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Thoracic Medicine

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Sleep Medicine

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Often times when we can’t sleep or we feel tired throughout the day, there are common “quick fixes” which we use to help us fall asleep easier and give us an extra boost in the morning. However, some of these habits can often be detrimental to your sleep health, affecting you not just at night, but throughout the day as well.


New research has found that the less we sleep in midlife, the faster our brains can decline and lead to cognitive impairment in old age.


“What is happening in YOUR sleep?!? How can you really know? Ever thought of using a sleep app? There are some misunderstandings to what data is relevant when using sleep apps so understanding the limitations are IMPORTANT. "It is always recommended to follow up with a sleep study to be sure nothing is missed. “


A diagnosis of obstructive sleep apnoea (OSA) may raise the risk of osteoporosis, particularly among women or older individuals, according to a new study. OSA is a condition that causes brief interruptions in breathing during sleep. If left untreated, OSA can raise the risk for stroke, cardiovascular disease and heart attacks.  New research shows that OSA may also increase the risk of osteoporosis.


Insomnia predisposes individuals to increased risk of stroke and this association is profound among young adults – up to eight times greater among insomniacs 18 to 34 years old.  The results of a recent study underscore the clinical importance of identifying and treating insomnia.


Heavy drinking damages the body in many ways. In addition to liver failure, alcoholics are at a much greater risk of developing pneumonia and life threatening acute respiratory distress syndrome (ARDS), for which there is no treatment. Researchers suspect that alcoholics are more susceptible to these lung diseases because the immune system in the lung is no longer strong enough to protect from infection and damage, but, it had been unclear why the immune system in the lung fails.


The Wesley Pulmonary Hypertension Unit

This unit has been developed to provide optimal care for patients with pulmonary arterial hypertension (PAH).  It is recognized that optimal care requires a close working partnership between the thoracic physicians, cardiologists, nursing staff, allied health staff and other physicians.

The Wesley Pulmonary Hypertension Unit (WPHU)is a designated Medicare/PBS treatment centre for PAH.

The team involves Dr John Feenstra, Director of the WPHU, Dr Andrew Scott, Thoracic and Sleep Physician and Dr David Cross, cardiologist.  The  WPHU also has close ties with Dr Fiona Kermeen, Thoracic and Transplant physician with the Prince Charles Hospital  Pulmonary Vascular Disease Unit for the management of CTEPH patients or if transplant is being considered.

Both Dr Feenstra and Dr Scott have trained in pulmonary hypertension at the Prince Charles Hospital Unit.  Dr Feenstra is actively involved with the Actelion Clinical Excellence Programme (ACEP), PHSANZ and has attended training at Beclere Hospital, France.  Dr Feenstra was also asked to present at the Inaugural Scientific Meeting of the PHSANZ.  Dr Scott has worked at the St Vincent’s Hospital Unit (Sydney) and Papworth Hospital Unit (Cambridge U.K.).  Dr Cross has been actively involved in cardiac investigations involving pulmonary hypertension for many years at The Wesley Hospital and The Royal Brisbane Hospital.

The establishment of the Wesley Pulmonary Hypertension Unit will allow your patient(s) a dedicated clinical pathway for the assessment and management of PAH.

Contact Us

Enquires and referrals can be directed to:

Dr John Feenstra (Director)
Suite 1, Level 9
Evan Thomson Building
24 Chasely Street, Auchenflower
QLD, 4066.

Ph (07) 3876 9033
Fax (07) 3871 3222

Dr Andrew Scott
Suite 1, Level 9
Evan Thomson Building,
24 Chasely Street, Auchenflower
QLD, 4066.

Ph (07) 3876 8405
Fax (07) 3870 3212

Email: This e-mail address is being protected from spambots. You need JavaScript enabled to view it

What is Pulmonary Hypertension?

Pulmonary arterial hypertension (PAH) is a chronic, progressively deteriorating disease that relates to an increase in blood pressure in the pulmonary arteries. This disease process leads to an increasing restriction of blood flow through the pulmonary arteries and progressive right heart failure causing non specific symptoms that are often hard to distinguish from other diseases or conditions, particularly in the early stages of the disease.  This frequently causes the formal diagnosis of PAH to be delayed, with diagnosis in Australia generally occurring  at least 2 years after actual disease onset.

PAH is more common in women than men and affects all ages and ethnic backgrounds.

Symptoms of PAH can include shortness of breath on exertion or normal daily activities, feeling fatigued, dizziness, fluid retention and fainting with exercise.

Types of Pulmonary Hypertension

The current classification system for pulmonary hypertension (DANA point presented by the World Health Organisation meeting in 2008) includes five major groups categorized and based on their pathophysiology and possible therapeutic approaches.  Pulmonary arterial hypertension is group one in the updated clinical classification of pulmonary hypertension and includes;

  • Idiopathic
  • Heritable
  • Drug and toxin induced
  • Associated with (APAH) which includes:
    1. Connective tissue disease (such as scleroderma, CREST and Mixed Connective Tissue Disease)
    2. HIV
    3. Portal hypertension
    4. Congenital heart disease
    5. Systemic Lupus Erythematosus (SLE)

Signs and Symptoms of Pulmonary Hypertension

Some of the early symptoms of PAH can include;

  • Shortness of breath on exertion or normal daily activities
  • Feeling fatigued
  • Dizziness (especially when climbing stairs or standing up)
  • Fluid retention
  • Fainting with exercise

In the early stages of the disease, these symptoms are often overlooked and attributed to over tiredness or a general lack of fitness.  As the disorder progresses, these symptoms become more intrusive to the patients’ lives and patients will begin seeking treatment and medical diagnosis.  As a result, the path to a confirmed diagnosis of PAH can take several years from the time of the first symptoms while other possibilities are being eliminated.

Diagnosis of Pulmonary Hypertension

History: To assist in the diagnosis of PAH, we need to gain a clear and detailed history of all prior and current medical conditions and those of close relatives.

Medication: Additionally, we need to know of any drugs including dietary pills and amphetamines that have been taken in the past or are currently being taken.

Examinations/Investigations: Blood tests and a physical examination should be conducted and subsequently further tests could be required to accurately identify PAH.  Further testing is due to a diagnosis usually resulting from ruling out the presence of other diseases which may have similar symptoms to PAH.

The World Health Organization (WHO) has developed a system to help doctors determine how limited a patient is in their ability to do the activities of daily living. In general, patients with more severe PH tend to have a higher functional class.

Class I: Patients with pulmonary hypertension but without resulting limitation of physical activity. Ordinary physical activity does not cause undue dyspnea of fatigue, chest pain or near syncope.

Class II: Patients with pulmonary hypertension resulting in slight limitation of physical activity. They are comfortable at rest. Ordinary physical activity causes undue dyspnea or fatigue, chest pain or near syncope.

Class III: Patients with pulmonary hypertension resulting in marked limitation of physical activity. They are comfortable at rest. Less than ordinary activity causes undue dyspnea or fatigue, chest pain or near syncope.

Class IV: Patients with pulmonary hypertension with inability to carry out any physical activity without symptoms. These patients manifest signs of right heart failure. Dyspnea and/or fatigue may even be present at rest. Discomfort is increased by any physical activity.

Prognosis of Pulmonary Hypertension

Without treatment, the prognosis for patients with PAH is extremely poor.  However, there are now several treatments available.  These can vary from oral tablets to nebulisers and at the very severe end of the spectrum, continuous intravenous infusion.

Many patients stabilize and improve with treatment but occasionally and only if these treatments are ineffective, more involved treatments including combination therapy and heart/lung transplantation are considered.  Close links are therefore in place with the Queensland Lung Transplant Unit and the Pulmonary Vascular Disease Unit at the Prince Charles Hospital.

As PAH is uncommon and it’s treatment complex, all patients with PAH should be managed by an a designated centre for pulmonary hypertension such as the Wesley Pulmonary Hypertension Unit.

Systemic Sclerosis Associated with Pulmonary Hypertension

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