Pneumology

Introduction

The mission of the Pneumology Department at the University Hospital of Bellvitge, created in 1985, is to provide specialist healthcare for respiratory system disorders in adult patients in its direct area of reference (l’Hospitalet de Llobregat and El Prat de Llobregat) and to provide specialist, tertiary healthcare to patients from the Southern Metropolitan Area, the health regions of Les Terres de l’Ebre and Camp de Tarragona, and, for certain diseases, for patients throughout Catalonia.

It also provides degree education for medicine students at the UB Bellvitge Campus and the specialist HUB training programmes. It conducts clinical and translational research focusing on the most relevant pathologies of the speciality.

 

Relevant aspects
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Hospitalisation Unit

Activity headed by Dr Jesús Ribas (head), and Dr Mercè Gasa and Dr Yolanda Ruiz. The hospitalisation unit is located on floor 16 and has 24 conventional beds.

Apart from the aforementioned physicians, doctors from other units of the department take part in hospitalisation activities, especially the UFIS-R (Functional Respiratory Community Healthcare Unit). Outside working hours, the hospitalisation unit’s activity is headed by the on-duty service of the department that remains physically present on site and also takes over work in our speciality in the A&E Department and in other HUB departments.

The catalogue of services of the hospitalisation unit is as follows:

  • Acute respiratory pathologies or chronic pathologies with signs of acute compromise from the HUB A&E Department or transferred from other departments and requiring conventional hospitalisation for management of their diagnosis or therapy.
  • Patients sent by other hospitals in the area of reference for tertiary diagnosis or therapeutic surgery.
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Intermediate Respiratory Care Unit
  • Located on floor 16, the Intermediate Respiratory Care Unit has 4 enclosed cubicles correctly set-up for different complex therapies in acute respiratory pathologies or severe chronic pathologies with signs of acute compromise.

This tertiary equipment allows for full, centralised monitoring and the safe application of different non-invasive types of ventilation, high-flow oxygen therapy and nebuliser therapy, under the supervision of specialist nurses and with the participation of respiratory physiotherapists. This device is aimed at treating severe respiratory pathologies, such as COPD, interstitial pulmonary disorders, pneumonias, neuromuscular disorders with respiratory pump failure, pulmonary oedema or pathologies that compromise the main airway. It also allows for strict monitoring of other severe pneumopathies, such as pulmonary embolism or life-threatening hemoptysis. Furthermore, the enclosed cubicles mean that isolation measures can be implemented for patients colonised with intra-hospital pathogens.

The head of this unit is Dr Ana Córdoba Izquierdo, with the usual collaboration of Dr Enric Prats Soro, Dr Eva Farrero Muñoz, and the on-duty specialists of the Pneumology Department.

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Respiratory Endoscopy Unit

Activity headed by Dr Noelia Cubero and Dr Rosa López Lisbona. Also involving Dr Marta Díez. This unit provides its services to the new clinics of the Digestive and Respiratory Endoscopy Area. Its catalogue of services includes:

Diagnosis procedures:

  • Conventional flexible bronchoscopy.
  • Includes static and dynamic inspection (malacia, small fistula, etc.),
  • BAS, endobronchial biopsy, cytology brush and protected microbiology brush, for the clinic and the critical care units of the hospital.
  • Bronchoscopy with autofluorescence or NBI (narrow band imaging) for the diagnosis and monitoring of dysplasia or carcinoma in situ.
  • Ultra-fine navigator-guided bronchoscopy for the diagnosis of peripheral pulmonary nodule.
  • Cryobiopsies for insterstitial pathologies.
  • Endobronchial ultrasound (EBUS) for the mediastinal staging of lung cancer, the diagnosis of extraluminal central and hiliar masses, and lymphomatoid granulomatous disorders (sarcoidosis, TB).

Therapeutic procedures:

  • Intubations under endoscopic control.
  • Extraction of foreign bodies (primarily with rigid bronchoscope) and post-operative clots (cryoextraction).
  • Dilatations in inflammatory pathology of the main airway (post-intubation, post-infection, post-caustic, etc.).
  • Recanalisation of the main airway (cancer, granuloma, etc.) with laser, cryoextraction, or mechanical resection. Laser removal of benign tumors (hamartoma, lipoma, etc.).
  • Combined therapy (endobronchial and vascular) for inoperable carcinoids.
  • Implantation of silicone or metal self-expanding prostheses in benign or malignant pathologies, both straight and Y-shaped, to stabilise the airway and for fistula occlusion.
  • Fitting of special tracheostomy cannula with associated tracheal pathology.
  • Fitting of Montgomery tubes (with prior tracheostomy). Closure of bronchopleural fistula (with valves). Treatment of carcinoma in situ and high grade dysplasias (cryotherapy). Treatment of radical necrosis (along with the hyperbaric chamber facilities at the Moisès Broggi Hospital).
  • Brachytherapy (ICO facilities), with the fitting of the probe and establishing of the area and necessary doses.
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Respiratory Sleep Disorders Unit 

Activity headed by Dr Carme Monasterio (head) and Dr Neus Salord. Also involving Dr Mercè Gasa. This unit performs its work in the laboratory located on floor 17 and in outpatients. Its catalogue of services includes:

Diagnostic examinations:

  • Complete monitored polysomnographies with simultaneous video recording.
  • Respiratory polygraphies.
  • Home respiratory polygraphy.
  • Home oxymetries (for screening).
  • Complete polysomnographies with multiple sleep latency test.
  • Actigraphies.
  • Examinations to control treatments:
  • Complete polysomnographies to control CPAP.
  • Complete polysomnographies to control BIPAP.
  • Complete polysomnographies to control servoventilation.
  • Respiratory polysomnographies to control CPAP.
  • CPAP control with AutoCPAP.
  • Home CPAP control with AutoCPAP.
  • Home oxymetries to control the effiicacy of the treatments. 
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Functional Respiratory Test Lab

Activity headed by Dr Vanesa Vicens (head) and Dr Mariana Muñoz. Its work is carried out in the clinics locate don floor -1 of the main building. Its catalogue of services includes:

  • Forced spirometry
  • Bronchodilator test
  • Pulmonary volume measurement by plethysmography
  • Pulmonary volume measurement by heli
  • Alveolar-capillary diffusion test
  • Methacholine bronchial provocation test
  • Mannitol bronchial provocation test
  • Exhaled nitric oxide
  • Aeroallergen prick-test
  • Expiratory flow
  • Blood oxygen tests
  • Vital capacity in supine position
  • Maximum inspiratory pressures
  • Pulmonary resistance by plethysmography
  • Overnight pulse oximetry
  • Sweat test 6 minute walk test
  • Cardiopulmonary stress test (cycloergometry)
  • Bronchial provocation stress test
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Functional Interdisciplinary Respiratory Community Healthcare Unit (UFIS-R)

Activity headed by Dr Eva Farrero (head) and Dr Enric Prats. Also involving Dr Ana Córdoba. This unit performs its work in the offices on floor 17 and in Outpatients. These activities include home care for patients on chronic ventilation. Its catalogue of services includes:

  • Single-speciality consultation for patients with home mechanical ventilation.
  • Single-speciality consultation for patients with amyotrophic lateral sclerosis (ALS) in the setting of a multi-disciplinary ALS unit.
  • Outpatient adaptation to non-invasive mechanical ventilation.
  • Nursing consultation for outpatient care of patients with home mechanical ventilation.
  • Arterial blood gas test
  • Outpatient oxymetry
  • Production of nose masks 6 minute walk test
  • Home care programme for patients with home mechanical ventilation.
  • Home mechanical ventilation protocol for hospitalised patients.
  • Overnight monitoring of mechanical ventilation
  • Overnight oxymetry
  • Transcutaneous PaCO2 monitoring
  • Ventilation software analysis
  • Polysomnography with ventilation
  • Functional and efficacy assessment of the cough in neuromuscular patients
  • Forced spirometry Assessment of muscle strength determining inspiratory and expiratory pressures (MIP and MEP)
  • SNIF pressure Cough efficacy assessment: Peak cough flow Physiotherapy consultation to learn of assisted cough techniques.
  • Manual assisted cough techniques Mechanical assisted cough techniques
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Functional Lung Cancer Unit

The coordinator of this functional multi-disciplinary oncology unit is Dr Susana Padrones, with the collaboration of Dr Samantha Aso. This unit works in the outpatient department of the Duran i Reynals Hospital and at the HUB Medical Day Hospital. Its catalogue of services includes:

  • Diagnosis and staging of cases with suspected pulmonary neoplasm sent from our hospital, from primary care, or from other hospitals in the area of reference.
  • Presentation of cases to the Lung Cancer Committee. Second opinion on cases sent by other hospitals.
  • Diagnosis and treatment of pulmonary toxicity from chemotherapy and radiotherapy.
  • Control of primary and metastatic malignant pleural effusion: pleural talcage, fitting of permanent tunnelled pleural drainage.
  • Pleural and pulmonary biopsy with ultrasound control.
  • Pneumology cross-consultation for the Oncology and Haematology (ICO) departments
  • Functional COPD Unit Activity headed by Dr Salud Santos (head) and Dr Marta López.
  • This unit works at the Medical Day Hospital and in Outpatients.
  • Its catalogue of services includes:
  • Comprehensive medical tracking with primary care.
  • COPD screening of patients seen at HUB.
  • Single-speciality consultation on COPD.
  • COPD patient rehabilitation programme.
  • Patient-oriented training activities: expert patient programme.
  • Special treatment committee.
  • Specific care programme for fragile COPD patients at the day hospital.
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Functional COPD Unit

Activity headed by Dr Salud Santos (head) and Dr Marta López. This unit works at the Medical Day Hospital and in Outpatients. Its catalogue of services includes:

  • Comprehensive medical tracking with primary care.
  • COPD screening of patients seen at HUB.
  • Single-speciality consultation on COPD.
  • COPD patient rehabilitation programme.
  • Patient-oriented training activities: expert patient programme.
  • Special treatment committee.
  • Specific care programme for fragile COPD patients at the day hospital.
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Functional Pulmonary Interstitium Unit

Unit Activity headed by Dr Maria Molina, with the collaboration of Dr Vanesa Vicens. This unit works at the Medical Day Hospital and in Outpatients. Its catalogue of services includes:

  • Diagnosis and treatment of interstitial pulmonary disorders.
  • Presentation of cases to the multi-disciplinary pulmonary interstitium committee.
  • Second opinion in cases with interstitial pathology.
  • Anti-fibrotic treatment of IPF: assessment for inclusion in clinical trials.
  • Monitoring of patients with IPF and care on request at the Medical Day Hospital.
  • Nursing consultation.
  • Assessment of suitability for lung transplantation. 
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Clinical Tuberculosis Unit

Participating in this multi-disciplinary unit on behalf of the Pneumology Department is Dr Jordi Dorca. It is located on the fourth floor of the Old Nursing School building. Its catalogue of services includes:

  • Diagnosis and treatment of pulmonary tuberculosis.
  • Study of contacts.
  • Control of cases with antibiotic intolerance and/or toxicity.
  • Re-treatments of pulmonary tuberculosis.
  • Diagnosis and treatment of Nontuberculous mycobacterial lung disease
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Single-speciality consultations

Activities located in the outpatients area (first floor, module 15).

Pulmonary hypertension

Head: Dr Jesús Ribas, with the collaboration of Dr Yolanda Ruiz.

Services:

  • PHT diagnosis study.
  • Presentation of cases to the Expert PHT Unit for recommended therapy.
  • Monitoring of complex cases.

Occupational lung disease: asbestosis

Head: Dr Vanesa Vicens. Services:

  • Diagnosis and monitoring of asbestos-related pleural-pulmonary disorders.

Chronic bronchial sepsis

Head: Dr Jordi Dorca. Services:

  • Bronchiectasis diagnosis study.
  • Prescription and control of inhaled antibiotherapy.

Pulomonary embolism and other pulmonary vascular disorders

Head: Dr Jesús Ribas. Services:

  • Monitoring of PE cases.
  • Chronic PE study.
  • Osler-Weber-Rendu syndrome study.
  • Hepatopulmonary syndrome study.

Quick Diagnosis Unit - Pneumology

Activity headed by Dr Mercè Gasa, Dr Marta López, and Dr Yolanda Ruiz. Services:

  • Initial fast circuit assessment of cases sent by A&E or other departments.
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Functional Bronchial Asthma Unit

This is a multi-disciplinary team that specialises primarily in care for severe and difficult-to-control asthma. Dr Mariana Muñoz coordinates the unit, which has been accredited as a specialist asthma unit with excellence criteria by the Spanish Society of Pneumology and Thoracic Surgery. Its catalogue of services includes:

  • Diagnosis and treatment of asthmatic pathology and its main comorbidities.
  • Presentation of complex clinical cases to the Functional Asthma Unit.
  • Assessment and indication of biological treatments.
  • Assessment for the inclusion of patients in clinical trials (Phase II, III & IV).
  • Monitoring of complex patients; preferential care of patients at high risk of worsening.
  • Specialist nursing consultation; comprehensive asthma education.

Research

Lines of research

  • Lung inflammation in response to various stimuli
  • Tracheal stenosis
  • New methods of endoscopic imaging
  • Metabolic repercussions of OSA
  • Pulmonary fibrogenesis
  • Bronchial neoproliferation
  • Vascular alterations in COPD
  • Chronic ventilation of neuromuscular disorders

Research groups

  • Researchers from the Idibell Pneumological Research Group form part of different research networks, such as Ciber, the Barcelona Respiratory Network (BRN), the SEPAR integrated research projects, and research groups from other universities (UPC and IQS), as well as different international groups.
  • Several partnership agreements have also been signed with different pharmaceutical and technological industries .

Education

Degree Education

  • In relation to the degree education, Jordi Dorca, adjunct professor of Medical Pathology at the University of Barcelona (Bellvitge Campus), is the coordinator of the Respiratory system disorders subject taken during the fourth year of the Medicine degree. Salud Santos and Maria Molina, associate professors of the Faculty, also teach some of the syllabus of the subject and collaborate in the practical work of the subject, in which most of the department’s staff also take part.

Master's degrees and accredited courses

  • In terms of specialist training, the department offers 2 places for every Residency, which have been fully covered over the past twelve years. All the assigned residents completed their training. The current tutors in the department are Enric Prats and Marta López. Apart from its own specialist training, the department collaborates in the training of other specialists, such as internal medicine, infectious diseases, cardiology, oncology, and family and community medicine. The department also regularly accepts the rotation of residents from other departments in Catalonia and the rest of Spain in the Residency system. Different doctors from the department take part in the combined theory and preparative training programme for European accreditation (Hermes) organised by the Catalan Pneumology Society and aimed at residents in the speciality.
  • Over recent years, the department has accepted internships by specialists from other centres in Catalonia, the rest of Spain, and different countries for ongoing training or to learn new techniques. Finally, the department regularly organises scientific meetings aimed at doctors from this and other specialities with an interest in respiratory diseases. 

Location

Main Building at Bellvitge University Hospital  

c/ Feixa Llarga, sn.

08907 L’Hospitalet de Llobregat. Barcelona

Floor 16 and 17

Telephone number 93 260 76 85