DEPARTMENT OF PULMONOLOGY

The Department of Pulmonology is the most advanced clinical department in Lithuania, specializing in pulmonology and utilizing the latest diagnostic and treatment techniques. The Department has 4 sectors:

• Functional diagnostics of obstructive lung diseases and respiratory function
• Thoracic Oncology and Interventional Pulmonology
• Vascular and Diffuse Diseases
• Sleep-disordered breathing and pulmonary ventilation

The doctors at our clinical department work at the following units:

• Outpatient Sector (2 consulting rooms)
• Pulmonology Unit (52 beds)
• Sleep Laboratory (3 specialised testing stations)
• Pulmonary Function Testing (PFT) room
• Bronchology Office
• Pulmonologist’s Office within the Chemotherapy Inpatient Day Unit

The Department also has a Pulmonology Laboratory, where research and other scientific activities take place.

The Department of Pulmonology examines and treats patients with all diseases of the lower respiratory tract. The latest state-of-the-art equipment is used to perform a wide range of pulmonary function tests (spirometry, bronchoprovocation test using methacholine (methacholine challenge test) or allergen, exercise challenge test, gaseous diffusion, plethysmography, respiratory muscle strength measurement, exercise tolerance test, sputum induction, fractional exhaled nitric oxide test, etc.). The Bronchology Office performs complex and wide-ranging interventional procedures, in some cases postponing or even substituting the need for surgical procedures, while minimising the incidence of potential complications. Interventional pulmonology is especially pertinent to lung cancer and interstitial lung diseases. In 2009, the pulmonologists at the Department became the pioneers in Lithuania by introducing endobronchial and endoscopic ultrasound, which is the most advanced and cutting-edge minimally invasive diagnostic technique. This method is equivalent to surgical procedures in terms of efficacy and is characterised by high safety and low complication rate. These tests can also be performed on an outpatient basis, eliminating the need for hospitalisation and surgery. Cryobiopsies have been performed since 2017. It is a new transbronchial lung tissue biopsy technique with relatively high sensitivity that facilitates the diagnosis of diffuse lung diseases.

To enhance the treatment of one of the most common lung diseases, lung cancer, the Department of Pulmonology initiated the first genetic testing for lung cancer in the Baltic States in 2010. This testing involves the detection of endothelial growth factor receptor (EGFR) mutations in both lung tissue and blood serum. Subsequently, they expanded the testing capabilities to include an anaplastic lymphoma kinase (ALK) translocation test. The findings from these studies are used to tailor individualized treatment with targeted therapy drugs for non-small cell lung cancer.

In 2016, the Department began treating idiopathic pulmonary fibrosis with anti-fibrotic drugs that effectively slow down the progression of the disease. The patient registry of the Department helps assess the long-term efficacy and safety of treatment.

Clinical work focuses considerably on multidisciplinary activities. All cases of thoracic oncology, interstitial lung diseases and severe asthma are discussed regularly (weekly) in multidisciplinary consilium meetings. Kaunas Clinics is the only facility in Lithuania performing lung and lung-heart complex transplants, which is why it actively cooperates with the Department of Cardiac, Thoracic and Vascular Surgery.

To optimise the examination of patients with rare diseases and to ensure ongoing specialist care, dedicated rare disease centres have been established at the Department of Pulmonology: Pulmonary Hypertension Centre (headed by Prof. Dr. S. Miliauskas), Adult Cystic Fibrosis Centre (headed by Prof. Dr. K. Malakauskas), Severe Asthma Centre (headed by Assoc. Prof. Dr. K. Biekšienė).

Doctors at the Adult Cystic Fibrosis Centre actively collaborate with paediatric pulmonologists, facilitating the substitution of treating physicians for the patients. Detailed genetic testing, including gene sequencing, and the use of one of the latest sweat chloride tests in clinical practice enable rapid and accurate testing of patients. A strong team of physical medicine and rehabilitation doctors, physiotherapists, and dieticians contribute to the effective treatment of patients. The Department has purchased a cough assist device to assist in clearing bronchial secretions from the airways. Stagnation of these secretions, caused by the pathogenetic mechanisms of the disease, may significantly worsen the patient’s condition. Since 2010, the Adult Cystic Fibrosis Centre has been participating in the European Cystic Fibrosis Society Patient Registry.

At the Pulmonary Hypertension Centre, patients are examined in line with global diagnostic guidelines. Specific treatments are prescribed for primary pulmonary hypertension, and patients receive rigorous monitoring and follow-up care. Patient data is collected, analysed and summarised in a local register.

The Severe Asthma Centre ensures the prompt referral of patients with severe asthma to specialist. It also performs a wide range of tests (from pulmonary function tests to complex radiological and interventional tests) in order to clarify the damage caused by the disease and to rule out other possible causes behind the severe disease process. Since 2017, the Department began implementing active treatment of severe asthma with biologics. These biological drugs are selected after assessing the patient’s disease phenotype, based on validated clinical and biological markers. Since 2018, Assoc. Prof. Dr. K. Biekšienė, head of the Severe Asthma Centre, has been approved as the national leader of the Severe Heterogenous Asthma Research collaboration, Patient-centred Clinical Research Collaboration project, funded by the European Respiratory Society (ERS) by the decision of the Steering Committee.