Treatment of lung emphysema with endoscopic reduction of lung volume by valve implantation

About the department

The Department of Pulmonology at the Nuremberg Hospital offers the full range of medical services to patients with lung and respiratory diseases. The department's main clinical focus is the treatment of infectious lung diseases, interstitial lung diseases, bronchial asthma, pulmonary emphysema, chronic obstructive pulmonary disease, and rare lung diseases. The department also specializes in the treatment of lung cancer and is part of the Lung Cancer Center certified by the German Cancer Society. The department has 155 beds for inpatient treatment. The medical facility also houses an Intensive Care Unit with 36 beds. State-of-the-art equipment is available here for the performance of all required therapeutic measures, including extracorporeal membrane oxygenation. The department has one of the largest Bronchoscopy Units in Germany, where modern interventional diagnostic and therapeutic procedures for patients with lung diseases are successfully performed. The department's medical team consists of more than 250 employees, 70 of whom are highly qualified physicians. More than 6,120 inpatients and about 5,000 outpatients are treated in the department every year. The Head Physician of the department is Prof. Dr. med. Joachim Ficker.

The department is a leading medical facility where many modern diagnostic and therapeutic procedures are performed that are not available in every medical center. The Bronchoscopy Unit is a source of pride for the department's specialists. It has the status of being one of the largest and best in all of Germany. Bronchoscopy is an indispensable procedure in the work of the department's pulmonologists and can be used for both diagnostic and therapeutic purposes. The essence of bronchoscopy is as follows: a special endoscopic instrument (bronchoscope) with an integrated video camera and a light source is inserted through the mouth or nose into the respiratory tract under imaging guidance. Depending on the clinical case, bronchoscopy can be performed either under sedation or local anesthesia, and in complex cases, it can also be performed under general anesthesia.

During diagnostic bronchoscopy, the department's pulmonologists have the opportunity to assess the features of the anatomical structure of the human respiratory system and its functions. When performing bronchoscopy, doctors can detect pathological changes in the bronchi, airway stenosis, trauma to the respiratory system, the presence of foreign bodies or neoplasms, etc. As for the treatment, bronchoscopy is an excellent alternative to open surgery when conservative therapy is ineffective. The department's doctors successfully use endoscopic techniques to perform procedures for treating stenosis and pulmonary hemorrhage, implanting special valves to treat severe forms of pulmonary emphysema, conducting argon-plasma coagulation, steam ablation, laser resection of lung neoplasms, removing foreign bodies from the respiratory tract, etc.

An integral part of the department's pulmonologists work is the treatment of lung cancer and pleural mesothelioma. Patients with these oncological diseases undergo treatment at a specialized center certified by the German Cancer Society (DKG). Lung Cancer Center employs highly qualified specialists, such as pulmonologists, thoracic surgeons, oncologists, radiation therapists, radiologists, and others who work hand in hand. The medical team of the specialized center admits more than 1,000 patients with small cell and non-small cell lung cancer every year, boasting unique experience and high professional skills.

Should lung cancer be suspected, the patient will undergo comprehensive diagnostics, including abdominal and chest CT, head CT or MRI, pulmonary function tests, bronchoscopy, heart ultrasound scanning, electrocardiography, biopsy, positron emission tomography, and laboratory tests. The specialists also have the necessary laboratory resources to detect gene mutations in lung tumors, which is important for successful treatment. The highly specialized physicians study the obtained diagnostic data during interdisciplinary boards, after which they elaborate an optimal treatment regimen. An attending physician discusses the upcoming treatment with the patient, providing detailed information about its specifics and expected outcomes. In most cases, surgical resection of a malignant tumor is the basis of treatment. Surgery may be complemented by conservative therapies, such as chemotherapy, radiation therapy, targeted therapy, immunotherapy, and other treatments.

The department has also gained vast clinical experience in the treatment of chronic obstructive pulmonary disease (COPD). The main symptoms of the pathology include coughing (often with sputum), wheezing, and increased fatigue. The therapy is aimed at slowing the development of the pathological processes and improving the quality and duration of the patient's life. In the course of COPD treatment, the department's pulmonologists use drug therapy in combination with physiotherapeutic procedures. Since the main cause of chronic obstructive pulmonary disease is smoking, the decisive factor in treatment success is its cessation. The department offers specially developed smoking cessation programs. The last-line treatment for COPD may include lung volume reduction surgery, home mechanical ventilation, and long-term oxygen therapy.

The department's key clinical focuses include:

• Diagnostics and treatment of lung cancer
• Diagnostics and treatment of pleural mesothelioma
• Diagnostics and treatment of chronic obstructive pulmonary disease
• Diagnostics and treatment of emphysema
• Diagnostics and treatment of bronchial asthma
• Diagnostics and treatment of interstitial lung disease
• Diagnostics and treatment of infectious lung diseases
  • Tuberculosis
  • Atypical mycobacterial diseases (MOTT, HTM)
  • Coronavirus
  • Pneumonia
  • Flu
• Diagnostics and treatment of rare lung diseases
  • Pulmonary lesions due to rheumatic diseases
  • Granulomatous lung disease: sarcoidosis and extrinsic allergic alveolitis
  • Pulmonary eosinophilia
  • Pulmonary alveolar proteinosis
  • Lymphangioleiomyomatosis
  • Birt-Hogg-Dube syndrome
  • Pulmonary Langerhans cell histiocytosis
  • Amyloidosis
  • Pulmonary hemosiderosis
  • IgG4-related lung disease
  • Primary ciliary dyskinesia
  • Cystic fibrosis
  • Swyer-James-MacLeod syndrome
  • Allergic bronchopulmonary aspergillosis
  • Alpha-1 antitrypsin deficiency
  • Pulmonary hypertension
• Diagnostics and treatment of other pulmonary diseases

The department's therapeutic options include:

• Drug therapy
• Endoscopic treatment (bronchoscopy)
  • Laser resection of tumors in the organs of the respiratory system
  • Argon plasma coagulation
  • Steam ablation
  • Endoscopic valve placement for severe forms of pulmonary emphysema
  • Endoscopic stent implantation
  • Endoscopic removal of foreign bodies
  • Cryotherapy
• Oxygen therapy
• Mechanical ventilation
• Inhalation therapy
• Physiotherapy
• Other treatment methods