RESPIRATORY SERVICES E-Consultation Top Tips For Non Urgent referrals please first use e-consultation : Interpretation of spirometry (especially restrictive) Please ensure spirometry graphs are available to view) Interpretation of minor abnormalities on chest x-ray Should this be a fast track pathway referral When is a referral likely to be helpful e.g. to Sleep Clinic or for a chronic cough  Please refer to the top tips below before you e-consult with the Respiratory Team Sleep Clinic Regarding requests for information about insomnia. We do see people with insomnia in the sleep clinic. We look for evidence of Obstructive sleep apnoea, as this can occasionally masquerade as insomnia; and we look for a sleep phase disorder when people sleep at the wrong time of day. However, if the patient is not sleepy during in the day, despite not sleeping at night, then we have little to offer, and psychological approaches may be more beneficial. Remember to record the Epworth score. https://www.midyorks.nhs.uk/download.cfm?doc=docm93jijm4n462.pdf&ver=549 Patients who snore, but are not sleepy- The NHS does not routinely commission surgery for the management of simple snoring. A number of treatments can improve outcomes in cases where this is not complicated by Obstructive Sleep Apnoea. These include weight loss, stopping smoking, reducing alcohol, addressing issues regarding impact of medication ie reducing opiate use in pain management, treatment of nasal congestion and mouth splints available on line or from the Dentist, who will charge the patient for provision and fitting If the patient’s sleep problems are as a result of losses, setbacks, or anxiety related to depression or an anxiety disorder, and they are registered with a Wakefield or North Kirklees GP, they can self refer to local IAPT services. Although not sleep specialists, these NHS funded services offer psychological therapies, including CBT, which can be very effective for sleep problems. For Wakefield registered patients, telephone 01924 234860 or go online to www.turning-point.co.uk  For Kirklees registered patients telephone 01484 343700 or go online to www.kirkleesiapt.co.uk For more information on driving please go to https://www.brit-thoracic.org.uk/document-library/about-bts/documents/position-statement-on-driving-and-obstructive-sleep-apnoea/ Chronic Cough The two common causes of persistent cough would be cough variant asthma and "silent" reflux. If there is anything to suggest an asthmatic tendency (e.g. personal or family history of atopy) then a trial of an inhaled steroid may be indicated. If not, we would suggest trying reflux treatment. The theory is that even small volumes of acid (not enough to cause heartburn) can cause cough, so there is not always a link with heartburn. It is necessary to switch off the acid completely to stop the Laryngopharyngeal reflux (LPR) Intensive acid suppression with Lansoprazole 30mg BD (30 min before breakfast and evening meal) with an alginate last thing at night for 2 months. If this works, wean off the PPI after a few more months. If not, consider referral. If appropriate a Chest X-Ray should be undertaken Other common causes that should be considered are Medication e.g. ACE inhibitors, beta-blockers, NSAIDs and calcium antagonists, A trial of stopping these may be warranted, Rhino sinus disease (postnasal drip) or Occupational exposure to irritants