Pneumology

We use a variety of tests and methods to analyse lung function:

• Spirometry: Measurement of respiratory volumes and flows to assess lung function
• Whole-body plethysmography: Measures lung volumes, airway resistance and other parameters for a comprehensive assessment of lung function
• Diffusion capacity measurements: Tests the ability of the lungs to exchange gases between air and blood
• Measurement of inspiratory and expiratory respiratory muscle function: Assesses the strength and coordination of the respiratory muscles
• Measurement of respiratory drive: Records the neurological control of the respiratory muscles
• Measurement of lung compliance: Assesses the distensibility of the lungs in response to pressure changes
• Pulse oscillometry: Assesses airway resistance using oscillatory techniques
• Bronchospasmolysis test: Tests the reversibility of airway obstruction after administration of a bronchodilator drug
• Bronchial provocation testing: Tests airway response to various stimuli such as methacholine, cold, exercise or specific allergens
• Ergospirometry: Tests cardiorespiratory fitness during physical exertion.
• Blood gas analysis including lactate measurement: Measures blood oxygen and carbon dioxide levels as well as lactate concentration to assess respiratory and metabolic function.
• 6-minute walk test: Measurement of the walking distance in 6 minutes to assess physical performance and exercise tolerance.

Haemodynamics describes the physical properties and movements of the blood within the circulatory system. It involves the analysis of the pressure, volume and flow of blood to examine the function of the cardiovascular system. Haemodynamics is crucial in assessing the circulation, particularly in relation to the heart, lungs and blood vessels.

• Transthoracic echocardiography uses sound waves from the outside, including Doppler measurements, to assess heart function and blood flow.
• Stress echocardiography allows the heart to be examined under stress, either by physical activity or medication, to assess the heart's response.
• The right heart catheter is used to accurately measure pressure and oxygen levels in the right heart, both at rest and under stress, for a comprehensive diagnosis.
• Vasoreactivity testing in pulmonary hypertension assesses the response of the blood vessels in the lungs and is critical in the diagnosis of pulmonary hypertension.
• Non-invasive measurement of cardiac output allows the amount of blood pumped by the heart per minute to be measured without invasive procedures, often using special equipment.

Bronchoscopy is an examination in which a thin, flexible tube (bronchoscope) is passed into the airways. This allows the doctor to look closely at the airways, take samples and identify potential problems.

Diagnosis:

• Flexible and rigid bronchoscopy: Examination of the airways using a flexible or rigid instrument.
• Bronchial secretion collection: Collection of airway mucus for examination
• Bronchoalveolar lavage: Washing out the alveoli for analysis
• Bronchial and tracheal biopsy: Removal of tissue samples from the airways
• Transbronchial biopsy (including cryobiopsy) of peripheral lung tissue: Removal of tissue from the lungs
• Screening for bronchial neoplasia: Detection of early stages of lung cancer
• Endobronchial ultrasound (EBUS): Ultrasound examination of the airways
• Ultrasound-guided fine-needle aspiration of lymph nodes (EBUS-TBNA including EBUS-cryobiopsy): Removal of tissue from lymph nodes

Treatment:

• Laser treatment (NeoDym-Yag laser, argon plasma coagulation): Removal of tissue with laser light
• Cryotherapy: Treatment with cold to remove abnormal tissue
• Stenting (bronchial, tracheal): Insertion of metal stents to keep the airways open
• Foreign body removal: Removal of foreign bodies from the airways
• Bronchoalveolar lavage (therapeutic): Flushing of the alveoli for treatment
• Afterloading (tracheal, bronchial): Radiotherapy to treat cancer of the airways
• Endoscopic lung volume reduction (valve implantation)

• Pleural sonography: A test that uses ultrasound to look at the pleura (lining around the lungs). This helps doctors to detect abnormalities or fluid build-up in the chest.
• Pleural puncture (diagnostic and therapeutic): A technique that uses a needle to remove fluid or air from the area between the lungs and the chest wall. This can be done for both diagnostic and therapeutic purposes.
• Pleural drainage: A tube that is inserted through the chest wall into the pleural cavity. It is used to drain excess fluid or air and reduce the pressure in the chest.
• Pleurodesis: A procedure to fuse the pleural layers together. This is done to prevent fluid from collecting between the layers.
• Sonographically guided pleural biopsy: A tissue sample is taken from the pleura using ultrasound for further examination. Sonography helps to ensure that the biopsy is performed accurately.
• Sonographically guided puncture of peripheral round foci in the lung: This technique allows tissue to be removed from small lung foci under ultrasound guidance to diagnose possible disease.
• Thoracoscopy (in collaboration with Thoracic Surgery): A minimally invasive surgical examination of the chest. Used in conjunction with thoracic surgeons to examine and treat problems in the chest cavity.

Allergology is the study and treatment of allergies, which are hypersensitive reactions of the immune system to certain substances.

• Prick test: A method in which small amounts of potentially allergenic substances are applied to the skin. The skin is then pricked lightly to check for a reaction.
• Intracutaneous test: A small amount of an allergenic substance is injected directly into the skin to observe the reaction.
• Rub test: An allergen solution is applied to the skin and then gently rubbed to provoke a reaction.
• Specific IgE testing (RASTR, CAP): These tests measure specific immunoglobulin E (IgE), which is involved in allergic reactions. RASTR and CAP are specialised tests.
• Nasal and bronchial provocation: Allergens are introduced into the nose or airways to induce and assess allergic reactions.
• Hyposensitisation: A treatment in which the body is gradually habituated to allergy-inducing substances in order to reduce the immune response and alleviate symptoms (in collaboration with the Clinic and Polyclinic for Dermatology).

Approximately five to six million Germans suffer from asthma. Around ten percent of asthmatics have a significantly reduced quality of life.

Bronchial thermoplasty in severe asthma

The Pneumology Outpatient Clinic of the Department of Internal Medicine II is one of the few German clinics to offer bronchial thermoplasty for patients with severe and persistent asthma. This procedure is suitable for asthma patients who have exhausted all drug therapies and innovative biological therapies without significant effect.

The procedure involves three 30-minute sessions during which patients undergo bronchoscopy (lung endoscopy) under general anaesthetic. Bronchial thermoplasty involves the controlled application of heat to the walls of the airways. This causes the smooth muscles in the airways to regress. These muscles play a key role in the bronchial spasm that occurs during an asthma attack.

Patients experience a significant improvement in their symptoms with bronchial thermoplasty:

• Fewer attacks
• Weaker attacks
• Better coping with everyday stress
• Less need for emergency treatment
• Lower doses of medication

Focus of the outpatient clinic

• Bronchial asthma and chronic bronchitis
• Interstitial lung diseases / pulmonary fibrosis
• Diagnosis and treatment of bronchial carcinoma
• Alpha-1 antitrypsin deficiency
• Primary ciliary dyskinesia
• Outpatient bronchoscopy

We also offer the following special consultation hours:

• Pulmonary hypertension outpatient clinic
• Cystic fibrosis outpatient clinic
• Outpatient clinic for sleep-related breathing disorders (sleep apnoea syndrome)
• Outpatient clinic for pre- and post-lung transplant patients
• IgE consultation

Overview of consultation hours at the Clinic and Polyclinic for Internal Medicine II