The Clinic for Obstructive Pulmonary Diseases and Acute Pneumopathies
The Clinic for Obstructive Pulmonary Diseases and Acute Pneumopathies has the capacity of 74 hospital beds distributed in 20 patient rooms (10, two and eight of which are two-bed, three-bed and six-bed rooms respectively); seven of the rooms are equipped with an air conditioner.
About 2,000 patients are treated at the Clinic in a year, suffering from acute low respiratory infections, asthma, chronic obstructive pulmonary disease (COPD), respiratory insufficiency, cystic fibrosis, rare pulmonary diseases, or undiagnosed lesions of the pulmonary thoracic area.
The Clinic is equipped with modern medical equipment, hotair and positive pressure inhalers and a central oxygen supply, installed in all rooms. Diagnostic and treatment procedures are carried out in compliance with the latest principles of the good clinical practice, as well as with national and international guidelines. Physicians of the Clinic have at disposal modern laboratory assays of biochemical and inflammation markers, diagnostic immunology and microbiology tests, histopathology analyses, radiologic and other imaging diagnostic procedures, as well as lung function tests (spirometry, plethysmography, diffuse capacity, exercise tests), blood gas analysis, induced sputum analysis, specific bronchial challenge tests, in-vivo and in-vitro allergy tests.
Education and training of the Clinic’s medical staff is carried out permanently, keeping constantly informed about the latest diagnostic and therapeutic achievements. One of our chief goals is to educate our patients about the nature of their disease, recommended life styles, instruct them how to use inhalers and make them aware of the importance of having their disease treated regularly. To achieve these goals, numerous pamphlets and handbooks have been published, intended for both the physicians and patients of the Clinic. We are very proud of the good cooperation we have with the physicians from other centres throughout Serbia and from surrounding countries: Montenegro, the Serbian Republic, Bosnia and Herzegovina, Croatia, Slovenia, Macedonia. It is not unusual that foreign patients are also referred to the Clinic for further diagnosing and treatment.
Department for Acute Pneumopathies
(Head Prof Mirna Djuric, MD, PhD; Physicians: Dusan Skrbic, MD, Marija Zdrnja MD.)
The patients most frequently treated in the Department for Acute Pneumopathies suffer from acute respiratory infections of bacterial, viral or obscure aetiology, bronchiectases, pleural effusions and infiltrative lung lesions of unclarified aetiology. In addition to basic laboratory analyses, contemporary inflammation markers, X-ray and CT screening of the chest, microbiological diagnostics (bacteriological, virologic, immunological and mycological analyses of the serum, sputum, bronchoaspiration and broncholavage samples) are utilised in the routine every-day practice of the Department, and when necessary, preparation for invasive diagnostic procedures (bronchoscopy, video-assisted thoracoscopy and thoracotomy) is also carried out. In cooperation with other departments and institutions, the Department carries out a regular monitoring of the isolated agents of severe community-acquired low respiratory infections in the city of Novi Sad and throughout the district of South Backa.
The Department also has a specific unit for care and treatment of adult patients with cystic fibrosis which, as recommended by the European Cystic Fibrosis Society, requires the inhalatory antibiotic treatment, respiratory rehabilitation and education, including a multidisciplinary approach in either the pharmacologic or nonpharmacologic therapy.
Department for Chronic Obstructive Pulmonary Diseases
(Head: Lidija Vrtunski-More, MD. MSc; Physicians: Jelena Papovic, MD, Olivera Maksimovic, MD. MSc.
The Department for Chronic Obstructive Pulmonary Diseases (COPD) admits patients with an acute exacerbation of COPD to be treated with the latest bronchodilatory and anti-inflammatory therapy, as well as with substitution oxygen treatment in case of pulmonary gas exchange disorder. The presence of comorbidities is investigated and the adequate treatment initiated. All COPD patients are included in the respiratory rehabilitation programme which contributes to a faster and better recuperation. The adequate treatment of COPD exacerbations reduces their frequency and severity, improving patients’ life quality and survival. An important segment of the treatment is education of the patients about the disease - its character, severity, prognosis and prevention, adequate inhaler use, importance of smoking cessation and other nonmedicamentous treatment measures. The selected cases are evaluated for an interventional surgical procedure in terms of the pulmonary parenchyma reduction or bullectomy.
(Head: Prof. Biljana Zvezdim, MD. PhD; Physicians: Violeta Kolarov, MD. PhD,Vesna Kosjerina Ostric, MD. MSc, Branislav Tusek, MD.)
The Department is intended for diagnosis and treatment of patients suffering from bronchial asthma and its acute exacerbation, carried out in compliance with the latest recommendations of the Global Initiative for Asthma accepted worldwide. The achieved asthma control is evaluated analysing all factors which may contribute to an unsatisfactory disease control. Comorbid conditions (rhinitis, sinusitis, gastro-oesophageal reflux, vocal cords dysfunction, depression, anxiety, osteoporosis, etc.) are considered and respective specialists consulted to confirm the diagnosis and initiate treatment. Asthmatic patients are daily educated about their disease, instructed how to apply inhalation therapy, adjust their life style, avoid risk factors, recognize first exacerbation symptoms which may be fatal, and informed about the importance of regular control examinations.
Our goal is to provide the best possible level of medical care, diagnosis and treatment for each individual patient, based on the multidisciplinary approach.
Department for Semi-Intensive Care of COPD and Allergy
(Head: Sanja Hromis, MD. PhD; Physicians: Srdjan Stefanovic, MD, Jelena Crnobrnja, MD, Tatjana Petrovic, MD.
Noninvasive Ventilation Unit 2 and Excessive COPD Exacerbation Unit
These units of the Department for Semi-Intensive Care of COPD and Allergy are intended for patients with severe chronic respiratory failure due to asthma and COPD exacerbations, as well as for patients suffering from severe asthma and allergic lung diseases. Great attention is paid to the detection and treatment of comorbidities and patients’ education on the importance of properly administered medication and sufficiently long treatment, timely recognition of symptoms of the disease and its exacerbations, proper inhaler handling, rehabilitation, vaccination and other nonpharmacological treatment measures.
By the Development Plan of the Institute, the Department is intended to be renovated and include a modern, semi-intensive care unit equipped with four appliances for noninvasive ventilation and four monitors, with a modern accompanying kit. Noninvasive mechanical ventilation is the initial therapy measure applied in patients with acute respiratory insufficiency accompanied with respiratory acidosis, reducing mortality, the need for invasive mechanical and hospital treatment duration, and improving patients’ survival. According to the latest treatment guidelines recommended by the Global Initiative for Chronic Obstructive Lung Disease (GOLD- http://goldcopd.org/), this treatment modality is qualified as 1А level guideline.
As assessed by the World Health Organisation, allergic diseases represent a huge health issue nowadays, threatening to become a pandemic. Only in Europe, about 150 million people suffer from allergy, and taking into account the current increasing tendency of allergic diseases, it has been assessed that almost one half of the entire European population will develop at least one allergic manifestation in the future 15-year period. Quite often, these patients have a severe form of these diseases which significantly affect their life quality, professional and personal prosperity, representing at the same time a great burden for the health system budgeting.
Allergic diseases of the respiratory tract constitute the most important category of these diseases, allergic rhinitis and asthma doubtlessly being the most common ones. Respiratory manifestations may occur in patients with allergy to pollens (grass, weeds, trees), house dust mites, fungi, allergens of domestic animals, insects, drugs, food and additives; respiratory symptoms may also be associated with anaphylactic reactions, skin lesions, gastro intestinal symptoms, or may manifest as a poorly controlled severe asthma or persisting rhinosinusitis.
About 3,000 first- and another-visit examinations are performed in the Allergy Unit of the Institute in a year, including the patients who suffer from asthma, chronic cough, unclarified bronchial obstruction and suspected allergy, as well as over 500 skin allergy tests. The Unit employs well educated and trained professionals with great experience in treating asthma and allergic diseases. The staff includes seven physicians, three of whom are subspecialists in asthma and allergology. The services provided at the Allergy Unit are coordinated with those provided in already existing subspecialist units in the territory of Novi Sad, for example the Allergy Office of the Dermatovenerology Clinic of the Clinical Centre of Vojvodina in Novi Sad, as well as the Rhinology and Phoniatry Units of the ENT Clinic of the Clinical Centre of Vojvodina in Novi Sad.
The following diagnostic and treatment procedures are performed in the Allergy Unit:
Skin prick tests are considered to be a reliable method for the diagnosis of IgE-mediated
allergic disease in patients with rhinoconjunctivitis, asthma, urticaria, anaphylaxis, atopical dermatitis and suspected food and drug allergy. The method is minimally invasive and cheap, providing immediate results immediately and having a high reproducibility if properly applied and interpreted.
Prick testing to inhalant allergens: respiratory allergy is the most common allergic disease and about 25% of the total population are sensitised to inhalant allergens.. Prick testing to inhalant allergens have currently been carried out in compliance with the Global Allergy and Asthma European Network, including the standard European test panel (modified with two allergens in compliance with the aerobiological situation in Serbia) with 17 allergens (hazel tree, alder, birch, plane tree, cypress, juniper tree, European ash, grass mixture, absinthe, ambrosia, alternaria, cladosporium, aspergillus, cat and dog hair, European house dust mite, cockroach), including a positive and negative control test. The testing is carried out as recommended by the European Academy for Allergology and Clinical Immunology.
Prick testing to food allergens, using commercial preparations produced by the Torlak Institute.
“Prick to prick“ tests: skin prick tests used to investigate the sensitivity to fresh food allergens (fruit, vegetables, wheat, hard-shelled fruit), represent ting the most common procedure in evaluating the food allergy. The number of allergens which may be examined in this way is not limited and the procedure sensitivity is very high, amounting to 85% for the oral allergic syndrome.
Nasal lavage, a diagnostic method enabling quantification of the type and stage of the nasal mucosa inflammation, which is used in order to investigate the seasonal and perennial allergic and infectious rhinitis.
Oesinophil nasal swab, is a simple and cheap procedure determining the presence of oesinophils in the nasal mucosa.
Allergen-specific immunotherapy – Immunotherapy is a single causal treatment of allergy resulting in the so called immunological tolerance, i.e. bearableness. Symptoms of the disease become reduced in most treated patients, accompanied with reduced medication and reduced risk of new sensitisations and allergic disease. Sublingual immunotherapy (SLIT) is also carried out in the Unit, using the allergens (house dust mites and pollens) produced by the Torlak Institute, in compliance with the European Academy for Allergy and Clinical Immunology guidelines.
Lung function tests are indicated and evaluated at the Unit, including spirometry, plethysmography, bronchodilation test, nonspecific indirect and direct bronchial challenge, specific bronchial challenge, induced sputum.
By development plans of the Clinic and the Allergy Unit, additional diagnostic procedures are to be introduced, thus extending and supplementing investigation for some specific types of asthma, as well as to introduce investigations for other allergic pulmonary and extrapulmonary diseases.
Sanja Hromis, MD. PhD, Specialist in Pulmonology, Subspecialist in Allergology
Lidija Vrtunski-More, MD. MSc, Specialist in Pulmonology
Jelena Papovic, MD, Specialist in Pulmonology
Prof. Biljana Zvezdin, Specialist in Pulmonology
Violeta Kolarov, MD. PhD, Specialist in Pulmonology, Subspecialist in Allergology
Dusica Stanojev , MD.PhD, Specialist in Pulmonology
Mirjana Jovancevic-Drvenica, MD, PhD, Specialist in Pulmonology, Subspecialist in Allergology
Olivera Maksimovic, MD. MSc, Specialist in Pulmonology