Pulmonology

The most common symptoms of the respiratory system include coughing, breathing difficulty and chest pain. Illnesses such as bronchial asthma, chronic bronchitis, emphysema and lung cancer have become the medical problems of contemporary society. Pulmonologists are often required to deal with these conditions in patients. In addition, the lungs often participate in the clinical condition of other non-pulmonary diseases, such as heart failure, rheumatologic disorders, neuromuscular diseases, etc.

At the Outpatient Clinic, patients are evaluated and undergo certain medical tests. They are then either admitted to hospital for further investigation and treatment (for emergencies and severe conditions) or are given instructions and sent home.

If a patient’s condition is deemed serious or requires further lab tests that cannot be performed externally, they are admitted to hospital. Patients are clinically examined, monitored and submitted to lab tests if deemed necessary every single day, even on holidays. Note that the Athens Euroclinic is on alert 24/7 and can treat any medical emergency. The Hospital is also supported by a modern Intensive Care Unit (ICU), staffed by experienced physicians and equipped with the latest technology. Furthermore, the Department physicians have received special training on assessing and treating patients with lung cancer.  In these cases, the patient’s treatment plan is designed in cooperation with the Hospital’s Oncology Council.

Bronchoscopy is the most popular interventional pulmonology procedure. It may be performed for diagnostic or therapeutic purposes. Apart from the most common procedures (bronchial, lymph node, pulmonary sample collection for biopsy, etc), other procedures performed during bronchoscopy include laser treatment, airway stent placement, endobronchial ultrasound (EBUS), immunofluorescence (from early diagnosis of endobronchial lesions), etc. The Department physicians have long experience in this field.

Apart from conventional tests, skin prick tests for allergies may also be performed at the Bronchial Asthma Clinic, if deemed necessary. In many cases, these may assist in the diagnosis of asthma.

The Obstructive Sleep Apnea Hypopnea Syndrome is a medical condition that has attracted major medical and social interest. Its estimated prevalence in the general adult population is around 6%, while the majority of sufferers are not even aware that they have the condition. It has been slowly emerging that increasingly more illnesses or conditions are related to the syndrome (obesity, arterial hypertension, cardiac ischemia, etc). The study and treatment of these patients falls within the sphere of Pulmonology, while the Department has broad experience in this field.

Smoking cessation is a must, especially among patients suffering from respiratory or cardiovascular conditions. As evidenced by relevant research, successful smoking cessation requires a specially designed center, such as the Athens Euroclinic Smoking Cessation Clinic.

It is an integral part of modern Pulmonology and modern Medicine in general. The Lab aims at offering specialized services and invaluable support to patients with respiratory diseases.

The Athens Euroclinic Bronchoscopy Lab has been set up in accordance with European standards and is one of the most comprehensive such labs in Greece. It performs:

• Diagnostic or therapeutic bronchoscopy with flexible bronchoscope. If the physician deems it necessary, it is possible to collect biopsy samples from mediastinal lymph nodes or other pulmonary lesions either via transbronchial needle aspiration through a flexible bronchoscope (performed blind by estimating the area of the lesion) or via endobronchial ultrasound (EBUS) guidance. This method provides more comprehensive and safe results, so that diagnosis is possible in over 92% of instances. Biopsy of peripheral lung lesions may also be performed through a bronchoscope under fluoroscopic guidance. These methods provide solutions to diagnostic problems that would have otherwise required mediastinoscopy or thoracotomy, i.e. surgical procedures with unavoidably higher morbidity rates and hospitalization costs. In 2004, the Athens Euroclinic became the first hospital in Greece and the third in Europe to have purchased the EBUS system.
• Bronchoscopic laser therapy and electrocautery. These two methods are used to relieve bronchial obstruction caused by various conditions (e.g. lung cancer) or to treat endobronchial bleeding.
• Endobronchial stent placement via bronchoscope. This is another method used to relieve bronchial obstruction.
• Bronchoscopic argon plasma coagulation for controlling hemorrhages due to various causes, but mainly capillary.
• Immunofluorescence via bronchoscope. It is a new method used for the early diagnosis of lung cancer.
• Narrow-band imaging (NBI) bronchoscopy. This is a new bronchoscopic method which uses a special wavelength that can detect the pathological pattern and involvement of superficial bronchial vessels. In this way, it may contribute to the early diagnosis of tumors.

All these methods mainly use flexible bronchoscopes. In some cases, it is necessary to use a rigid bronchoscope, i.e. a metal tube through which it is possible to place endobronchial stents or perform laser therapy. The Department’s medical team has been trained in using this type of bronchoscope.

The Bronchoscopy Lab encompasses all the special and effective tools necessary to contemporary pulmonologists, making it an indispensible ally for diagnosing and treating respiratory diseases.

The Lab is equipped is one of the best pulmonary function testing systems.

Nearly all respiratory conditions require measurement of various respiratory parameters, which is considered pivotal for diagnosing and monitoring them. This is also necessary in the preoperative assessment of patients about to undergo lung, heart, abdominal or other surgery. These measurements determine how well the respiratory system functions.

• Spirometry/Flow-Volume Loop is the most popular out of these tests. It is necessary for diagnosing and monitoring patients with obstructive lung diseases, such as chronic obstructive pulmonary disease or COPD (which is what chronic bronchitis and emphysema are called nowadays), as well as bronchial asthma. It is also necessary for diagnosing and monitoring patients with restrictive lung diseases (e.g. idiopathic pulmonary fibrosis, sarcoidosis).
• Lung Diffusing Capacity Test (or simply Diffusion Testing) is a significant medical exam, especially for restrictive lung diseases.
• Plethysmography is another significant test for studying and monitoring obstructive and restrictive lung diseases.
• Measurement of respiratory muscle strength. This test is not performed very often, but it is useful in detecting possible involvement of the lung in neuromuscular conditions.

The test is usually performed via peripheral arterial puncture, usually of the brachial artery. Blood gas testing is necessary for various diseases and pathological conditions (not only pulmonary) that require measurement of the oxygen, carbon dioxide and other parameters in arterial blood.

The saturation of oxygen in the blood is recorded non-invasively overnight using a special oximeter with large memory. A drop in oxygen while sleeping is considered very significant and may be consistent with severe respiratory disorders.

The Obstructive Sleep Apnea Hypopnea Syndrome (OSAHS) is a common pathological condition marked by complete or partial interruption of the airflow during sleep, often accompanied by snoring and poor quality sleep. OSAHS can have immediate effects (e.g. arrhythmia, cerebrovascular accident, heart attack), next-day effects (e.g. sleepiness, fatigue, deceased alertness) or long-term effects (arterial hypertension, cerebrovascular or cardiovascular disease, endocrinological problems, behavioral and sexual disorders, depression, etc) on patients. People most commonly affected are middle-aged men and obese individuals.

Clinical suspicion of the syndrome starts by evaluating the patient’s medical history and is confirmed through a sleep study known as polysomnography.

At the Athens Euroiclinic Sleep Lab, the sleep study is performed by experienced technicians, it is monitored (Type I) and it is considered the best method to explore sleep disorders. In certain cases, it may be performed at the patient’s home with the use of a portable device (unattended polysomnography, Type II).

The study is evaluated by a pulmonologist with long experience in this field.

The Cardiopulmonary Exercise Test is a dynamic exam which simultaneously records cardiac, respiratory and metabolic parameters. This simultaneous recording is quite useful for physicians as it provides combined information, and enables them to make a safer diagnosis and monitor the patient more efficiently.

The test is performed at the Athens Euroclinic Ergospirometry Lab on a treadmill (i.e. similarly to a stress test), with both a Pulmonologist and a Cardiologist present.

The test may be indicated in the following cases: breathing difficulty due to unclear etiology, lung diseases (e.g. evaluation of capacity to exercise and indication for oxygen therapy in chronic obstructive pulmonary disease and interstitial lung diseases), heart diseases (e.g. coronary disease, cardiomyopathy, cardiac valve disease), preoperative functional assessment for patients about to undergo pneumonectomy (e.g. due to lung cancer), etc.

Vibration Response Imaging (VRI) is the latest diagnostic method available in pulmonary testing. It displays on a computer monitor the chest sounds a physician hears through a stethoscope, i.e. the sound vibrations generated through respiration. These sounds are recorded by highly sensitive microphones that are placed on the patient’s back.

It is a simple, radiation-free test that can assist in detecting and monitoring anatomical and functional lung disorders. It is mainly indicated for adolescents and pregnant women, while it may also be used to explore airway patency following diathermy, laser therapy or endobronchial stent placement.