Breathing that has stopped responding to the usual treatment.
A specialist chest clinic in Coimbatore for asthma, COPD, interstitial lung disease, bronchiectasis, fungal lung disease and sleep apnoea — with a full lung function laboratory and sleep study under the same roof.
Most breathlessness is treatable once it is correctly labelled
Asthma and COPD are routinely diagnosed on symptoms alone and treated for years without a single breathing test. A large share of what arrives here as “difficult asthma” turns out to be something else — ABPA, bronchiectasis, reflux, an obstructing airway lesion, or untreated sleep apnoea.
The first job of this clinic is to confirm the diagnosis objectively — spirometry with reversibility, HRCT, blood and immunological testing, a sleep study where indicated — before adding another inhaler.
The second is to treat to a target rather than to a prescription: control in asthma, exacerbation-free time in COPD and bronchiectasis, disease stability in fibrosis, and genuine nightly CPAP use in sleep apnoea. Every visit reviews whether that target is being met.
From first visit to a stable year
Chronic lung disease is not fixed in one appointment. This is the sequence every patient moves through, and what happens at each stage.
- Full symptom, exposure, occupational and drug history
- Review of every previous scan, report and prescription
- Inhaler technique checked in the room, not assumed
- Same-day spirometry wherever the clinic list allows
- Post-bronchodilator spirometry, DLCO, lung volumes
- FeNO, blood eosinophils, IgE and allergy testing
- HRCT chest, sputum microbiology, fungal serology
- Attended in-lab polysomnography where sleep-disordered breathing is suspected
- Right drug, right device, dose matched to severity
- Biologics in severe type-2 asthma; antifibrotics in progressive fibrosis
- Antifungal and antimicrobial courses with monitoring
- CPAP or NIV set up and titrated, not merely prescribed
- Written action plan for worsening symptoms
- Pulmonary rehabilitation and airway clearance training
- Vaccination and tobacco cessation support
- Scheduled review with repeat testing, not symptom-only follow-up
Conditions seen in this clinic
Each condition is managed against current international guidance — GINA for asthma, GOLD for COPD, ATS/ERS for fibrosis, ISHAM criteria for ABPA and AASM standards for sleep.
Bronchial asthma
GINA-based · difficult & severe asthma clinic- Objective diagnosis — spirometry with bronchodilator reversibility, FeNO, bronchoprovocation where needed
- Inhaler technique and adherence review before any step-up
- ICS-formoterol as reliever therapy; SABA-only treatment is no longer recommended
- Phenotyping in severe asthma — blood eosinophils, total and specific IgE, FeNO
- Biologics for type-2 severe asthma: anti-IgE, anti-IL-5/5Rα, anti-IL-4Rα, anti-TSLP
- Comorbidity workup — rhinosinusitis, GERD, obesity, vocal cord dysfunction, ABPA
COPD
GOLD-based · exacerbation and rehab pathway- Diagnosis confirmed on post-bronchodilator spirometry, not symptoms alone
- Symptom and exacerbation grading; dual bronchodilation as the usual backbone
- Eosinophil-guided decisions on inhaled corticosteroids
- Structured exacerbation and hospital-discharge follow-up
- Pulmonary rehabilitation, vaccination, smoking cessation and long-term oxygen assessment
- Screening for coexisting sleep apnoea in the breathless or hypercapnic patient
Interstitial lung disease
HRCT + multidisciplinary discussion- Detailed exposure, occupational and drug history; connective tissue disease serology
- High-resolution CT read against current IPF and fibrotic-ILD criteria
- Multidisciplinary discussion — pulmonology, radiology, pathology, rheumatology
- BAL and transbronchial lung cryobiopsy where the pattern is not definite
- Antifibrotic therapy for IPF and progressive pulmonary fibrosis; immunosuppression for CTD-ILD and hypersensitivity pneumonitis
- Oxygen assessment, 6-minute walk testing and timely transplant referral
Bronchiectasis
Cause-directed · airway clearance first- HRCT confirmation and severity scoring
- Aetiology workup — immunoglobulins, ABPA screen, CF and PCD where relevant, post-TB sequelae
- Sputum microbiology including mycobacteria and Pseudomonas
- Daily airway clearance and physiotherapy as the foundation of treatment
- Eradication of first-isolate P. aeruginosa; long-term macrolides for frequent exacerbators
- Written exacerbation plan; bronchial artery embolisation pathway for haemoptysis
Chronic pulmonary aspergillosis
Common after TB — and commonly missed- Suspect in cavitary or post-TB lung disease with weight loss, cough or haemoptysis over ≥3 months
- Aspergillus-specific IgG is the key diagnostic test
- CT for cavitation, aspergilloma, pleural thickening; serial imaging to show progression
- Bronchoscopy for sputum-negative cases — BAL culture and galactomannan
- Long-term oral azole therapy with drug-level and toxicity monitoring
- Embolisation for haemoptysis; surgical referral for resectable simple aspergilloma
ABPA
ISHAM criteria · asthma and bronchiectasis overlap- Screened for in every poorly controlled asthmatic and in bronchiectasis
- Aspergillus fumigatus-specific IgE, total serum IgE, blood eosinophils, specific IgG
- CT features — central bronchiectasis, mucus plugging, high-attenuation mucus
- Staged treatment with oral corticosteroids and/or itraconazole
- Total IgE tracked serially to judge response and relapse
- Bronchoscopic clearance of obstructing mucoid impaction when needed
Obstructive sleep apnoea
Diagnosis, titration and long-term follow-up- Assessment for obstructive sleep apnoea, central apnoea and hypoventilation
- Level 1 attended polysomnography with a full diagnostic montage
- Manual CPAP/APAP titration; BiPAP for hypoventilation and overlap syndrome
- Obesity hypoventilation syndrome and neuromuscular disease — non-invasive ventilation setup
- Weight, positional therapy, and ENT or oral appliance referral for selected patients
- Adherence review with machine download data at every follow-up
Other chest medicine
Routine referrals handled in the same clinic- Pulmonary tuberculosis and drug-resistant TB, including post-TB lung disease
- Community-acquired and non-resolving pneumonia
- Chronic cough — structured algorithmic workup
- Unexplained breathlessness and pre-operative lung assessment
- Pulmonary hypertension screening and referral
- Occupational and environmental lung disease
Long-term care
What changes outcomes between visits- Pulmonary rehabilitation — the highest-value intervention in COPD and ILD
- Influenza, pneumococcal and COVID-19 vaccination
- Written self-management and exacerbation action plans
- Home oxygen and home NIV assessment and review
- Lung cancer risk counselling in the high-risk smoker
The tests, in the same building
No second appointment at a second centre to get a breathing test done.
- Spirometry with bronchodilator reversibility
- Diffusion capacity (DLCO)
- FeNO measurement
- 6-minute walk test with oximetry
- Arterial blood gas analysis
- Level 1 polysomnography
- CPAP / BiPAP titration
- Specific IgE and Specific IgG
- Sputum microbiology, AFB, CBNAAT and fungal culture
- HRCT and CT-guided sampling
- Forced oscillation testing (FOT)
It’s not the snoring that’s concerning - it's the pauses in breathing
Obstructive sleep apnoea is one of the most under-diagnosed conditions in general medicine. It contributes independently to resistant hypertension, atrial fibrillation, type 2 diabetes, stroke risk and daytime road-traffic accidents — and it is one of the few chronic conditions where treatment works from the first night.
Diagnosis needs a sleep study, not a questionnaire alone. We use attended level 1 polysomnography — the reference standard — which records airflow, respiratory effort, oxygen saturation, EEG sleep staging, limb movement and cardiac rhythm through the night. That matters where the picture is mixed: central apnoea, nocturnal hypoventilation, an overlap with COPD and other sleep disorders are distinguishable on a full study and can be missed on an abbreviated one.
Treatment is not automatic CPAP. It depends on severity, symptoms, cardiovascular risk and what you will actually tolerate — which is why follow-up reviews the machine’s own usage data rather than asking how you feel.
Worth getting tested if you recognise these
- Loud habitual snoring, most nights
- Someone has seen you stop breathing or gasp in your sleep
- Waking unrefreshed after a full night in bed
- Daytime sleepiness — dozing off while reading, watching TV, in meetings or at traffic lights
- Morning headache or a dry mouth on waking
- Blood pressure that stays high on three or more drugs
- Neck circumference over 43 cm in men, 41 cm in women
- Nocturia, night-time reflux, or unexplained atrial fibrillation
Recognising several of these does not confirm sleep apnoea, and recognising none does not exclude it. It is a reason to be tested, not a diagnosis.
When to come in sooner
Some symptoms need assessment within days rather than at the next scheduled appointment.
Who you will see
The same three consultants who run the interventional service hold the general chest and sleep clinics.
Dr. V. R. Pattabhi Raman
MD, DNB — Pulmonary MedicineConsultant in Interventional Pulmonology & Sleep Medicine
Dr. S. Mahadevan
MD — Pulmonary MedicineConsultant in Interventional Pulmonology & Sleep Medicine
Dr. Arjun Srinivasan
MD (Internal Medicine), DM (Pulmonary & Critical Care Medicine)Consultant in Interventional Pulmonology & Sleep Medicine
When the clinic needs the procedure room
Difficult asthma that turns out to be ABPA or a narrowed central airway; fibrosis needing a cryobiopsy to settle the diagnosis; bronchiectasis or post-TB lung disease with heavy haemoptysis; an empyema that needs thoracoscopic adhesiolysis; a nodule found on a CT ordered for something else. The same consultants run the interventional service in this hospital, so these move across without a new referral or a new waiting list.
See the interventional pulmonology serviceThe group has 26 peer-reviewed publications and co-authored five national guidelines and position statements — listed in full here.
What to bring, and what to expect
Bring every previous chest X-ray and CT scan, any earlier lung function or sleep study reports, and all your current inhalers and tablets in their original packs — not a written list. If you use a CPAP machine, bring the machine or its data card.
Before a breathing test: avoid a heavy meal and vigorous exercise beforehand, and ask when you book whether to hold your inhalers that morning — some tests need them stopped, others do not.
For referring doctors: we accept general chest and sleep referrals as well as procedural ones, and return the patient to your care with a written report and a clear plan.
Common questions
Are inhaled steroids harmful if I use them for years?
Inhaled corticosteroids deliver a very small dose directly to the airway, which is why they are the mainstay of long-term asthma treatment worldwide. The common side effects are local — oral thrush and a hoarse voice — and both are largely preventable by rinsing your mouth after each dose. The risks of leaving asthma untreated, including attacks needing steroid tablets, are considerably greater. Oral steroid tablets are a different matter, and part of our job is to get you off repeated courses of those.
Can asthma be cured?
Asthma cannot usually be cured, but in most people it can be controlled well enough that it stops interfering with daily life, sleep and exercise. Control is the realistic target, and it is measurable. If you are still using a reliever inhaler several times a week, waking at night, or needing steroid tablets, your asthma is not controlled and the treatment needs reviewing — not accepting.
Do I have asthma or COPD?
They overlap and are frequently confused. The distinction rests on spirometry before and after a bronchodilator, age of onset, smoking history and the pattern of symptoms — not on how the breathlessness feels. Some patients have features of both. Getting the label right matters because the drug choices, particularly around inhaled steroids, differ.
Will I need CPAP for the rest of my life?
CPAP treats sleep apnoea while you use it; it does not cure it. That said, significant weight loss can reduce or occasionally remove the need, and mild positional apnoea sometimes responds to other measures. We reassess rather than assume — if your circumstances change, so does the plan.
What actually happens during a sleep study?
You come in the evening and sleep in a private room. A technician attaches sensors to the scalp, face, chest, abdomen and a finger — all external, none painful — which record brain waves, breathing, oxygen level, heart rhythm and leg movement. Most people sleep less well than at home; the study still gives a valid result. You leave the next morning, and the report is discussed at your follow-up.
My CT report says bronchiectasis. Is that serious?
Bronchiectasis is permanent widening of the airways, often following infections such as tuberculosis. It does not necessarily worsen over time. Treatment focuses on preventing flare-ups through daily airway clearance and identifying any treatable underlying cause.
I was treated for TB years ago and I still cough. Why?
Post-TB lung disease is common and often under-recognised. Old TB can leave behind bronchiectasis, airway narrowing, fibrosis, or a cavity that later becomes colonised with Aspergillus — chronic pulmonary aspergillosis, which is a specific diagnosis with a specific treatment. Persistent cough, weight loss or blood in the sputum after previously treated TB should always be investigated rather than assumed to be a relapse.
What should I bring to my first appointment?
All previous chest X-rays and CT scans (films or a CD, not just the reports), earlier lung function and sleep study reports, and your current inhalers and tablets in their original packs. If you use a CPAP machine, bring it or its data card. If you have had TB before, bring the treatment records if you still have them.
Who should get vaccinated?
Vaccination is important for everyone, but especially for children, older adults, pregnant women, smokers, and people with chronic lung disease or reduced immunity. The vaccines you need depend on your age, health and previous vaccination history.
Book a pulmonology or sleep consultation
Send the request and the clinic will confirm a slot. First visits are longer than a routine outpatient appointment because the history and previous investigations are reviewed in full.
If a breathing test or sleep study is needed, it is arranged at the same visit wherever the schedule allows.
Get the diagnosis checked before adding another inhaler
Breathlessness, a cough that will not settle, asthma that keeps flaring, or sleep that leaves you exhausted — all of these deserve an objective answer.
