What is a Fractional Exhaled Nitric Oxide (FeNO) test?

This is a quick and easy way to measure inflammation (irritation) in the lungs. 

The test may be done in the diagnosis of asthma, to evaluate a chronic cough, or to see how well treatment is working in a patient who has already been diagnosed with asthma. 

What does the test involve?

• You should not smoke on the day of the test.
• You should avoid eating nitrate rich foods (such as leafy green vegetables and beetroot) on the day of the test.
• You will be asked to sit in a chair for testing
• You will be asked to take a deep breath in as fully as possible and blow out at a steady pace for about ten seconds. 
• The test takes about five minutes to complete. 

What happens after the test? 

The results will be sent to the healthcare professional that requested the test and they will discuss the results with you at your next appointment.

Reference 

ATS/ERS Recommendations for standardized procedures for the measurement of exhaled nitric oxide 2005 (Joint statement).

© North Bristol NHS Trust. This edition published June 2024. Review due June 2027. NBT002534.

Important information

• Please avoid vigorous exercise on the day of your appointment.
• Please take all medication as normal and please bring a list of all medication with you.
• Please do not smoke, consume alcohol or eat a heavy meal within four hours of the test.
• Please wear loose clothing and shoes suitable for exercise.
• Do not wear lipstick or nail varnish/false nails.
• Please do not wear any body lotion. 

Thank you for your co-operation. This will assist us in obtaining accurate information and enable us to provide you with the most appropriate treatment. 

What is an exercise assessment test?

An exercise assessment, also called cardiopulmonary exercise test, involves performing an increasing level of activity so that your heart and lungs can be monitored to assess your level of fitness.

Why do I need to have this test? 

These tests will help us understand what may be causing any limitation to the amount of activity you can do. This will help to give you the most appropriate treatment or advice.

Who will perform my test? 

The test will be performed by two respiratory physiologists. Respiratory physiologists are staff who have extensive training and knowledge in respiratory physiology and performing lung function tests.

What will happen during the test? 

Before the test begins the physiologist will explain the test to you in detail and answer any questions that you have. 

To begin with you will be asked to perform some breathing tests through a mouthpiece. You will then have some electrodes attached to your chest so we can monitor your heart and be fitted with a facemask so we can monitor your breathing. 

The exercise is usually done on a bicycle. Every minute the workload will increase until you feel you can no longer continue.

Frequently asked questions 

Will there be any discomfort or side effects of this test? 

This is a maximal test so you will feel short of breath and fatigued at the end but this will resolve once the test has ended. Your breathing and heart rhythm are monitored continuously during the test. At any time either you or the physiologist can stop the test.

Is there a different test I could have? 

There is no other test that would give us all this information about your exercise tolerance and limitations. 

When will I be told the results of my test? 

The results will be sent to the professional that requested the test. They will discuss the results with you at your next appointment. 

Further information

If you have any questions regarding your appointment please call us on 0117 414 9939.

© North Bristol NHS Trust. This edition published February 2025. Review due February 2028. NBT002876

Important information

• Please continue to take all medications as normal.
• Please do not wear nail varnish to your appointment.
• You are advised not to book or pay for any flights until you have had the results of this test.
• It is very dangerous to go on a flight if you have been advised against this or to travel without oxygen if you have been advised to use it. You could experience serious breathing difficulties.

Thank you for your co-operation. This will assist us in obtaining accurate information and enable us to provide you with the most appropriate treatment.

What is a hypoxic challenge test? 

A hypoxic challenge test is a procedure performed to give us information about what might happen to your blood oxygen levels if you travel in an aeroplane.

Why do I need to have this test? 

In an aircraft there is less oxygen available in the air. For people with a respiratory problem this can cause their oxygen levels to drop too low. This test will determine whether you need additional oxygen when you are in an aircraft. 

What happens during the test?

Before the test begins the Physiologist will explain the test to you in detail and will answer any questions that you may have. 

For the duration of the hypoxic challenge test you will be seated. A probe will be put on your finger. This will provide us with information about your blood oxygen levels. 

As part of the test it is also necessary to take several pinpricks of blood from your earlobe to provide further information about your blood oxygen levels. 

The test may take up to 90 minutes to complete. The length of the test may vary depending on your blood oxygen level. 

Frequently asked questions

Will I experience any discomfort or side effects?

The only discomfort you may experience is a slight scratch on your ear when a pinprick of blood is taken. There are no known side effects associated with this test.

Is there a different test I could have?

There is no other test that would give us this information about your blood oxygen levels in a flight environment.

When will I be told the results of my test?

The Physiologist will provide information about the outcome of the test at your appointment. The report will be sent to the professional requesting the test. If you require paperwork to be completed for the airline this will need to be completed either by your Consultant or GP. If you require oxygen it will be your responsibility to organise this with the airline that you are travelling with.

What should I wear when I attend for my test?

You should wear normal comfortable clothing.

Reference

British Thoracic Society Standards of Care Committee (2011) BTS Clinical Statement on air travel for passengers with respiratory disease. London: British Thoracic Society.

© North Bristol NHS Trust. This edition published February 2025. Review due February 2028. NBT002290.

Coronary angiogram 

This page is for patients whose doctor has requested that you have a coronary angiogram. The following information will answer some of the questions you may have about this procedure.

What is a coronary angiogram?

Why do I need to have an angiogram?

What is an angioplasty/PCI?

What are the risks?

What happens before the procedure? 

Pre-assessment

Medication guidelines

Preparation for the procedure checklist

On the day of the procedure 

When you arrive

During the procedure

What happens after the procedure?

How long will I have to stay in recovery?

What happens next? 

Before you are discharged

Discharge advice

Any problems

© North Bristol NHS Trust.  This edition published June 2024. Review due June 2027. NBT002237.

Information for kidney patients who need to lower the phosphate levels in their blood.

Eating less phosphate from additives can help this.

Phosphate is often added to food by manufacturers as additives. This phosphate from additives gets into your blood stream more easily than the phosphate found naturally in foods. Phosphate additives can make your blood phosphate levels too high. 

This information explains which foods have these additives and how you can avoid them, and which foods you can eat that don’t have phosphate additives. 

Some foods are naturally high in phosphate (also known as phosphorous). You could eat less of these too. Ask your dietitian for advice about this.

How can I reduce phosphate additives?

Why do I need to reduce the phosphate level in my blood?

How do I eat less phosphate additives?

If a food contains phosphate additives, you will see the name or E number on the ingredient label. Additives with “phos” in their name contain phosphate. You may be able to swap to a different brand without phosphate additives. 

Check ingredient labels and try to avoid these additives:

E number	Name	Where found
E338	Phosphoric acid	Processed meats, sweets. cakes, chocolate, cola drinks.
E339	Sodium phosphates	Dried milk powder, canned soup, breaded chicken and fish, UHT products
E340	Potassium phosphates	Processed meats and cheeses, sports drinks, dried milk powder.
E341	Calcium phosphates	Shop-bought desserts and powder dessert mixes, instant pasta mixes.
E343	Magnesium phosphates	Bakery products, liquid egg, salt, substitutes.
E450	Diphosphates	Bakery products, processed meat and cheeses, soups and sauces.
E451	Triphosphates	Processed cheese, icing sugar, flavoured syrups.
E452	Polyphosphates	Processed potato products.

To help you avoid phosphate additives, here are some examples of food labels. They show how phosphate additives are listed on the packaging.

Sausages

Cake

If food contains phosphate additives try checking similar options to find one without. 

What foods can I eat?

How can I eat more sustainably?

Summary

This page has shown you ways you can eat less phosphate from food additives by:

• Eating freshly cooked, unprocessed food more often.
• Checking labels for phosphate additives, and limiting foods with phosphate additives.
• Swapping brands to avoid phosphate additives.

Useful webpages:

© North Bristol NHS Trust. This edition published May 2024. Review due May 2027. NBT003616.

People can become experts in their everyday surroundings, so they’re the ones best placed to solve problems or develop evidence through research. Whether you’re in a clinical or non-clinical role, we’re looking to increase the range of roles carrying out research at NBT. 

This webinar gives a good introduction to Research.

Contact research@nbt.nhs.uk for further help.

We're here to help! Here are some Frequently Asked Questions

How do I know if my study is research?

I am very busy in my current role, but I would like to get involved in research. Is there any way I can combine it with my day-to-day role?

Do I need to have experience in research to write up a research proposal?

Who should I contact to help me with costing my grant application and developing my project?

What support can the Research Development & Grants team offer me?

When is it appropriate to reach out to the Research Development and Grants team?

How long will it take to cost my research project for my grant application?

Information for before your visit 

Why have I been referred?

Our Preterm Birth Prevention Clinics offer extra care for women who may be at higher risk for preterm (premature) birth. There are several reasons why women may be at higher risk, including if you have experienced any of the following:

• Previous preterm birth.
• Previous prelabour, premature rupture of membranes (water breaking early).
• Previous miscarriage after 16 weeks gestation. 
• Previous cervical surgery including caesarean sections at full cervical dilation.
• Uterine anomalies.
• Shortened cervix seen on ultrasound scan.

We offer the following assessments in the clinic:

• An internal ultrasound scan to assess the length of your cervix.
• A urine test and vaginal swab may be taken to screen for infection.

What will happen when I visit the clinic?

Please arrive 10 minutes before your appointment time so we can take your blood pressure and perform a urinalysis. These are routine tests offered at most antenatal appointments during your pregnancy.

You will see a doctor and a specialist preterm birth prevention midwife who will discuss your risks for preterm birth, including information regarding your current and previous pregnancies. All tests offered are safe for you and your baby.

You will be offered a transvaginal ultrasound scan to measure the length of your cervix. This scan involves a small ultrasound being inserted into the vagina - it requires an empty bladder.

What treatments do you offer?

Not everyone who attends the clinic will require treatment. Depending on the initial assessment you may be offered further monitoring and reassurance with repeat ultrasound scans.

If you are at higher risk of preterm birth, you may be offered vaginal hormone (progesterone) pessaries/tablets. More rarely a stitch around the cervix may be recommended to those at highest risk of preterm birth.

When to seek advice

Sometimes there are signs that you may be going into labour. Often the signs may not lead to preterm birth, but it’s important to seek urgent advice. These signs may include:

• Period-like pains or cramps which come and go.
• Constant back pain.
• Fluid leaking from the vagina.
• Bleeding from the vagina. 

If you think you may be in labour, do not wait for your next appointment. You should call the Central Delivery Suite at Southmead Hospital on the same day. The phone number is on the front of your yellow maternity notes. 

Should I still attend my antenatal appointments?

Yes, you should.

Lifestyle modifications

Many of the risks for preterm birth cannot be changed, however there are some lifestyle changes that can be made where possible.

• Smoking has been associated with preterm birth, and therefore cutting down or stopping smoking is a positive step that can be taken to reduce the risk of your baby being born prematurely. You can speak with your midwife or with the doctor at the preterm birth prevention clinic for advice and ask for a referral for support with giving up smoking. 
• Drinking alcohol during pregnancy has been associated with premature birth. Drinking no alcohol at all is safest. 
• Tooth decay and gum disease has been associated with preterm birth, and therefore it is a good idea to see your dentist, especially if you think you may have tooth decay or toothache. You can organise free dental care with your maternity exemption card.

© North Bristol NHS Trust.  This edition published December 2024. Review due December 2027. NBT003698.

Use of email

Our NBT email address has been accredited to the NHS Digital Accreditation Standard DCB1586 (The secure email standard - NHS Digital) so you can be assured when sending confidential information to us that this is as secure as NHS.net.

See individual department pages for telephone numbers and appropriate emails.

Address and location

Severn Pathology
Pathology Sciences Building
Southmead Hospital
Westbury-on-Trym
Bristol
BS10 5NB

We are looking for people who have lived experience of Community Acquired Pneumonia. 

We would like you to join a group of health professionals to help us to see what research would make a difference to adults who have lived experience of community acquired pneumonia.

What is community acquired pneumonia? 

Community acquired pneumonia is the commonest reason that people are admitted to hospital in the UK. It is an infection of one or both lungs that is usually caused by bacteria and viruses. We call it community acquired because people who get it are living in the community as opposed to being in hospital at the time. 

What are we asking you to do? 

We are anticipating that the group will meet monthly for approximately 12 – 18 months. Most of the meetings will be held on-line (virtually) and will take no more than two hours per meeting. 

There may occasionally be face to face meetings which will be a little longer, to make good use of the opportunity to work together in this way. Travel expenses will be reimbursed, and you will also be compensated for your time with non-cash transferable vouchers as a way of saying thank you for your time. 

What do you need to do now? 

• If you would like to be involved, please reply to Julie.Gibbs@nbt.nhs.uk 

Who is funding the project? 

James Lind Alliance and Southmead Hospital Charity 

The James Lind Alliance is non-profit making initiative bringing patients, their families and carers, and clinicians together in a Priority Setting Partnership (PSP) to identify and prioritise uncertainties, or ‘unanswered questions’, about Community Acquired Pneumonia  that have not been answered by previous research, and are important to patients, their families and carers with lived experience, and professionals who look after them. 

Southmead Hospital Charity 

The Charity will be working closely with the Health Professionals and the James Lind Alliance to list  all the possible areas for research will then be discussed and the top 10 prioritised. This will ensure that researchers and those who fund research, focus on what really matters to both patients and clinicians. 

This information is for patients who have been referred to the Pain Clinic.

Pain Clinic Services 

Your appointment

Pain that persists can be distressing and disabling. You have been referred to the pain service because your pain is interfering with your ability to function effectively. We are a team of specially trained healthcare professionals who are skilled in supporting patients with pain to manage their symptoms. Most of the treatments we offer will help about one third of patients only and will reduce the intensity of pain but not take it away. Response to treatment varies from person to person, even if they seem to have the same symptoms. Your pain specialist will make an assessment of you and of your pain and decide which treatment or treatments might be helpful in your case. 

Injections may help some individuals but they often only have a limited effect and should be part of a multidisciplinary management programme. A decision on an injection will only be made after a full discussion with the patient if it is considered appropriate.

With support, patients can start to exercise, engage with hobbies and resume work (full or part-time). Our aim in this service is to help people move forward and for this reason it is unhelpful for us to disable our patients by saying they are unfit to work.

Our service works to support you and your GP to manage your pain. The treatments we offer are familiar to your GP and your GP will be experienced in managing day-to-day queries about your pain treatment. Your pain specialist may make a pain treatment plan for you and your GP to follow together. Your GP will be able to deal with queries and if you have a problem with medication you can also discuss this with 
your pharmacist.

Service objectives

• Provide a multi-professional patient specific assessment of your pain and out in place an individual management plan. 
• We help you to manage your pain enabling you to lead a more normal life with reduced disability. 
• Increase social and physical functioning. 
• Promote independence and wellbeing for patients through the provision of structured self-management support. 

In our team we have the following staff: 

• Consultants in pain medicine.
• Consultants in neurosurgery.
• Specialist physiotherapists.
• Specialist Pain Nurses.
• Clinical psychologists.
• Pharmacists.

You will not necessarily see more than one specialist, but as one of the major pain centres in the UK, we are able to adopt a multidisciplinary approach for those patients who need it. 

Can you keep your appointment?

If you cannot attend your appointment please phone and tell us as soon as you can. We can rearrange your appointment and offer your old appointment to another patients. 

Phone: 0117 414 9937

If you do not attend your appointment or cancel on the day of the appointment, we will have to discharge you back to your GP. You will then have to ask to be referred again.

Please let us know if you change your:

• Name.
• Address.
• Phone number.
• GP. 

Preparing for your appointment

Please think about the following things and write them down to bring to your appointment: 

• Have you attended a Pain Clinic before? If you have please write down the name of the Pain Clinic, the year you attended, and the name of the doctor you saw.
• A list of all the medicines (if any) you take, even they are not for pain. 
• A list of all the medicines you have tried for pain.
• A list of all the other treatments you have tried for pain e.g. acupuncture, TENS, physiotherapy.
• You could use a diagram to mark where in your body you feel pain.
• Have you had to change, reduce, or stop any of your activities (including exercise, socialising, housework, leisure etc.)? 
• As a consequence of living with pain, people often experience feelings of anger, frustration, anxiety and/or low morale. How would you say you were at the moment in terms of emotions or mood?

Further management

Management of your pain will be discussed at your appointment. You will be given a blue form to take to the reception desk to make an appointment for further treatment if this is appropriate. If you are referred to the Pain Management team an appointment for an assessment will be sent to you in the post.

Comments

We want to know what we are doing well and what we ought to be improving. Please help us to provide a service that matches what our patients need. There is a comments box in the waiting area. You can also speak to a member of staff if you wish to make a comment about the service you have received. 

© North Bristol NHS Trust. This edition published February 2024. Review due February 2027. NBT002044