Aciclovir

Amikacin

Bedaquiline

Benzylpenicilin (Penicillin G)

Chloramphenicol

Ciprofloxacin

Colistin

Cycloserine

Daptomycin

Ethambutol

Flucloxacillin

Fluconazole

Flucytosine

Ganciclovir

Gentamicin

Isavuconazole

Isoniazid (+ N-Acetyl-Isoniazid)

Itraconazole

Levofloxacin

Linezolid

Meropenem

Moxifloxacin

Posaconazole

Rifabutin

Rifampicin

Streptomycin

Sulphamethoxazole in (Co-trimoxazole)

Teicoplanin

Tobramycin

Trimethoprim in (Co-trimoxazole)

Vancomycin

Voriconazole

Leukaemia and Non-Hodgkin Lymphoma Diagnosis and Monitoring

The laboratory provides a comprehensive service in the investigation of Leukaemia and Non-Hodgkin Lymphoma. Immunophenotyping provides additional information to morphology and cytogenetics in the diagnosis, classification and monitoring of these disorders.

HIV Monitoring
Immunophenotyping is used serially to monitor CD4 levels.

Investigation of Cellular Immunodeficiency Disease
Wrong choice of tests, especially in the paediatric setting, can mean rare cases of immunodeficiency are missed. Vital information includes type and site of infections, family history, other pathology results, X-rays and clinical features. Please refer to the Clinical Immunologists: ward or clinic referral is the ideal.

• Immunophenotyping identifies numerical defects in lymphocyte subsets, inherited or acquired, and are indicated in cases with recurrent viral, fungal or mycobacterial infection.
• PNH Testing performed on peripheral blood samples looking for the absence of GPI-linked proteins on neutrophils, monocytes and red blood cells.
• Functional Leucocyte Assays

These assays are technically complex and require prior discussion with the laboratory. Abnormalities are rare, most commonly due to poor sample quality, testing during drug therapy or intercurrent infection.  Abnormal findings should always be confirmed on a second sample.  True abnormalities may need further, more specialised tests to specify the disorder.

• Lymphocyte function studies are indicated in cases of recurrent viral, fungal and mycobacterial infections in whom no numerical lymphocyte defect has been defined. The investigation provides a measure of lymphocyte activation. Lymphocytes are cultured for 5 days with mitogens which mimic antigen activation.
• Neutrophil function studies screen for defects in the metabolic burst and adhesion molecules and are indicated in cases with recurrent fungal or bacterial infection with a normal neutrophil count (>1x109/1).A normal result excludes major defects in neutrophil function.

Quantiferon Assay

The QuantiFERON-TB test is an interferon gamma release assay (IGRA) used for the diagnosis of latent Tuberculosis (TB). The assay requires special blood tubes and has specific sample handling requirements. The laboratory can issue guidance and sample tubes to requestors. Interpretation of the result needs to be in the context of clinical history and other laboratory and clinical investigations.  The antigens used in the test are absent from all BCG vaccine strains of TB and from most known non-tuberculoid mycobacteria, it is possible to have a reactions to M. kansasii, M. szulgai and M. marinarum.  If such infections are suspected, alternative testing should be sought.

The QuantiFERON-TB test (and other TB IGRAs) may give false negative results in immunosuppressed patients. The laboratory provides a positive control tube for all tests to ensure the validity of results. Where the positive control fails (indeterminate result) the laboratory may suggest alternative testing. Please see guide below for interpreting indeterminate results.

Guide to interpretation

•    Negative: A negative result indicates that latent infection with M. tuberculosis is NOT likely. This result does NOT exclude active TB infection. The investigation of suspected active TB requires clinical, radiological and microbiological assessment.
•    Positive: A positive result is consistent with latent or active TB. This result may be due to exposure to M.tuberculosis complex (except M. bovis BCG), M. kansasii, M. szulgai or M. marinarum.  IGRA should not be used for the investigation of suspected active TB. The investigation of suspected active TB requires clinical, radiological, and microbiological assessment.
•    Indeterminate: The likelihood of the patient having M. tuberculosis infection cannot be determined from the blood sample provided. Please see the guide to interpreting indeterminate results below.

Quick guide to interpreting INDETERMINATE and EQUIVOCAL QuantifFERON-TB results

INDETERMINATE RESULTS

An indeterminate result from the QuantiFERON-TB assay means that the likelihood of the patient having M. tuberculosis infection cannot be determined from the blood sample provided.

The majority of indeterminate results are caused by a low T lymphocyte response to mitogen stimulation (reported as mitogen tube failure).  
This can be caused by:

•    An insufficient number of T lymphocytes in the blood sample. Is the patient immunosuppressed?
•    A functional inability of the patient’s lymphocytes to generate Interferon-gamma (IFN-γ) in response to mitogenic stimulation, for example if they are taking drugs that supress their immune system.
•    Reduced lymphocyte function due to improper sample handling.

Ideally repeat the QuantiFERON-TB test once with a fresh blood sample. If a mitogen tube failure is reported a second time, there is no value in repeating the QuantiFERON-TB test again until the underlying cause has been identified and resolved. 

Rarely a high background in the negative control (Nil) tube generates an indeterminate result. 
This can be caused by:

•    Excessive levels of circulating IFN-γ or the presence of heterophile antibodies in the sample. Stimulating the cells further as part of the QuantiFERON-TB test does not produce a further IFN-γ response.

Ideally repeat the QuantiFERON-TB test once with a fresh blood sample. If a high background is reported a second time, there is no value in repeating the QuantiFERON-TB test again until the underlying cause has been identified and resolved.

Other causes of indeterminate results can include:

•    Incorrect filling/mixing of the Lithium Heparin or QuantiFERON-TB tubes.
•    If the time between venepuncture and sample incubation in the laboratory is greater than 16 hours.

These indeterminate samples should be repeated using the correct sampling and handling procedures.

For further information please see:

https://www.qiagen.com/gb/tb-testing/what-is-quantiferon/how-does-qft-work/quantiferon-tb-test-result-interpretation

EQUIVOCAL RESULTS

An equivocal reference range of 0.2 – 0.7 IU/mL is now applied to the Q-TB results generated when subtracting the negative control tube value (NIL) from the TB1 and TB2 tube results: TB1-NIL and TB2-NIL.

Where both TB1-NIL and TB2-NIL results are within the equivocal range (0.2 – 0.7), or where one result is equivocal (0.2 – 0.7) and one is true negative (<0.2) the Q-TB results will be reported as EQUIVOCAL with the following interpretation applied:

The significance of this result is uncertain. The risk of progression to active TB disease is likely to be different when compared to patients with clear positive (>0.7) or clear negative (<0.2) results. Suggest repeat testing if clinically indicated; approximately one third of patients with equivocal results will revert to either a clear positive or clear negative result when a fresh blood sample is analysed within six months.

Why have we implemented an equivocal reference range?

Reversion and conversion of low positive (TB-NIL: 0.35 – 0.7) and high negative (TB-NIL: 0.2 – 0.34) Q-TB results on repeat testing is a well-recognised phenomenon. To address this issue, multiple European centres have proposed an equivocal range of 0.2 – 0.7 IU/mL [1-7]; conversion to true positive results have been shown to occur most frequently when the first Q-TB result is between 0.2 – 0.35 IU/mL, and reversions to a true negative result have been shown to occur more frequently when the initial result is between 0.35 – 0.7 IU/mL [5].

The Royal Free hospital in London has implemented this equivocal range in line with other low-incidence TB European settings [6].  Data from the Royal Free lends support to the use of the equivocal range for the reporting of Q-TB results; ~1/5th of their results that fell just below the 0.35 cut-off were positive when repeated on a fresh blood sample, and half of those just above the 0.35 threshold were negative when repeated on a fresh blood sample. This data strongly implies that relying on results within the equivocal range could result in either over-treatment or under-treatment of patients.

1. Torres Costa J, Silva R, Sa R, et al. Serial testing with the interferon-gamma release assay in Portuguese healthcare workers. Int Arch Occup Environ Health 2011; 84: 461–469.
2. Schablon A, Harling M, Diel R, et al. Serial testing with an interferon-gamma release assay in German healthcare workers. GMS Krankenhhyg Interdiszip 2010; 5: Doc05.
3. Schablon A, Diel R, Diner G, et al. Specificity of a whole blood IGRA in German nursing students. BMC Infect Dis 2011; 11: 245.
4. Ringshausen FC, Schablon A, Nienhaus A. Interferon-gamma release assays for the tuberculosis serial testing of health care workers: a systematic review. J Occup Med Toxicol 2012; 7: 6
5. Nienhaus A, Ringshausen FC, Costa JT, et al. IFN-gamma release assay versus tuberculin skin test for monitoring TB infection in healthcare workers. Expert Rev Anti Infect Ther 2013; 11: 37–48.
6. Brown J, Kumar K, Reading J, et al. Frequency and significance of indeterminate and borderline Quantiferon Gold TB IGRA results. Eur Respir J 2017; 50: 1701267
7. Hermansen TS, Lillebaek T, Langholz Kristensen K, et al. Prognostic value of interferon-gamma release assays, a population-based study from a TB low-incidence country. Thorax 2016; 71: 652–658.

Blood Transfusion

Telephone: 0117 4148350
On-Call Haematology BMS via bleep 9433

Autolab heldesk

Telephone: 0117 4148383
On-Call Haematology BMS via bleep 9433

Medical Staff

Dr A Whiteway
Consultant Haematologist
Head of Clinical and Laboratory Haematology
Via Haematology secretaries - Telephone: 0117 4148401

Dr Michelle Melly
Consultant Haematologist
Via Haematology secretaries - Telephone: 0117 4148401

Dr M Kmonicek
Consultant Haematologist
Via Haematology secretaries - Telephone: 0117 4148401

Dr Samreen Siddiq
Consultant Haematologist
Via Haematology secretaries - Telephone: 0117 4148401

Dr Sophie Otton
Consultant Haematologist
Via Haematology secretaries - Telephone: 0117 4148401

Dr Jaroslaw Sokolowski
Consultant Haematologist
Via Haematology secretaries - Telephone: 0117 4148401

Dr Surenthini Salmon
Consultant Haematologist
Via Haematology secretaries - Telephone: 0117 4148401

Dr Kiri Dixon
Consultant Haematologist
Via Haematology secretaries - Telephone: 0117 4148401

Laboratory Staff

Mrs Allison Brixey
Blood Sciences Manager
Telephone: 0117 4148416

Mr Tim Wreford-Bush
Lead BMS Blood Transfusion
Telephone: 0117 4148363

Dr Karen Mead
Specialist Practitioner of Transfusion
Telephone: 0117 4148358

Mrs Grace VanDerMee
Lead BMS Haematology
Telephone: 0117 4148356

Mrs Halina Collingbourne
Quality Manager
Telephone: 0117 4148354

Anticoagulation Monitoring Service

Please note that this service has moved to Pharmacy.

Llinos Jones
AMS@nbt.nhs.uk
Telephone 0117 4148405
Contactable from Mon-Fri 09:00 - 17:00

Secretaries Office

Telephone: 0117 4148401
Email: HaematologySecretaries@nbt.nhs.uk

The clinical service is staffed with 8 Consultant Haematologists for interpretation and advice.  The technical and clinical service is provided by Biomedical Scientists (BMS), Clinical Scientists (CS), Associate Practitioners (AP) and Medical Laboratory Assistants (MLA).  In 2024 the laboratory processed 600,000 full blood counts, 250, 000 HbA1Cs & 100,000 clotting requests, with 10% growth each year. Haemoglobinopathy testing is also undertaken, including sickle cell and thalassaemia (SCT) screening for the antenatal and newborn programmes.

The Blood Transfusion laboratory issued over 13,000 blood components and processed 50,000 group and save samples. It also supports the Adult Major Trauma Centre at NBT and provides blood components to two air ambulances for the prehospital setting.  

The department has been approved for BMS training by the IBMS and our Trainee BMS staff are trained in accordance with the IBMS and HCPC regulations. Our qualified staff (CS and BMS) are required to be registered with HCPC. The department is also accredited to train staff undertaking the STP and HSST programmes with the National Science Healthcare school.  There is active encouragement for staff to follow further education courses, such as MSc (Haematology) and management qualifications.

The Department has a dedicated Quality Manager who is responsible for maintaining accreditation and compliance to ISO 15189 and BSQR (https://www.nbt.nhs.uk/severn-pathology/quality/pathology-accreditation-status) . The department participates in all appropriate External Quality Assurance Schemes accredited to ISO 17043 (https://www.nbt.nhs.uk/severn-pathology/quality/external-quality-assurance) for which performance is closely monitored.

Clinical Head of Service
Dr Alastair Whiteway

Blood Sciences Manager
Mrs Allison Brixey

The department of Clinical Biochemistry provide the Newborn Bloodspot Screening service for a large part of the South West Region. Testing is undertaken on filter paper bloodspots which are collected from babies when they are 5 days old. Our UKAS accredited laboratory currently screens approximately 35,000 babies each year for ten conditions:

• Sickle cell disease (SCD)
• Cystic Fibrosis (CF)
• Congenital Hypothyroidism (CHT)
• Inherited Metabolic Diseases:
  • Phenylketonuria (PKU)
  • Medium-chain acyl-CoA dehydrogenase deficiency (MCADD)
  • Maple syrup urine disease (MSUD)
  • Isovaleric acidaemia (IVA)
  • Glutaric aciduria type 1 (GA1)
  • Homocystinuria (pyridoxine unresponsive) (HCU)
  • Hereditary Tyrosinaemia type 1 (HT1)

Early detection through screening and prompt treatment significantly reduces the morbidity and mortality associated with these conditions.
The newborn screening bloodspot programme is provided in close collaboration with health care professionals throughout the region.

Screening for SCD is provided with the department of Haematology at North Bristol NHS Trust (NBT) and Cystic Fibrosis with the Bristol Genetics Laboratory

Information for public and professionals regarding the SCID evaluation.

The screening laboratory works very closely with the South West Regional Metabolic Biochemistry laboratory, co-located with the Newborn SCreening Laboratory, which provides diagnostic testing to support the newborn screening programmes and monitoring of patients identified though the Inherited Metabolic Disease screening programmes. Bloodspot testing for PKU, hypothyroidism (TSH) and a monitoring service for Congenital Adrenal Hyperplasia (17-OHP) is also available.

All of our screening results are uploaded to the Newborn Blood Spot Failsafe Solution (NBSFS) on a daily basis. This is a national web-based solution which allows maternity units, child health record departments, and screening laboratories to verify the screening status of any baby registered in England. It enables easy early identification of those babies who have had no blood spot card received in the laboratory, making it less likely that any babies will miss screening, and also promotes timeliness of repeat sampling.

Laboratory Visits

We offer half-day training sessions to midwives, health visitors, dieticians, nurses, doctors and other healthcare professionals involved in the collection of bloodspots. Please contact us to arrange a visit.

Please see below for responses to our most recent user survey

Key Contacts

Roanna George
Director of Newborn Screening & Consultant Clinical Scientist
Telephone: 0117 4148425

Maryam Khan
Principal Clinical Scientist
Telephone: 0117 4148418

Emma Smith-Thomas
Senior Clinical Scientist
Telephone: 0117 4148427

Dr Sophie Otton
Consultant Haematologist
Telephone: 0117 4148359

Grace VanDerMee
Lead Biomedical Scientist - Haematology
Telephone: 0117 4148356

Rebecca Whittington
Principal Clinical Scientist - Genetics
Telephone: 0117 4146175

Clare Le Masurier
Senior Biomedical Scientist
Telephone: 0117 4148430

Zuzana Miklankova
Senior Biomedical Scientist
Telephone: 0117 4148346

Katherine Carr
Senior Biomedical Scientist
Telephone: 0117 4148430

The Metabolic Biochemistry Laboratory (previously Biochemical Genetics) at Southmead Hospital provides a regional diagnostic and monitoring service for the investigation of inherited metabolic diseases. Routine analyses performed include urine organic acids (including quantitative methylmalonic acid, if required), bloodspot/plasma acylcarnitines (including free carnitine), plasma/urine/CSF quantitative amino acids, qualitative galactosaemia screening test, plasma free fatty acids and 3-hydroxybutyrate.

In addition, the laboratory provides specialist testing for the investigation of peroxisomal disorders (plasma very long chain fatty acid analysis, including pristanic and phytanic acids), Smith-Lemli-Opitz syndrome (plasma 7-dehydrocholesterol and 8-dehydrocholesterol)

The Metabolic Biochemistry department is a Centre for Galactosemia investigations and offers a variety of tests for the diagnosis and monitoring of disorders of galactose metabolism including:

• first line galactosaemia screens,
• quantitative galactose-1-phosphate uridyltransferase activity for confirmation of classical galactosaemia;
• urine galactitol for screening and monitoring of galactokinase deficiency or screening for classical galactosaemia if infant has been transfused;
• galactokinase activity for confirmation of galactokinase deficiency;
• galactose-1-phosphate for monitoring treatment of classical galactosaemia.

The Metabolic Biochemistry Laboratory at Southmead Hospital is a member of the UK National Metabolic Biochemistry Network (MetBioNet). 

The Metabolic Biochemistry laboratory works very closely with the Southwest Newborn Screening Laboratory to aid in the diagnostic testing to support the newborn screening programmes and monitoring of patients identified though the Inherited Metabolic Disease screening programmes. Bloodspot monitoring for PKU (Phenylalanine and tyrosine) and CAH (17-OHP) for known patients and testing for hypothyroidism on bloodspot (TSH)

We provide a comprehensive advisory service and welcome enquiries to discuss appropriate patient investigation and result interpretation. Clinical and laboratory advice is available during working hours, via contacts listed.

Details of Sample Requirements and Transport can be found under “Requesting” and “Test Information” via the menu at the top of this page.

For any urgent analyses or additional testing on samples already received, please telephone the laboratory to discuss.

(Source: CSF amino acid reference intervals from the Cardiff Working Group, MetBioNet)

User Handbook

Request form

User Survey

Useful Links

National Metabolic Biochemistry Network (MetBioNet)
British Inherited Metabolic Diseases Group
Cardiff Porphyria Service

Information from the Breast CNS Team

This page is supportive information to back up a face-to-face session. This is ideally done 5 weeks after your operation. We are happy for you to come at a later date if you cannot make the original date offered. 

What's next?

Long-term follow-up

Personalised care and support planning appointment and Living Well Day

Breast pain

Lymphoedema

Exercise and energise

Fatigue

Menopausal symptoms

Self-assessment

Symptoms to report

Penny Brohn

Located in Pill, this is a great place with multiple treatment support programmes, or just to have a very tasty lunch!

• Regular group sessions/in person activities – Yoga, relaxation, nutrition support, QI Gong, creativity workshops, strength and stamina classes.
• Self-care resources
• Personal consultations
• Visit the grounds for a walk
• Go to the café. 

Penny Brohn UK – Cancer wellbeing for everyone

Maggie’s House

Maggie’s House centres offer support to anyone with cancer or their loved ones.  Support offered includes: 

• Cancer support specialist available.
• Pilates.
• Benefits advice and support.
• Choir.
• Tai Chi.
• Managing stress course.
• Fitness sessions.
• Relaxation sessions.
• Where now post treatment course.

Maggie's | Everyone's home of cancer care

Bosom Buddies

Other support groups

Macmillan Centre

My Medical Record

My Medical Record is a free and secure website where you can access information about your post cancer treatment follow-up, access to information resources and message centre.

If you would like access to My Medical Record or have any questions, please contact: BreastMMR@nbt.nhs.uk

End of treatment summary

Moving forward

© North Bristol NHS Trust. This edition published December. Review due December 2028. NBT003834.

The Avon Orthopaedic Centre, based at North Bristol NHS Trust, has a long history of being one of the leading centres in the country for research and innovation in orthopaedic care.

The Bristol Medical School Musculoskeletal Research Unit are also based within the site, with this partnership enabling clinicians and research methodologists to closely collaborate both locally and internationally to deliver high quality research based on our multidisciplinary expertise.

Please speak to the person treating you to find out if there is a research study that may be able to help you.

An integral part of the Severn Major Trauma Network (SMTN) based at NBT, this highly skilled team are able to include patients in the crucial early phases post traumatic injury in a sensitive and caring manner.

Trauma & Orthopaedics Studies:

*SMTN specific-research

FOREST

TILLI

REACH

POP-I

REPPORT

DIDACT

DRAFT 3-CASP*

WHiTE 10 LIT*

WHITE 11*

Elective Orthopaedics Studies:

ACL Starr-UK

Adaptis

Stability 2

PART

HIPPY

Furlong Evolution® Hip Trial

UK Multi-centre, observational, prospective, Post-Market Clinical Follow-up of the INFINITY® Total Ankle System

ReMatch

PERSONA

Hip Replacement Failure & Bone Density

RAPSODI

IMPACT

THRIVE

Pulmonary fibrosis (PF) describes a variety of disorders that may lead to scarring in the lung.

What is Pleuroparenchymal Fibroelastosis (PPFE)?

Pleuroparenchymal Fibroelastosis (PPFE) is a rare form of PF that tends to affect the upper parts of the lung. The scarring tends to involve the areas just beneath the lining of the lungs (the pleura) and the lung itself (the parenchyma).

What are the symptoms?

In PPFE it can be more difficult for the lungs to transfer oxygen into the bloodstream. This means the body may not get the oxygen it needs to work properly. This can cause breathlessness and/or a cough from the irritation. Some people experience a dull pain around the lungs and feel fatigued. Weight loss and recurrent lung infections may occur.

Why does PPFE happen?

It is not entirely clear why PPFE happens. It is sometimes associated with a separate lung fibrosis condition affecting the bottom of the lungs or following previous treatment for cancer.

It is difficult to predict how the condition will develop in a person as it can vary a lot.

What tests will I have?

Your specialists will take a detailed medical history and perform a thorough physical examination. You may be asked to have the following investigations:

• Chest X-ray.
• Lung function tests. These are breathing tests which show how well your lungs are working. They are used later to monitor your lung disease, to see if it is progressing. You may also be asked to have a walk test where you will be asked to rate how breathless you are and measure your walking distance and oxygen levels.
• A series of blood tests will be done to screen for systemic inflammatory conditions.
• A CT scan of your chest will show a detailed picture of your lungs that allow your specialist to identify scarring of the lungs.
• Some people may also have a bronchoscopy, where a small flexible tube is passed down into your lungs to allow collection of cells. This may help with diagnosis and management.

What treatments are available?

Treatments may differ depending on the symptoms you have, and your specialist will discuss which treatment is right for you.

Antifibrotic medications, like nintedanib, can slow down the build-up of scar tissue in the lungs. They may be used to treat PPFE if there is evidence that it is getting worse. These treatments may reduce the rate that your lung fibrosis progresses, but they don’t stop the lung scarring completely. And they won’t get rid of any scar tissue that has already formed.

You may be prescribed an antibiotic to prevent lung infections.

Other medications and therapies are used to help relieve symptoms, such as cough and breathlessness. Your specialist will discuss options with you on an individual basis.

Pulmonary rehabilitation is a supervised exercise and education programme that can help you to learn to manage your breathlessness and remain active. The programmes are multidisciplinary, meaning that the team includes respiratory physiotherapists, nurses, dieticians, doctors and others, and can help improve your energy, strength, and quality of life.

As the lung fibrosis stops enough oxygen getting into the bloodstream, some people may need supplemental oxygen therapy. Oxygen therapy may help with breathlessness and help you to be more active. Corrected levels of oxygen in the blood are necessary for normal body functions and reducing additional health problems.

You should also discuss with your doctor if there are any clinical trials you can participate in. Clinical trials are voluntary research studies designed to answer specific questions about the safety and/or effectiveness of medications.

A small minority of patients may require assessment for and be suitable for lung transplantation.

How can I help myself?

Have your seasonal vaccinations (COVID-19 and flu) and the pneumonia vaccination (you only have this once).

You may be eligible for a variety of benefits such as Attendance Allowance or Personal Independence Payment if you need help with personal care or getting about.

Our specialist nurses run a regular Pulmonary Fibrosis Support Group which is a space for discussion with other patients with lung fibrosis. Here we also aim to have several presentations from a variety of guest speakers and charities.

Keep active and do what you enjoy!

Further information and resources

Action for pulmonary fibrosis

Asthma + Lung UK

How to contact us

• Bristol Interstitial Disease Service
  Southmead Hospital
  Bristol
  BS10 5NB
• 0117 414 7762
• ILD@nbt.nhs.uk

© North Bristol NHS Trust. This edition published June 2025. Review due June 2028. NBT003790. 

What is Organising Pneumonia (OP)?

Organising Pneumonia (OP) is a rare lung disease that causes inflammation and scarring in the small airways (bronchioles) and air sacs (alveoli) of the lung. Although OP has pneumonia in its name, it is not an infection and cannot be passed on.

What are the symptoms?

In OP it can be more difficult for the lungs to transfer oxygen into the bloodstream. As a result the body may not get the oxygen it needs to work properly. This can cause breathlessness and/or a cough from the irritation, and you may feel fatigued. Some people can have a flu-like illness, high temperatures, or lose weight.

Why does OP happen?

It some cases is not entirely clear why OP develops and this may be called idiopathic or cryptogenic disease. In rare cases it may be linked to an inflammatory condition that affects other parts of the body.

What tests will I have?

Your specialists will take a detailed medical history and perform a thorough physical examination. You may be asked to have the following investigations:

• Chest X-ray.
• Lung function tests. These are breathing tests which show how well your lungs are working. They are used later to monitor your lung disease, to see if it is progressing. You may also be asked to have a walk test where you will be asked to rate how breathless you are and measure your walking distance and oxygen levels.
• A series of blood tests will be done to screen for systemic inflammatory conditions.
• A CT scan of your chest will show a detailed picture of your lungs that allow your specialist to identify scarring of the lungs.
• Some people may also have a bronchoscopy, where a small flexible tube is passed down into your lungs to allow collection of cells. This may help with diagnosis and management.

What treatments are available?

Treatments may differ depending on the symptoms you have, and your specialist will discuss which treatment is right for you. In some mild cases, symptoms of OP may resolve without treatment and can simply be monitored and treated later if necessary.

Medications

Steroids are produced naturally in the body by the adrenal gland. Additional steroids called prednisolone can be given to try and reduce inflammation in some patients.

They are usually given in a tablet but may be given intravenously (into a vein). If you are prescribed steroid tablets long-term, you should not stop taking them suddenly. You will be given a ‘steroid emergency card’ which you should always carry with you.

The specialist may also see if you need bone protection medication and anti-reflux treatment whilst on steroids.

Immunosuppressive medication

Mycophenolate mofetil and azathioprine are medications that lower the activity of the immune system to help control the disease. Treatment with immunosuppressive medications may allow you to stop taking steroids. As a result, they are sometimes also called a ‘steroid-sparing agent’. You will require regular blood tests to monitor your response to treatment.

Other treatments

Other medications and therapies are used to help relieve symptoms, such as coughs and breathlessness. Your specialist will discuss options with you on an individual basis.

Pulmonary rehabilitation is a supervised exercise and education programme that can help you to learn to manage your breathlessness and stay active. The programmes are multidisciplinary. This means the team includes respiratory physiotherapists, nurses, dieticians, doctors and others. It can help improve your energy, strength, and quality of life.

As the lung fibrosis stops enough oxygen getting into the bloodstream, some people may need supplemental oxygen therapy. When levels of oxygen are low, oxygen therapy may help with breathlessness and enable you to be more active. Corrected levels of oxygen in the blood are necessary for normal body functions and reducing additional health problems.

You should also discuss with your physician if there are any clinical trials in which you can participate. Clinical trials are voluntary research studies, conducted in people, which are designed to answer specific questions about the safety and/or effectiveness of medications.

How can I help myself?

Have your seasonal vaccinations (COVID-19 and flu) and the pneumonia vaccination (you only have this once).

You may be eligible for a variety of benefits such as Attendance Allowance or Personal Independence Payment if you need help with personal care or getting about.

Our specialist nurses run a regular Pulmonary Fibrosis Support Group which is a space for discussion with other patients with lung fibrosis. Here we also aim to have several presentations from a variety of guest speakers and charities.

Keep active and do what you enjoy!

Further information and resources

Action for pulmonary fibrosis

Asthma + Lung UK

How to contact us

• Bristol Interstitial Disease Service
  Southmead Hospital
  Bristol
  BS10 5NB
• 0117 414 7762
• ILD@nbt.nhs.uk

© North Bristol NHS Trust. This edition published June 2025. Review due June 2028. NBT003789.