Respiratory Medicine Unit

Presentation

The Unit has historically been characterised by its activities in the field of diagnosis, treatment and research of respiratory diseases, with a focus on vascular diseases (pulmonary hypertension and pulmonary embolism) and those mainly affecting the airways, such as chronic obstructive pulmonary disease (COPD). Clinical activity is structured in both inpatient and outpatient settings. Careful and rigorous clinical observation is the basis for the research objectives.

The Unit carries out care, research and teaching activities for patients suffering from the vast majority of respiratory diseases, both acute and chronic.

The Unit employs 6 medical specialists in diseases of the respiratory system.

Clinical activities are organised as follows:

  • ordinary hospitalisation: 9 beds available with the possibility of accessing monitored beds with greater intensity of care. Admissions to our inpatient unit may be elective or urgent;
  • outpatient activities: for general respiratory medicine visits and consultancy activities, and assessment of patients to be included in the liver transplant list;
  • Day Hospital/Day Service activities: diagnostic pathways established for the diagnosis and treatment of respiratory diseases in general, and more particularly with pathways dedicated to pulmonary hypertension;
  • diagnostic activity: outpatient clinic dedicated to performing chest ultrasound; performing long-term cardiorespiratory monitoring for the evaluation of patients with suspected obstructive sleep apnoea syndrome;
  • respiratory pathophysiology laboratory: here, it is possible to request the carrying out of complete respiratory function tests, both in a plethysmographic booth and with an open-circuit spirometer, arterial sampling for blood gas analysis and completion, with a possible hyperoxia test to screen for blood flow shunts; execution of the six-minute walk test, with adequate space and dedicated personnel; execution of cardiopulmonary exercise tests; execution of pulmonary gas exchange with mass spectrometry.

Major milestones.

The clinical activity takes the form of inpatient activities (9 beds available, which may be increased according to demand for patients admitted in urgent or elective cases for acute and chronic respiratory pathologies, approximately 300 admissions/year), outpatient activities both for general respiratory medicine activities (Monday and Friday mornings) with initial examinations and check-ups, as well as in specific outpatient clinics (evaluation of patients with liver disease for inclusion on the liver transplant list, evaluation and follow-up of patients suspected of having pulmonary hypertension), thoracic ultrasound clinics (evaluations and follow-up in pleural disease, pulmonary consolidation, interstitial and diaphragmatic disease), respiratory function testing clinic (spirometry, diffusion and blood gas analysis), ergospirometry clinic (for evaluations of chronic cardio-respiratory pathologies, of competitive and professional sports activities in collaboration with the AOUP Sports Medicine and the Lucca Sports Medicine Unit of the Prevention Department of the Toscana Nord-ovest Local Health Authority), pulmonary perfusion scintigraphy outpatient clinic (to exclude or confirm pulmonary embolism, and for evaluations of shunt pathologies), pulmonary gas exchange outpatient clinic. In addition, as part of an outpatient follow-up pathway for patients who have contracted SARS-COV-2 infection (COVID-19), as per the Tuscany Region guideline document, our Respiratory Medicine Unit works in collaboration with all the Directors of the University and Hospital Respiratory Medicine Units of the Tuscany Region for the planning of common pathways.
Multidisciplinary care of patients with Pulmonary Hypertension. In total, this activity results in approximately 6500 services per year.

Pulmonary hypertension is one of the cornerstones around which the department’s activity is structured. The professional skills and work organisation present within the group make it possible to quickly obtain the diagnosis and classification of the disease, with a completely internal diagnostic process within the Foundation. This result is possible thanks to the coexistence of different specialist figures within the Institution, who collaborate in the clinical assessment of the patient (respiratory specialist, cardiologist, cardiac surgeon, radiologist, nuclear physician and haemodynamics specialist), in addition to the constant collaboration with departments outside the Foundation (AOUP Cardiology, AOUP Respiratory Medicine, AOUP Infectious Diseases and AOUP Rheumatology), always in the context of an assessment capable of managing the sometimes very complex therapies that the disease requires, thanks to the presence of specially trained nurses, capable of providing the necessary care support, and of instructing the patient and family members (care givers for home therapy management). Our department is the HUB centre for Tuscany and the Regional Reference Centre for the diagnosis and treatment of Pulmonary Hypertension. The Unit’s staff is also actively involved in the assessment of patients suffering from Systemic Sclerosis pertaining to the Rheumatology Unit of the AOUP, a European reference centre for the diagnosis and treatment of connective tissue diseases within the multi-disciplinary group dedicated to patients.

In the field of pulmonary vascular diseases, the outpatient clinic dedicated to the evaluation of hepato-pulmonary syndrome and porto-pulmonary hypertension in patients with liver cirrhosis who are candidates for liver transplantation is worth mentioning. In this regard, our team represents the Reference Centre for specialist pulmonary counselling and diagnostic activities concerning the eligibility criteria for organ transplantation within the Azienda Ospedaliera Universitaria Pisana (AOUP), in collaboration with the Liver Transplant Unit, which sees a large influx of patients from all over Italy.

In recent years, our department has also strongly characterised itself in the diagnosis of pulmonary embolism (PE), and has developed a non-invasive diagnostic strategy of PE using clinical probability of disease and perfusion lung scintigraphy. Many scientific papers have been published on the subject. At the moment this activity has been greatly reduced, however the department maintains a wealth of expertise in this regard and is able to offer a medical-nuclear service for inpatients and outpatients.

The Unit’s staff is engaged daily in consultancy activities for the Cardiology Departments of FTGM, and for the respiratory assessment of patients with congenital heart disease of the Massa Cardiology Unit.

Activities include participation in sponsored drug trials in both COPD and asthma and in pulmonary hypertension.

Characteristics

With regard to COPD, the department has historical expertise in the evaluation of respiratory function and gas exchange parameters, as well as in the use of thoracic imaging techniques for the characterisation of pulmonary emphysema and chronic bronchitis. The equipment of our Respiratory Pathophysiology Laboratory allows in-depth examinations to be carried out to study static-dynamic volumetry, respiratory gas exchange function, airway inflammation by measuring expiratory NO concentration, and exercise tolerance (cardiopulmonary exercise test).

The department makes use of intensive care expertise to treat in-patients requiring ventilatory support. In this regard, the Unit obtained one of the best national scores with regard to in-hospital mortality due to COPD exacerbation.

For some time, the department has been actively involved in the early diagnosis of chronic obstructive pulmonary disease. Regular meetings are scheduled with the General Practitioners Regional Association managers to further extend the collaboration with general practitioners; participation in regional round tables for the definition of care pathways for COPD patients is also active. In this context, the Unit has specialist services dedicated to the diagnosis and treatment of respiratory failure (prescription and monitoring of long-term home oxygen therapy [LTOT], and adaptation to non-invasive mechanical ventilation [NIV] at home).

The assessments necessary for the prescription of home oxygen therapy are carried out, as well as check-ups over time to adjust the administration of oxygen. The assessments necessary for the prescription of NIV at home are then carried out, as well as the subsequent periodic follow-up of these patients and those who have presented with a severe episode of exacerbation leading to hospitalisation and treatment with NIV.

Medical staff

Management

Staff

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