Respiratory medicine

Pulmonology-from the Greek pnèymon (lung) and logos (speech)-is the specialty of internal medicine that deals with the diagnosis and treatment of diseases of the respiratory system, which includes a conduction system represented by the airways and a gas exchange system represented by the lung.

• Chronic obstructive pulmonary disease and emphysema: a potentially progressive disease often caused by tobacco smoking, characterized by coughing and breathing-related problems that slowly worsen.
• Bronchial asthma: frequent inflammatory disease of the bronchi characterized by fluctuating and tendentially reversible obstruction causing difficulty breathing, varying in magnitude and time in response to external stimuli (e.g., allergens, infections).
• Bronchiectasis: bronchial dilatation of various origins manifested by increased phlegm and propensity for lung infections.
• Benign and malignant tumors of the respiratory system.
• Sleep breathing disorders: including obstructive sleep apnea syndrome and obesity syndrome (hypoventilation), conditions characterized by impaired breathing during sleep that is fragmented, resulting in daytime sleepiness.
• Respiratory tract infections.
• Interstitial lung disease: conditions characterized by thickening of the supporting structure of the lung that manifests in progressive fatigue to breathe and can result in irreversible pulmonary fibrosis.
• Pulmonary hypertension: a condition of various origins characterized by elevated pressure values in the pulmonary arteries that requires highly specialized care for proper framing and specific care.
• Cystic fibrosis: a disease involving several organs due to a genetic mutation that results in the production of excessively dense mucus.
• Respiratory failure due to neuromuscular diseases.
• Rare pulmonary diseases.

Specialist examination

Including history, objective examination, evaluation of previously performed examinations and the need for further investigation for optimal problem taking, taking into account the patient's individualized clinical situation and wishes.

Diagnostic examinations

• Respiratory function tests: useful for framing the functional disorder and assessing its severity. Specifically, spirometry, body plethysmography, diffusion test, methacholine bronchoprovocation test or exercise bronchoprovocation test, measurement of respiratory mechanics are proposed.
• Exercise capacity examinations: ergospirometry is used to determine the presence and extent and origin of decreased exercise capacity.
• Sleep respiratory pathology examinations: inpatient or outpatient respiratory polygraphy, pulse oximetry, capno oximetry, and therapeutic titration with CPAP equipment.
• Airway endoscopy: diagnostic flexible bronchoscopy examinations that allow visualization of the airway using a flexible tube in the airway under deep sedation or general anesthesia. Bronchoscopy allows biopsy and microbiological samples that are essential for the diagnosis of multiple lung conditions. Technologies present: ultrafine bronchoscopes, endosonography (EBUS and R-EBUS), radioscopy, cryoprobe.
• Chest sonography: non-invasive, radiation-free imaging technique that is increasingly being used for the diagnosis of various lung and pleural diseases.

Proposed treatments and therapies

• Prescription of inhaled and systemic treatments according to the diagnosed pathology and instruction in their execution.
• Sleep respiratory disease therapy: CPAP (continuous positive pressure therapy), mandibular advancement system therapy, and positional therapy for patients with obstructive sleep apnea syndrome.
• Chronic respiratory failure therapy including prescription and adaptation of home oxygen therapy and noninvasive and invasive ventilotherapy.
• Therapeutic rigid bronchoscopy: for removal of foreign bodies, recanalization of lower airway with or without placement of endoprosthesis (stent) due to tumor invasion or compression. Technologies present: various rigid bronchoscopes, argon plasma coagulation, cryoprobes, metal and silicone stents.
• Multidisciplinary discussion and proposal for personalized treatment of oncologic diseases of the chest within the Swiss Italian Lung Center.
• Intercantonal multidisciplinary discussion of some complex diseases: Severe Asthma, Interstitiopathy, Pulmonary Hypertension, Emphysema Board.
• Tobaccology consultation.

Useful information