This service diagnoses and treat patients with interstitial lung disease (ILD) and sarcoidosis.

The term ILD encompasses a wide range of conditions affecting the lung tissue (as opposed to asthma and COPD which affect the airways). These conditions can sometimes result in scarring of the lungs (pulmonary fibrosis). The most common conditions we manage are idiopathic pulmonary fibrosis, sarcoidosis, chronic hypersensitivity pneumonitis and ILD associated with connective tissue disease (ILD-CTD). We offer this service at Hammersmith and St Mary’s hospitals.

Our ILD service is a national service commissioned by NHS England. This status reflects the standards of care that we achieve for this disease through our unique way of working. We have a dedicated multiprofessional ILD team including a number of ILD specialist nurses, a multidisciplinary (MDT) coordinator as well as ILD specialist doctors.  We hold regular ILD multidisciplinary team (MDT) meetings to discuss patient cases. The MDT meetings include an expert ILD radiologist, ILD physicians, pathologists, rheumatologists and if needed, pulmonary hypertension experts. We work as part of a network where respiratory physicians from district general hospitals interact with us and refer cases to us. We adopt a shared care approach to these patients, including interaction with transplantation centres.

Conditions and treatments

We treat all forms of ILD, including:

  • Idiopathic pulmonary fibrosis (IPF)
  • Sarcoidosis (including cardiac sarcoidosis and neuro-sarcoidosis) 
  • ILD associated with connective tissue disease or collagen vascular disease (ILD-CTD)
  • Langerhans' cell histiocytosis (LCH)
  • Connective tissue-associated ILD including scleroderma and lupus-related lung disease
  • Hypersensitive pneumonitis
  • Drug-induced lung disease

We offer a variety of treatments for all forms of ILD, including using oral and inhaled medications, steroid treatments and intravenous (into the vein – IV) treatments as appropriate. Supportive treatments which may be advised whatever the cause include smoking cessation, high dose PPI (anti-acid reflux treatment), mucolytics (mucus-thinning agents), home oxygen, and referral for physiotherapy and/or pulmonary rehabilitation. We also provide a range of treatments for inflammatory lung disorders such as connective tissue disease associated lung fibrosis including biologics and cyclophosphamide in our various day units.

We have a specialised sarcoidosis service associated with a large sarcoid research facility. We have linked specialist cardiologists who look after our cardiac sarcoid patients, as well as linked dermatologists, rheumatologists, neurologists and HIV specialists for sarcoid, as well as ophthalmology services available 24 hours a day.

Our service is also unique in having close links with an internationally recognised renal and respiratory vasculitis service linked to the West London Renal and Transplant Centre at Hammersmith Hospital, and the national service for Langerhans' cell histiocytosis patients. In addition, our service has close links colleagues in the Trust’s haematology, pulmonary hypertension, rheumatology and kidney and transplant services, as well as with specialists in infectious diseases and cardiothoracic surgery.

Clinics

Interstitial lung disease at Hammersmith Hospital

Address

Main outpatients department 
Ground floor 
A Block  
Hammersmith Hospital
Du Cane Road
London W12 0HS

Hours

Monday, Wednesday and Thursday afternoons

Contact information

Phone (respiratory secretary Jennifer McKenzie): 020 3313 1178

 

Interstitial lung disease at St Mary’s Hospital

Address

Chest and allergy clinic
Ground Floor
Mint Wing
St Mary’s Hospital
Praed Street
London W2 1NY

Please note: The chest and allergy clinic can be accessed via entrance E to the Mint Wing, off of South Wharf Road. 

Hours

Monday and Wednesday mornings

Contact information

Phone (chest clinic sister): 020 3312 1836
Phone (Dr Wickremasinghe’s secretary Helen Crawford): 020 3312 1344
Email: helen.crawford1@nhs.net

Meet the team

Respiratory consultants

Dr Raminder Aul
Dr Robina Coker
Dr Arnab Datta
Dr Katie Ward
Dr Melissa Wickremasinghe

ILD radiologists

Dr Sue Copley
Dr Maureen Quigley
Dr Sarah Sheard 

Respiratory ILD pharmacist

Radha Patel
Zaneeta Nagji

Respiratory ILD nurse specialist

Geeta Vekaria

Multidisciplinary team coordinator

Cherie February

Cherie is responsible for managing the multidisciplinary team (MDT) meetings so that the team can achieve the national requirements for the ILD service. This includes collecting, storing and submitting the required data for both national and local divisions. Cherie also assists with management of the electronic referral system (ERS), to make sure that all referrals are vetted and booked within the national referral-to-treatment (RTT) time frame. 
Cherie works closely with the lead service clinician in developing ways to improve the patient’s experience, including assisting with expanding the Care Information Exchange (CIE) which offers patients the option to access their records and results as well as to have direct communication with the service through the online message centre and video conference calls. 

Senior respiratory physiologists

Sophia Martin
Hannah Tighe

Cardiac sarcoid clinic

Consultants 

Dr Graham Cole
Dr Amanda Varnava
Dr Melissa Wickremasinghe

Clinical nurse specialist 

Sian Jones

Pulmonary Langerhans Cell Histiocytosis (PLCH) clinic

Consultants

Dr Melissa Wickremasinghe

Patient information

Before your appointment

You are welcome to bring a relative, close friend or carer with you to your appointment. You are also welcome to ask for a chaperone and we will endeavour to provide one for you.

We recommend that you wear loose fitting clothing and comfortable shoes to your appointment, as we may do a walk test during your consultation. On occasion, we may ask you to withhold from using your inhaler for 24 hours prior to lung function tests.

Please remember to check your appointment letter for anything specific you have been asked to bring with you. In addition, it would be helpful if you could bring the following:

  • Your full address and telephone number(s)
  • Your appointment card and appointment letter
  • Your GP’s name and address
  • Money to pay for any prescriptions, or an exemption card
  • A list of questions you may want to ask your consultant
  • A list of current medications

During your appointment

Please note that we are a teaching hospital, so medical students may be present for some appointments. If you do not wish to have them in the room please let the nurse or doctor know and the students will be asked to step outside.

People are usually referred to this clinic if they have shortness of breath and a productive cough. At your appointment, a specialist respiratory doctor will discuss these and any other symptoms with you and will review your condition. Some tests may be carried out, including x-rays, more detailed scans of your chest, breathing tests and blood tests. Sometimes we also look into your lungs with a small camera to take samples. The clinics include input from a variety of professionals including specialist nurses and symptom-control specialists.

We will also ask you to see our clinic nurse who will go over the investigations that you may require as well as the timeline for these which will include CT scans, full lung function tests and may include bronchoscopies or endobronchial ultrasound, transbronchial node aspirates, blood tests and cardiac tests.

After your appointment

Once your tests have been completed your case will be discussed in the ILD MDT and an MDT outcome generated, and the ILD specialist seeing you will discuss your diagnosis and management plan in detail and liaise with your referring doctor. You will be given written information sheets on your diagnosis and treatments.

Refer to this service

GP referrals

Please use NHS e-Referrals to refer a patient to our respiratory services. 

Suggested investigations prior to referral

Please arrange for the patient to have a chest x-ray at the hospital you intend to refer to. This should take place prior to referral or on the day of referral so images can be accessed at the clinic appointment. Please also send the results of any relevant blood tests and inform us of any relevant social circumstances that are impacting the patient’s health and well-being.

Secondary care

Referrals are best done by letter (and fax) to either Dr Robina Coker or to Dr Melissa Wickremasinghe.
Fax Dr Robina Coker: 020 3313 3260
Fax Dr Melissa Wickremasinghe: 020 3312 1613

Patients who are remote geographically from the hospital may prefer to have blood tests and imaging done first locally; lung function can usually be arranged on the day of their visit to the hospital.

Imaging can be transferred by IEP and reviewed at an ILD MDT before the patient is seen.

For certain patients, day case admission can be arranged to facilitate investigations and review.

Additional information

Clinical trials and research

The EME-TIPAC clinical trial is currently open for patients with IPF. Other trials may open in the near future.

As part of a busy clinical service we also participate in multicentre and multinational clinical trials in the Imperial College Clinic Trials Unit (ICCRU), and we also are involved in basic science research in ILD, and in sarcoidosis where there is an ongoing research programme headed by Professor Ajit Lalvani and Dr Trevor Hansel. You may be approached to ask if you wish to participate in these trials.

Education and elective placements

We offer these rarely, and only by personal recommendation. Please write to Dr Robina Coker in the first instance. 

The ILD Service provides excellent educational opportunities for specialist registrars in respiratory medicine, as well as nurses and physiotherapists. Dr Coker and Dr Wickremasinghe run a number of different educational events throughout the year.

Further online resources