Dr Thomas Crowhurst

Conditions managed

Dr Crowhurst consults in the full range of sleep and respiratory disorders. Some of the common problems that Dr Crowhurst manages are outlined below.

There are also links to high-quality websites that patients are encouraged to visit for further information.

Sleep conditions

More information about sleep disorders can be found at the Sleep Health Foundation, which is an excellent professional resource for patients.

Obstructive sleep apnoea (OSA) is a common disorder of breathing in sleep characterised by repetitive partial or complete collapse of the upper airway (mouth and throat) in sleep, which disrupts airflow in and out of the lungs and causes fragmentation of sleep and reduced oxygen levels. OSA is associated with snoring, unrefreshing sleep and excessive daytime sleepiness. There are excellent diagnostic and therapeutic options available for OSA.

Numerous other disorders can arise with breathing in sleep, beyond the most common form of obstructive sleep apnoea. These include central sleep apnoea, where there is repetitive transient failure of respiratory drive from the respiratory control centres in the brainstem, and mixed obstructive and central sleep apnoea where both central and obstructive elements exist. These disorders are complex and usually require sleep physician input.

Restless legs syndrome is characterised by an unpleasant sense of needing to move the legs, sometimes described as a pain, which begins at rest and is temporarily relieved by moving only to then recur. It usually worsens in the evening and is often associated with leg movements in sleep called ‘periodic limb movements of sleep’. Restless legs syndrome can be due to other underlying medical problems or can arise independently in otherwise well people. It can have a significant impact on quality of life, but treatment is available.

Some patients have persistent excessive daytime sleepiness for which no cause can be found despite a rigorous medical assessment including a polysomnogram (sleep study). Some such individuals will ultimately be found to have a so-called ‘central disorder of hypersomnolence’, the archetype of which is narcolepsy. Careful clinical assessment and specialised testing in a sleep laboratory is required to establish such a diagnosis. Once this diagnosis is made, however, PBS-subsidised treatment becomes available which can lead to substantial improvements in quality of life.

Modern life poses all sorts of challenges to healthy sleep, with sleep-phase disorders and insomnia being commonly associated with lifestyle-based factors (although medical conditions can also be important contributors). In basic terms, sleep-phase disorders describe a scenario where a patient goes to sleep either too early (advanced phase) or too late (delayed phase), and where there is clinical distress / dysfunction arising from this. Insomnia is a notoriously frustrating problem for patients and can impact daytime function substantially. A careful medical assessment is helpful, while optimal management usually involves assistance from a sleep psychologist.

Respiratory conditions

More information about respiratory disorders can be found at the Lung Foundation Australia website, which is a great resource for patients and families.

Asthma is a common but complex disorder involving the immune system and small muscles in the airways (bronchi), typically presenting with breathlessness and wheeze plus chest tightness and cough. Although many patients with mild asthma will achieve excellent control with inhaled medication, some will have persistent symptoms and even life-threatening exacerbations. It is important to achieve good asthma control for both quality of life and to prevent potential complications. More information can be found at Asthma Australia.

Chronic obstructive pulmonary disease (COPD) is a condition where airflow out of the lungs is impaired. There can be associated inflammation of the airways (bronchi) leading to excess mucus production and worsened symptoms (chronic bronchitis). These conditions are most often caused by long-term exposure to tobacco or other smoke, but can also be caused by occupational exposures and inherited genetic mutations. Emphysema is related to COPD and describes the destruction of normal spongy lung tissue. Nicotine is an extremely addictive substance, but the first step in managing any lung disease is to stop smoking. QuitLine provides excellent assistance in this space.

There are many treatments potentially available to patients with COPD and emphysema, from inhaled medication through to pulmonary rehabilitation and specialised procedures.

Bronchiectasis describes abnormal widening of the airways (bronchi) in the lung. This disrupts the normal mechanism whereby the lungs clean themselves (the mucociliary escalator), which leads to increased vulnerability to mucus retention and recurrent infection. These infections then drive further widening of the bronchi, worsening the bronchiectasis and establishing a ‘vicious cycle’ type scenario. Bronchiectasis is a complex disorder that requires a careful assessment to evaluate for any underlying cause, determine the physiologic and microbiologic characteristics of the condition for the individual patient, and optimise the treatment plan. Like many respiratory disorders, bronchiectasis is a chronic condition that benefits from long-term care and diligent adherence to treatments.

The ‘interstitium’ of the lung describes the complex tissues between alveolar (air sac) spaces. Interstitial lung disease (ILD) is a very broad umbrella term that refers to a wide range of conditions that damage this ‘interstitium’. Some such conditions have underlying causes like connective tissue disease (e.g. rheumatoid arthritis or systemic sclerosis), medications or environmental / occupational exposures. However, other forms of ILD arise without any identifiable cause and are then labelled ‘idiopathic’. Some interstitial lung diseases can be stable for many years while others can progress quickly and cause severe breathlessness and eventually hospitalisation and death. Careful specialist assessment is required to evaluate ILD and many cases benefit from discussion in a multi-disciplinary meeting with input from a radiologist and pathologist.

Lung cancer was the fifth most common malignant cancer diagnosed in Australia in 2018 but is our most common cause of cancer-related death. Prompt specialist input is essential when questions about possible lung cancer arise. More information and helpful patient resources can be found at the Lung Foundation Australia website .

Pulmonary embolism (PE) describes the phenomenon where a blood clot in a vein (most often a deep venous thrombosis in the leg or pelvis) breaks off from the vein and moves up through the right side of the heart and then out into the pulmonary artery. As the pulmonary artery divides into an arterial tree of gradually diminishing calibre (which delivers deoxygenated blood from the right side of the heart into the lungs to be re-oxygenated), the blood clot eventually becomes stuck. This can put back-pressure on the right side of the heart and can impair oxygen absorption within the lung.

PEs can be acute or chronic, and can be large and life-threatening or only very small. PEs are managed by a range of different specialists including respiratory physicians, haematologists and general physicians. It is important to ensure an appropriate duration of anticoagulant (blood thinning) medication is used and that follow-up is undertaken to ensure no long-term complications arise.

Chronic cough is a common and bothersome condition, not only for patients but also often their families. There are some serious possible causes of cough which should be promptly excluded. Chronic cough can be caused by multiple different conditions and in many patients there are two or indeed more contributors, with each factor potentially waxing and waning over time. Careful medical assessment is required to identify and optimally manage each different potential contributor; with such an approach, good outcomes can often be obtained, but it is important to note that medical research suggests around one-third of patients with chronic cough will have persistent symptoms even after such a rigorous approach.

Breathlessness is an awful symptom which can markedly impair quality of life. There are many potential causes of breathlessness including respiratory disease, heart problems, unfitness, obesity, blood disorders and mental health conditions among others. Pulmonary function testing is an essential component of the investigation of otherwise unexplained breathlessness, with multiple other tests potentially appropriate depending on the specifics of the case. Detailed specialist clinical evaluation can identify previously hidden contributors, potentially opening access to treatment pathways and providing patients with a better understanding of their bodies and their symptoms.

Procedures by Dr Crowhurst

Dr Crowhurst is certified in the full range of bronchoscopic and pleural procedures included in the Thoracic Society of Australia and New Zealand program. He performs these procedures at Calvary Adelaide Hospital and the Lyell McEwin Hospital. Dr Crowhurst will carefully explain to you the reasons why he may recommend a particular procedure in your case. He will outline the likely benefits and potential risks, and require informed consent before proceeding.

If Dr Crowhurst believes that you require subspecialised input from an interventional pulmonologist or cardiothoracic surgeon, he will explain this and arrange necessary referrals with appropriate clinical handover in order to streamline your ongoing care.