, and we will help you build a plan that is right for you.

Lung Function Testing: Measuring How Your Lungs Work

Why test lung function?

Symptoms alone cannot tell us how well your lungs are working, and lung function tests give us objective answers.

Spirometry

Spirometry, the most common test, measures how much air you can blow out and how fast, and helps diagnose and monitor asthma and COPD.

FeNO

FeNO measures the level of nitric oxide in your breath, a simple marker of airway inflammation that helps us confirm asthma and guide treatment.

Lung volume testing

Lung volume testing measures the total amount of air your lungs can hold, and shows whether the lungs are too stiff or over inflated.

DLCO

DLCO measures how well oxygen passes from the lungs into the blood, and is particularly useful in ILD, emphysema and conditions affecting the blood vessels of the lung.

What to expect

The tests are non-invasive and take only a short time, and together they give us a much clearer picture than any one test alone.

Next steps

Dr Venkatachalam consults at Aeden Health. To arrange a consultation, book an appointment or read more about The Aeden Physicians.

Related guides: Intensive Care: A Guide for Families · General Medicine: Common Conditions Explained

Frequently Asked Questions

What tests help identify the type of asthma?

We now know how to better identify our asthmatic patients using imaging, lung function testing and blood tests.

Is COPD treatment only about inhalers?

However COPD treatment is beyond just inhalers and injections. Pulmonary rehabilitation and symptom control with tailored strategies that may involve psychologists and nutritionists plays an important role.

Can people with bronchiectasis live a normal life span?

Thankfully, most patients with bronchiectasis can have a normal life expectancy. A tailored approach involving not only medications, but physiotherapists and airway clearance devices often help patients get their lives back.

Can the progression of ILD be slowed?

Medications such as antifibrotics are able to slow the progression and alleviate the symptoms in the most aggressive forms of this disease.

What is EBUS and how is it done?

With EBUS (endobronchial ultrasound), a thin flexible scope passed through the mouth lets us see and sample lymph nodes in the chest under ultrasound guidance, without any cuts. It is usually done as a day procedure, and it confirms the diagnosis and shows how far the cancer has spread in the same sitting.

Are lung nodules usually cancer?

The vast majority are harmless, often the scar of an old infection. Finding a nodule should neither be ignored nor be a cause for panic, and the right plan is the one that is tailored to you.

Who should have lung cancer screening?

Low dose CT scanning of high risk individuals, mainly long term smokers, has been shown to find cancers early, when cure is possible, and to save lives. We also know that lung cancer occurs in people who have never smoked, particularly in Asia, and who should be screened is a question that is still being studied.

Can I fly or dive after a pneumothorax?

We also advise on practical matters such as air travel and diving, which should be avoided until you have been cleared.

How long does it take to recover from pneumonia?

Recovery can also take longer than people expect, and tiredness and cough may linger for weeks.

Is coughing up a small amount of blood serious?

Coughing up blood is frightening, and it should always be taken seriously, even when the amount is small. If you have noticed blood in your sputum, please do not wait for it to happen again before seeing a doctor.

Why is my chest X-ray normal but I still cough?

Many patients have already had several chest X-rays that were normal. This is because chronic cough often arises outside the lungs, from acid reflux, nasal and sinus problems, or from medications such as some blood pressure tablets.

Is TB curable?

The good news is that TB is curable. Most patients are well again after six months of treatment, provided every dose is taken.

What causes fluid to build up around the lungs?

It is not a diagnosis in itself, but a sign of another problem such as heart failure, infection, liver or kidney disease, or cancer.

How is sleep apnoea diagnosed and treated?

A sleep study makes the diagnosis. CPAP, a gentle flow of air delivered through a mask, remains the mainstay of treatment, and getting the right mask and support makes all the difference. Weight loss, sleeping position, oral appliances and sometimes surgery all have a place.

Who uses NIV at home?

Some patients with long term breathing failure, from conditions such as COPD, obesity or neuromuscular disease, use NIV at home at night.

What helps ease breathlessness?

Breathing techniques, pacing activities, positions that ease the chest, a handheld fan and pulmonary rehabilitation all help. Anxiety often feeds breathlessness, and addressing it breaks the cycle.

What are the symptoms of a pulmonary embolism?

A pulmonary embolism is a blood clot that travels to the lungs, usually from the veins of the legs. It may cause sudden breathlessness, chest pain or collapse, but sometimes the symptoms are mild and easily missed.

Which vaccines help protect the lungs?

The vaccines we most often discuss include yearly influenza, pneumococcal, COVID-19 and, for older adults and those at higher risk, RSV.

What does spirometry measure?

Spirometry, the most common test, measures how much air you can blow out and how fast, and helps diagnose and monitor asthma and COPD.