Pediatric Pulmonology Clinic
The Pediatric Pulmonology Clinic at the Archbishop Makarios III Hospital started its operation in 1998 and is the only national tertiary referral centre for children suffering with respiratory problems in Cyprus. The Pediatric Pulmonology Clinic provides a high-level critical care to children with common and complex respiratory problems, applying diagnostic, monitoring and treatment protocols based on current international guidelines.
The Pediatric Pulmonology Clinic manages children with a wide range of respiratory disorders, including asthma, chronic and acute bronchitis, chronic cough, noisy breathing, respiratory tract infections, complicated pneumonias, bronchiectasis, congenital respiratory disorders, as well as patients with gastroesophageal reflux disease and children supported by non-invasive home mechanical ventilation.
The Clinic is also a national center for reporting and monitoring chronic hereditary lung disorders, such as Cystic Fibrosis and Primary Ciliary Dyskinesia. Early diagnosis and proper treatment may prevent or delay the progression of these diseases.
The Clinic has been participating since 2018 in the European Reference Network for Rare Respiratory Diseases (European Reference Network – ERN-LUNG). Since October 2021, the Clinic has been approved to participate as a full member in the ERN-LUNG for PCD after an external evaluation of the quality of services offered to Primary Ciliary Dyskinesia patients by an independent body. In addition, the clinic is a member of the Clinical Trials Network (CTN) for PCD.
In May 2022, the Pediatric Pulmonology Clinic has been successfully accredited with ISO 9001:2015 and ISO 15224:2016 for its inpatient and outpatient services.
MEDICAL EQUIPMENT AND TESTS
LUNG FUNCTION TESTING - Spirometry Electrical impedance tomography (EIT) Forced Oscillation Technique (FOT) Multiple Breath Washout Test Fractional Exhaled Nitric Oxide (FeNO) Measurement
We use standard as well as advanced lung function tests for diagnostic and research purposes, such as:
Spirometry
To perform a spirometry test, the patient is asked to blow forcefully into a mouthpiece connected with a handheld electronic device. As it needs patient’s cooperation, it is feasible to perform the test from late preschool age. It measures lung volumes and flows and estimates central airway function. Two portable Vitalograph spirometers (Ennis, Ireland) are available in our laboratory.
Electrical impedance tomography (EIT)
The electrical impedance tomography (EIT) (ENLIGHT 2100, Innoventiv, BE) is an innovative functional imaging method that records local impedance changes in the thorax cavity and provides an estimate of ventilation distribution in the lungs, without using any kind of radiation.
Multiple Breath Washout Test
The MBW test is performed during tidal breathing, and thus it is feasible to perform from infancy onwards. Our laboratory is equipped with the EXHALYZER D washout system (Ecoedics AG), which allows for the measurement of lung volumes and estimates peripheral airway function, as well as the degree of inhomogeneous ventilation in the lung (using the Lung Clearance Index, LCI).
Fractional Exhaled Nitric Oxide (FeNO) Measurement
FeNO concentration is a marker of allergic airway inflammation and is measured by exhaling slowly into a device. Our lab has one stationery CLD88sp Nitric Oxide Chemiluminescence Analyzer (Ecomedics) and three hand-held NIOX VERO (Circassia) FeNO devices with an electrochemical sensor.
Forced Oscillation Technique (FOT)
The forced oscillation technique is a non-invasive method to characterize the mechanical properties of the respiratory system under different frequencies and provides airway resistance measurements. Our laboratory is equipped with the Resmon V3 (Restech) device.
PRIMARY CILIARY DYSKINESIA (PCD) DIAGNOSTICS - Nasal Nitric Oxide (NO) Measurement High Speed Video Microscopy (HSVM) Transmission Electron Microscopy (TEM) Genetic Analysis Ciliated Cells Culture Unit
Our laboratory uses state-of-the-art diagnostic methods for PCD, based on the latest ERS guidelines (Lucas J et al, Eur Respir J 2017):
Nasal Nitric Oxide (NO) Measurement
The measurement of exhaled nasal NO concentration is used as a screening test for PCD diagnostics, as nasal NO is found low in PCD patients. Our laboratory uses the Ecomedics CLD88sp Nitric Oxide Analyzer.
High Speed Video Microscopy (HSVM):
HSVM is used to assess cilia motility ex vivo in tissue collected through nasal biopsy. Our laboratory is equipped with an inverted microscope (Axiovent 200M, Carl Zeiss AG), a High-Speed Video Microscopy camera (Basler scA640, Ammons Engineering), and the automated SAVA SYSTEM (Ammons Engineering) for the performance of HSVM.
Transmission Electron Microscopy (TEM):
In collaboration with the Cyprus Institute of Neurology and Genetics, tissue collected through the nasal biopsy is further processed for TEM examination (TALOS L120C) of the ciliary ultrastructure.
Genetic Analysis
In collaboration with the CY Biobank at the Medical School of the University of Cyprus, blood samples are further processed for genetic analysis to identify PCD-causing mutations.
Ciliated Cells Culture Unit
In collaboration with the Laboratory of Cell Biology and Molecular embryology, Dept of Biology of the University of Cyprus, nasal epithelial cells are cultured in air-liquid-interface (ALI) cultures for research purposes.
BRONCHOSCOPY
Endoscopy is used to inspect the upper and lower airways for diagnostic and therapeutic purposes, using flexible bronchoscopes. The lab is equipped with the full range of pediatric scopes from 2.2 to 3.8 mm outer diameter (Olympus, Germany), enabling airway examination in the pediatric age group from premature infants until adolescents.
ESOPHAGEAL PH-IMPEDANCE STUDIES
This is the gold-standard method for diagnosis of gastro-esophageal reflux in infants and children by inserting a pH-Impedance catheter into the esophagus. For the performance of 24-hour esophageal pH-Impedance studies, our laboratory is equipped with the Ohmega MMS system (Laborie, NL).
Inpatient Care and Coverage
The Pediatric Pulmonology Clinic operates daily (Monday to Friday) dealing with referrals from personal doctors or specialists. Patients that require inpatient care are managed, depending on their age and condition, either in the general pediatric wards or in the intensive care units (neonatal or pediatric) under the supervision of the Pediatric Pulmonary Clinic, in collaboration with the physicians of the respective departments/units.
Please phone 22-405116 to book appointments. The appointment’s telephone line operates daily, from 08:00 to 13:00.
COMMUNICATION WITH FAMILY AND PATIENTS
There is direct and continuous communication between the specialised physicians of the Pediatric Pulmonology Clinic of the Archbishop Makarios III Hospital and the patients and their families at any stage of their management, aiming to answer in a timely and effective way any possible questions that may arise about the diagnosis, course of the disease and treatment plan. The Clinic has also adopted the model of “Nurse Specialists”, where registered nurses, after many years of training and experience, take on a special role in the communication and guidance of patients and their families during their contact with the hospital through the various stages of follow up, assessment and treatment.
EXTERNAL ACCREDITATION
In May 2022, the Pediatric Pulmonology Clinic of the Archbishop Makarios III Hospital, under the guidance of the Pediatric Pulmonologists of the Medical School of the University of Cyprus, has successfully passed the external accreditation by the standards ISO 9001:2015 and ISO 15224:2016 for the quality of the inpatient and outpatient services that provides to its patients.
Also, in 2021, the Pediatric Pulmonology Clinic of the Archbishop Makarios III Hospital, in collaboration with the Medical School of the University of Cyprus and the Cyprus Institute of Neurology and Genetics, was approved as a full member of the European Reference Network for rare lung diseases (ERN – LUNG), for the disease of Primary Ciliary Dyskinesia (PCD core). The accreditation came after extensive evaluation and on-site audit by European Commission officials, At the same time, the Clinic is a member of the Clinical Trials Network (CTN) for Primary Ciliary Dyskinesia, which aims to improve clinical and translational research and develop new treatments for the disease.