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Research and care: a history of respiratory medicine at Royal Brompton Hospital

Professor Michael Polkey, specialist in respiratory medicine with an interest in advanced respiratory disease and lung failure



Professor Michael Polkey

28 June 2018


Royal Brompton Hospital has always been synonymous with research and innovative treatments:  my predecessors ran the first ever trial of cod liver oil to treat tuberculosis (TB) in 1848. 


A large controlled trial showed clear benefit of cod liver oil in what was then termed consumption, paving the way for better understanding of vitamin D and lung health. John Hutchinson, 


The inventor of the spirometer was assistant physician to the Hospital for Consumption, Brompton – the original name for Royal Brompton hospital – from 1850-52.


In 1928, Tudor Edwards performed the first, one-stage lobectomy (surgical removal of a lobe of, in this case, the lung) on a patient with a tumour. So when the NHS came into being in 1948, Royal Brompton Hospital was already highly respected.

 

Shortly after the inception of the NHS Guy Scadding created the Institute of Diseases of The Chest which merged with the Institute of Cardiology to form the Cardiothoracic Institute based at the Royal Brompton Hospital. 


Over the last 70 years it has held its own and become a leading hospital – known and respected in the UK and around the world – for its contribution to pulmonary medicine.


Dame Margaret Turner Warwick


Dame Margaret Turner Warwick, an early graduate of the Institute and specialist in thoracic medicine and respiratory diseases, who practised as clinician and professor at the hospital between from 1965 to 1987 is, in part, to thank for this. Dame Margaret set up studies and attracted clinicians for new sub-specialties that were emerging, in particular asthma and fibrosing lung disease.

 

Dr Lynne Reid laid the foundation of the modern study of lung pathology working at Royal Brompton between 1967 and 1976 and serving as the first dean of the National Heart and Lung Institute’s forerunner, the Cardiothoracic Institute.  Jack Pepys was professor of clinical immunology from 1967 to 1979 and has been considered the ‘father’ of allergy and occupational asthma in the UK.

 

It had been anticipated in the 1970s that respiratory medicine as a specialty might disappear once drugs capable of treating TB emerged. 


In fact, the foundations for the management of the many non-infectious lung conditions that we currently treat were laid down during this period, by the clinicians who entered training at that time, many of whom guided research and practice at the end of the 20th century. 


Collaborative working


When it comes to research, there are very few innovations that are done by one centre or one person. Most breakthroughs are made by collaboration. Therefore the real issue that researchers face is to what extent they should be broad in their approach or focus on a single issue over a long period of time. 


The latter may yield a bigger breakthrough ultimately but is a big gamble if the idea cannot be made to work.


The truth is, most of the easy problems were solved long ago. We are left with the difficult issues. 


This is not to say that the NHS hasn’t seen breakthroughs which have made significant impact on serious illnesses and people’s lives. In respiratory medicine I would highlight some areas which have progressed even in my professional lifetime:

 

  • medical imaging has progressed both in terms of technology but also radiological expertise. Consequently as a clinician one can discuss diagnosis, prognosis and treatment with greater confidence
  • new drugs have changed the way we manage thromboembolic disease (where clots cause blockages), cancer and increasingly asthma
  • non-invasive ventilation has transformed quality of life for patients with respiratory failure and the range of possibilities is growing.


Over the course of my own career, I have published over 250 papers. My research interest is broad, but in general we have focused on aspects of COPD (chronic obstructive pulmonary disease) outside the lung. In particular we have tried to understand how leg muscles can influence exercise performance and quality of life.

 

Working for a hospital, as opposed to a university, is very useful in terms of research. Being a clinician you see different aspects of the problem, which gives you different ideas. Ideas have to flow both ways. 


The recent emphasis has been on discovering things in the lab and forwarding on to clinic, but there’s also a place for the other way round, where clinicians are feeding back ideas.

 

I do take pride in the fact our group has trained a lot of good people. One past PhD student is now a lead academic and professor at St Thomas’s, we also have Royal Brompton-trained professors in Paris, China and Oxford, as well as of course retaining some of our academics here at Royal Brompton and Harefield hospitals.

 

This country’s rigorous research and collegiate approach allows better communication and the sharing of knowledge. NICE (The National Institute for Health and Care Excellence), for example, has a global influence. 


Other countries look to us to see what we’re doing. It gives the UK an importance on the worldwide scientific and medical stage that is disproportionate to our size or population.

 

Ultimately the fact people can get word-class health care regardless of their wealth or social standing, free of charge, is a matter of national pride. 

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