Recherche

What is a respiratory allergy? A blocked or running nose, itching eyes, sneezing, night cough, breathing problems... Whether chronic, persistent or seasonal, these symptoms can be the sign of a respiratory allergy (such as hay fever) and/or an asthma of allergic origin. Not all cases of asthma or rhinitis are attributable to an allergy. However, it is important to know whether or not this is the case as this will determine the choice of treatment, its effectiveness and even certain reimbursements!  Care The H.U.B’s Asthma and Allergic Diseases Clinic offers diagnosis and treatment for persons with these diseases or who present respiratory or skin symptoms of the allergic type.    Diagnosis and follow up   First consultation: The person is seen by a pneumologist who notes the symptoms, their frequency and the moments and circumstances in which they appear. The doctor will also carry out a spirometry test which is a simple test that measures the respiratory function. A prick test is also carried out to identify the allergen(s) responsible for the symptoms. This skin test involves placing a drop of the allergen on the arm and then pushing it beneath the epidermis using a fine needle.  The patient should also have a blood test the same day at the Testing Centre. There is no need to fast. In all cases the doctor will already be able to diagnose treatment to relieve the symptoms.    Tests for asthma: if asthma is suspected,  If the respiratory test shows a bronchial obstruction, a bronchodilatation test is carried out immediately;    If the respiratory function is normal, the person is asked to return for a bronchial provocation test using histamine. Carried out under medical supervision, this test makes it possible to either rule out or confirm asthma with quasi certainty.    Second consultation : 6 to 8 weeks later, the patient returns for a consultation.  Aims: to assess the response  to the symptomatic treatment and to discuss the blood test results and other treatment that could be considered.    Follow-up consultations : Once the asthma or respiratory allergy is under control, follow up is proposed at a frequency that depends on the severity of the condition.    Good to know: Depending on the case and needs, the H.U.B.’s Asthma and Allergic Diseases Clinic proposes joint consultations. This enables patients to see  a pneumologist and ENT specialist at the same time or, in the case of a skin allergy, a pneumologist and dermatologist.    Persons with asthma can also benefit from treatment education programmes at the  School of Asthma. Treatment Treatment for a respiratory allergy depends both on the allergens in question and the symptoms.    Symptomatic treatment includes antihistamines taken orally, corticoid-based nasal sprays and eye drops.     Immunotherapy consists of modifying the immune response of the patient, causing it to evolve from an allergic status to a tolerance status in regard to the allergen.   Immunotherapy often involves taking tablets that melt on the tongue or otherwise drops. This treatment is effective but it is relatively long and costly. It is only reimbursed if the asthma is caused by an allergy to dust mites and associated with a dust mite allergic rhinitis.      Asthma treatment (bronchodilatators, anti-IgE, anti-interleukins, biological treatment, etc.) is varied and  depends on the type of asthma. As the illness varies over time, the treatment must be adapted accordingly.    Advice Treatment by avoidance is always recommended in the case of allergies. This involves avoiding as much as possible exposing oneself to allergens or applying certain measures to reduce to the maximum exposure to the allergens. For example: washing sheets at 90°C; airing rooms in winter when it is cold; in the case of allergy to dust mites, closing the windows when pollen is at a peak (allergies to grains and other pollens), etc.    Image Research The main line of translational research pursued by the H.U.B’s Asthma and Allergic Diseases Clinic concerns inflammation of the lower respiratory tract (bronchi). Doctor  researchers work on the use of exhaled NO to guide immunotherapies and biological therapies as well as on induced expectorated sputum as a means of identifying the phenotype of an asthma and to guide treatment.    Related service Related doctors

What is irritable bowel syndrome? Irritable bowel syndrome is a chronic digestive disorder that affects the small and large intestine. Common symptoms are stomach pain and bloating associated with changes in the intestinal transit (constipation or diarrhoea). An estimated 10% of Belgians suffer from this disease. The causes are multiple and examinations (blood tests, imaging, endoscopy) do not show any anomaly.  Clinic The Functional Digestive Disorders Clinic at the Erasmus Hospital proposes a digestive comfort consultation in order to evaluate the situation, relieve symptoms and improve the quality of life of patients. Treatment includes changes to diet, dietary consultation, medication and sometimes physiotherapy as part of a multidisciplinary approach.    Research Innovative tratment is regularly proposed in the framework of clinical trials.    Our specialists Associated service

What is Parkinson’s disease? Parkinson’s disease is a common neurodegenerative disease, the second most common after Alzheimer’s. It is caused by a lack of the neurotransmitter dopamine that is present deep in the brain. Parkinson’s is estimated to affect some 30,000 people in Belgium, which is about 2.5 people for every 1,000 inhabitants. Parkinson’s disease is slightly more prevalent among men than women. The causes remain unclear and complex genetic and environmental factors are no doubt involved. Typical signs of Parkinson’s are resting tremors, stiffness and slowness of movement. There can also be non-motor symptoms that may affect sleep, behaviour or memory for example. Treatment Neurologists can prescribe medication. This does not treat the disease itself but is effective in alleviating symptoms. Physiotherapy can also play an important role in maintaining a good physical condition. A complete physiotherapy assessment can be carried out in cooperation with the Centre for Adult Neurological Functional Rehabilitation. At an advanced stage of the disease, deep brain stimulation  may be proposed in cooperation with the Department of Neurosurgery, especially for persons  aged under 70. Other persons can benefit from pump treatment that introduces medication into the digestive tract. This is carried out in cooperation with the Department of Gastroenterology.    Other diseases Certain rare diseases can resemble the early stages of Parkinson’s disease. Neurologists will draw on their expertise to detect specific signs of these diseases that are known as  Parkinson-plus syndromes and they will make the differentiation, often in cooperation with the Departments of Diagnostic Neuroradiology, Nuclear Medicine and in association with neuropsychologists.   Not all tremors indicate Parkinson’s. Essential tremor is a disease that can be distinguished by the fact that the trembling is the only symptom and is distinctive in that it occurs when making certain movements, such as eating, drinking or brushing your teeth. It is often overlooked despite the fact that it is probably more common than Parkinson’s disease. It can be treated very effectively with medication and more rarely with neurosurgery.   Dystonia is a neurological disease resulting in an abnormal muscle tone caused by a bad signal sent by the brain. Persons with dystonia suffer from involuntary muscle contractions. This causes abnormal posture or movements, such as torticolis, writer’s cramp and blepharospasm (involuntary contraction of the eyelid muscles). It can also be generalised, confining patients  to a wheelchair or distorting  the skeleton. It can affect people of any age, including children. Treatment is by medication, especially botulinum toxin injections, and sometimes by neurosurgery with deep brain stimulation.   Huntington’s disease is a neurodegenerative disease characterised by involuntary movements that are called chorea, cognitive disorders and behavioural disorders. It is transmitted by parents to the children with a 50% risk of transmission. A simple genetic test gives a diagnosis with 100% certainty. There is worldwide registration of Huntingdon’s disease, on the  Enroll-HD research platform to which we contribute, and that operates as a gateway to possible clinical trials. Treatment is for the symptoms only and of limited effectiveness although progress in recent years is encouraging.  Other pathologies are also treated:   restless leg syndrome, Gilles de la Tourette syndrome, paroxymal dyskinesia, orthostatic tremors, etc.   Our specialists Related service

What is systemic mastocytosis Systemic mastocytosis is a rare disease. Mastocytosis is a group of diseases that cause an excessive build up of mast cells in the body. A mast cell is a type of white blood cell that helps our immune system to function correctly.  When you suffer from systemic mastocytosis an excess of mast cells builds up in the skin, bone marrow, digestive tract or other body organs. When activated these mast cells release substances that can trigger signs and symptoms similar to those of an allergic reaction. Serious inflammation can sometimes cause organic lesions. Common triggers include alcohol, spicy food, insect bites and some medicines. Mast cell activation syndrome and systemic mastocytosis present the same signs and symptoms. In the case of mast cell activation syndrome there is no build up of mast cells in the bone marrow. Systemic mastocytosis is also characterised by the presence of a mutation of the c-KIT gene. This mutation is not generally hereditary.  Care The signs and symptoms of systemic mastocytosis depend on the part of the body affected by an excess of mast cells. An excess of mast cells can build up in the skin, liver, spleen, bone marrow or intestines. More rarely, other organs such as the brain, heart or lungs can also be affected The signs and symptoms of systemic mastocytosis can include Flushing, itching.Abdominal pain, diarrhoea, nausea or vomiting.Palpitations, feeling faint.Allergic reactions ranging from urticaria to Quincke’s oedema and anaphylaxis Coughing, shortness of breath, rhinorrhea, lachrymation.Frequent urination, urinary burning.Bone and muscle pain.Depression, mood changes or problems concentrating.Anaemia or bleeding disorders.Enlarged liver, spleen or lymph nodes.The various triggers for mastocytosis symptoms include: Insect bites.Food rich in histamine or histamine liberators.Physical factors (change in temperature, fever) Surgery, traumas.Certain medicines.To diagnose systemic mastocytosis a biopsy of the organ or organs affected is necessary to establish the link between the symptoms and the illness. The biopsy is to detect the presence of an accumulation of mast cells as well as the c-KIT mutation. The tryptase level is a blood marker that is very often useful for the diagnosis. Once the diagnosis has been established a number of additional examinations must be carried out (abdominal ultrasound, bone density test, osteo-medular biopsy) to determine the severity.   There are two aspects to mastocytosis treatment. The symptomatic treatment aims to control the symptoms whereas the antiproliferative treatment aims to control the excessive production and accumulation of mast cells in the organs. Antiproliferative treatment is not always required and will depend on the specialist’s assessment. Symptomatic treatment is based on identifying and eliminating factors that trigger the symptoms as well as the use of antihistamines, antacids and other anti-allergy medication. An adrenaline pen is proposed to patients who have had a severe anaphylactic reaction.The antiproliferative treatment is based on chemotherapy and certain targeted therapies. In rare cases an allogeneic stem cell transplant can be envisaged  Advice If you are being monitored for a stystemic mastocytosis and you have respiratory distress or feel faint (Quincke’s oedema or anaphylaxis) you should go immediately to the emergency department or dial 112. If you have an auto-injector EPIPEN (adrenaline) you should use it to make an intramuscular injection while awaiting the arrival of the ambulance.  Focus Patients with symptoms that are suspected to indicate a mastocytosis will be directed to a consultation with a specialist. You may be directed initially to haematology or internal medicine and then redirected to another specialist depending on the results.  Our specialists Related services

What is Histiocytosis? Histiocytosis refers to a group of rare tumour pathologies characterised by the accumulation of histiocytes (a subgroup of immune system cells) in various tissues. This group of diseases includes, most notably,  Langerhans cell histiocytosis, Erdheim-Chester disease, Rosai-Dorfman disease and malignant histiocytoses and cutaneous histiocytoses.  Frequently affected organs are the skin, bones, lungs, pituitary gland, the central nervous system, the heart, the large blood vessels and the retroperitonium.The diagnosis is based on microscopic and genetic analyses carried out on biopsies of the affected organs.  Due to the rarity of these diseases and the sometimes difficult anatomopathological analysis, consultation is required between the reference centres for the purposes of diagnosis and treatment.    Treatment A multidisciplinary approach is adopted for the treatment of histiocytosis. The treatment will depend on the type of histiocytosis and the seriousness of the affected organs  Close monitoring without treatment can sometimes be proposed. In some situations, the use of analgesic medicines and bone consolidation succeeds in managing symptoms.  For certain localised bone or cutaneous forms of histiocytosis, surgery and radiotherapy enable the disease to be managed or even cured. In other more serious situations it can be necessary to have recourse to the use of corticoids or chemotherapy.  In 2010, the discovery of genetic anomalies in cases of histiocytosis made it possible to improve significantly the treatment of severe forms thanks to the use of targeted therapies.  The often chronic nature of these diseases justifies regular monitoring by a specialist in the field of histiocytoses.     Useful linksAssociation Histiocytose France et Groupe d’Etude des Histiocytoses : Histiocytose.org - Histiocytose Langheransienne - histiocytose.orgFilière de santé Maladies Rares Immuno-Hématologiques (MARIH) : Accueil - MaRIH - Filière de santé Maladies Rares Immuno-Hématologiques Our specialists Prof. Virgnie de WildeAssociate Director of Hematology (Erasme) Make an appointment Dr. Tom AbrassartHematologistSpecialist in Histiocytosis Make an appointment Advice Patients with histiocytosis sometimes have a long waiting period before obtaining a firm diagnosis. Please feel free to contact our team regarding a diagnosis and benefit from a medical assessment. Focus Our department is actively involved in  number of protocols for translational and clinical research (expression of BCL2 in histiocytoses, in cooperation with the French reference centre for histiocytoses, under the supervision of Professor Julien Haroche.Do not hesitate to talk to your haematologist.  Discover our Hematology Department

What is porphyria? Porphyrias are rare disorders caused by a deficient production of haem, an essential molecule for the transport of oxygen (via the haemoglobin) and the elimination of medicines (via the cytochromes). Depending on the type of porphyria these diseases result in abdominal pain,  neurological disorders and/or skin problems. Some crises can be triggered by certain medicines, fasting, alcohol or an infection. In most cases porphyrias are hereditary diseases that develop during adulthood. Some of the skin problems can become apparent during childhood while others can be secondary to other health problems. The diagnosis is established by blood, urine and genetic tests. Treatment of porphyria Treatment of porphyria depends on the type of porphyria. Acute porphyrias require a multidisciplinary approach based on prevention and the treatment of acute attacks. Haem is administered via a central venous catheter in acute situations.  Pain management sometimes requires the administration of powerful analgesics. Neurological disorders can require specific care.  Prevention consists principally of  eliminating trigger factors such as certain medicines (especially the contraceptive pill) and alcohol.  Certain severe forms may require a liver transplant.  Recently, a new treatment with Givosiran has made it possible, under certain specific conditions, to improve the quality of life of patients who suffer recurring acute attacks of porphyria. This can only be prescribed following an initial assessment at one of the 2 reference centres in Belgium, one of which is at the Brussels University Hospital (H.U.B) and the other at UZ Leuven university hospital. When the porphyria takes the form of a skin complaint, treatment can be by bleedletting, medicines and/or protection against the sun.  In the long term, porphyrias  can be accompanied by complications such as high blood pressure, chronic kidney disease or liver problems.Regular follow-up with a specialist is therefore essential to prevent acute attacks and to identify complications related to the disease. Our specialists Need some medical advice?Dr. Tom AbrassartHématologistSpecialized in porphyria Make an appointment Focus The Hematology Department of the Brussels University Hospital (H.U.B) and the Medical Chemistry Department of LHUB-ULB together form the Belgian Porphyria Centre, which is one of the 16 expert clinical centers for porphyrias (PECC). In Belgium, it is one of the two centers authorized to initiate treatment with Givosiran.The Medical Chemistry Department is one of the specialized centers in the international network dedicated to porphyria, IPNET. It also holds recognition as a National Reference Center for Rare Diseases for certain analyses related to porphyrias. Discover our Hematology Department Associate doctors Prof. Frédéric Cotton - Head of Medical Chemistry Department - Laboratoire Hospitalier Universitaire de Bruxelles (LHUB-ULB).Prof. Fleur Wolff - Head of Hormonology Clinic -  Laboratoire Hospitalier Universitaire de Bruxelles (LHUB-ULB).Ph.Biol. David Fage - Medical Director - Special Biochemistry -  Laboratoire Hospitalier Universitaire de Bruxelles (LHUB-ULB).

What is a vasospasm ? A brain vasospasm is a frequent and serious complication that occurs following a subarachnoid haemorrhage (SAH) due to the rupture of an intracranial aneurysm. It is characterised by a prolonged and severe narrowing of the brain arteries, thereby reducing the blood flow to the brain and possibly resulting in secondary strokes.  Symptoms Vasospasm symptoms can vary depending on the area of the brain affected and include:  Severe headachesConsciousness  problemsFocal neurological deficits (paralysis, speech problems)Confusion, agitationEpileptic fitsThese symptoms generally appear between the third and 14th day after the aneurysm rupture, the incidence peaking at around the seventh day.    Treatment Imaging examinationsTo detect and monitor a vasospasm a number of imaging methods are used:    Brain angiograph: regarded as the gold standard for detecting a vasospasm.CT scan  with angiograph (CTA) and perfusion : useful for visualising  the brain arteries and the impact on the arrival of blood in the brain  Magnetic Resonance Imaging (MRI) with angiograph (MRA): non-invasive alternative that is a more complex procedure to carry out in an emergency.Transcranial Doppler (TCD) ultrasound: non-invasive method that makes it possible to measure the rate of the blood flow  to the brain arteries, indicative of a vasospasm.  Medical pathwayPatients having suffered a vasospasm are generally treated at a specialised hospital, in particular in neurosurgery or interventional neuroradiology. The pathway includes the intervention of :  Emergency staff: first to intervene following the rupture of an aneurysm.Neurosurgeons: for initial management of the aneurysm and complications.Interventional neuroradiologists: for diagnosis and treatment with embolization of the aneurysm.Neurologists: for follow up and management of neurological complications.TreatmentTreatment options for a vasospasm include:    Medicinal treatment: administration of calcium channel blockers (nimodipine) to prevent  vasospasms. A high level of evidence for prevention but limited for treatment.  Endovascular treatment: balloon angioplasty, stents or intra-arterial administration of vasodilators  (nimodipine, papaverine, milrinone). These treatments show a variable effectiveness depending on the studies and are often used in the case of severe and refractory vasospasm.  Haemodynamic treatment: increase in blood pressure and in the intravascular blood pressure to improve the blood flow to the brain. Evidence of its effectiveness is debatable.  Multidisciplinary discussionVasospasm treatment requires a multidisciplinary approach involving regular meetings of neurosurgeons, neuroradiologists, neurologists and critical care medicine specialists to discuss complex cases and adapt treatment strategies.  Follow upOngoing monitoring of patients having experienced a post-stroke vasospasm is crucial. This includes:    Regular neurological follow up: to detect and manage neurological  sequels.Rehabilitation: to help patients  recover lost functions.Imaging: to monitor the condition of the blood vessels in the brain and detect any relapses.  Risk factor management: blood pressure checks, stopping smoking, etc. to prevent future strokes.Follow up must be carried out by a multidisciplinary team to optimise the long term results of patients   Discover our Interventional NeuroRadiology Department Our Specialist Dr. Adrien GuenegoRadiologist  Expert in interventional and diagnostic neuroradiology  Specialized in strokes, cerebral aneurysms, AVMs, dAVFs, carotid artery stenosis, pulsatile tinnitus, idiopathic intracranial hypertension, vasospasm, retinoblastoma, and chronic subdural hematomas. Prendre rendez-vous

What is Thrombotic Thrombocytopenic Purpura? TTP or Thrombotic Thrombocytopenic Purpura is a rare disease of the group known as thrombotic  microangiopathies. These are diseases  in which the platelets or thrombocytes (involved in coagulation) clog together in an abnormal manner leading to the formation of blood clots.  This phenomenon causes three problems:A reduction in the number of available platelets = Thrombocytopenia.The red blood cells collide with these clots and break up leading to a reduction in number = Anaemia.The clots can block the blood vessels and reduce the oxygenation of tissues with possible serious consequences for the heart, brain, kidneys, etc.  A number of causes can be responsible for the occurrence of these thrombotic microangiopathies. The TTP is caused by the deficiency of a protein known as   "Adamts 13". This deficiency is most frequently due to the presence of an antibody (= immune TTP) or otherwise it may be a genetic anomaly (congenital TTP).   Treatment TTP must be treated as a vital emergency. Without treatment the mortality rate is 90%. A rapid diagnosis is essential followed by optimal treatment at an expert centre.  Initial treatment of immune TTP consists of two action plans:1.Acute treatmentIncreasing the level of Adamts 13 proteins by means of plasma exchanges: The plasma (the liquid component of the blood that contains cells) is replaced with healthy plasma that serves to increase Adamts 13 levels and remove antibodies.    Since 2019 an innovative medicine specific to TTP has made it possible to prevent the platelets from attaching themselves to each other, thereby resolving the three problems indicated above. This has permitted a clear improvement in the treatment of acute stage patients. Our centre always has this medicine on hand for rapid administration.    2.Fundamental treatmentStopping the production of antibodies that act against Adamts 13. First line treatment consists of the administration of corticoids and a monoclonal antibody that targets the cells that produce the antibodies  Treatment of congenital TTP is based on the administration of plasma. The administration of  synthetic Adamts 13 is not yet reimbursed but is accessible.  All persons suffering from TTP require lifelong monitoring by a haematologist specialising in this type of pathology.    Our specialists Advice TTP can present various and variable symptoms as it can affect a number of organs. The primary clinical manifestation is abnormal bleeding, major hematomas or petechiae (multiple small red/violet marks on the skin).  More severe symptoms can be the signs of a heart attack or stroke.  A blood test showing anaemia and a thrombocytopenia can quickly suggest the diagnosis .Useful links:   Thrombotic Microangiopathies - MaRIH – Rare Immuno-Haematological Diseases Health Network National Reference Centre Microangiopathies TTP Community - Home (Dutch language site)  Make an appointment Focus Our hematology team has gained extensive experience in managing this condition and regularly receives requests for the care of patients from external centers.We regularly collaborate with expert centers from various European countries (France, United Kingdom, Italy).We participate in multidisciplinary consultation meetings with French expert centers. Discover our Hematology Department

What is idiopathic intercranial hypertension? Idiopathic intercranial hypertension (IIH), also known as a pseudotumor cerebri, is a condition characterised by high pressure in the cerebrospinal fluid (CSF) without any identifiable cause revealed by imaging examinations. It is more common in women of childbearing age or who are overweight. SymptomsThe symptoms of IIH include:Severe and persistent headaches, often worse when lying down.Blurred or double vision.Temporary loss of vision.Ringing in the ears (pulsatile tinnitus).Nausea and vomiting.Swelling of the optic nerve   (papillary oedema) visible during an ophthalmological examination. Treatment Imaging examinationsTo identify IIH and exclude other causes a number of imaging examinations are carried out:  Brain MRI: to visualise the brain structures and  exclude anomalies such as tumours or malformationsMagnetic Resonance Angiography (MRA): to evaluate the cerebral veins and rule out a cerebrovascular thrombosis.  A CT scan of the brain: sometimes used in an emergency to rule out other causes of high intracranial pressure.Medical pathwayPatients with IIL need to consult  number of specialists for comprehensive treatment as a matter of urgency to avoid any deterioration of  the visual function: GP: for an initial assessment of symptoms and to direct the patient to the appropriate specialists.  Neurologist: principal specialist in diagnosing and managing IIH.  Ophthalmologist: to evaluate the effects of the IIH on vision and to monitor the papillary oedema.  Neuroradiologist: to interpret the brain imaging examinations.Neurosurgeon or interventional neuroradiologist: if surgery or endovascular intervention is necessary.TreatmentIIH treatment seeks to reduce the intracranial pressure and prevent any loss of vision:  Weight loss: recommended for overweight patients, this is often effective in alleviating symptoms.Medicines:  Acetazolamide: A diuretic that reduces the production of CSF and is a first line treatment with a high level of evidence.  Repeated lumbar punctures: to drain off excess CSF and used in the case of severe symptoms.  Surgery:  Optic nerve decompression: to prevent irreversible loss of vision in the case of severe papillary oedema.  Cerebrospinal shunt: to drain off the CSF if other treatments fail.  Interventional neuroradiology: venous sinus stenting to improve drainage of venous blood and reduce intracranial pressure when these veins narrow.  Multidisciplinary discussion  IIH management requires a multidisciplinary approach that includes meetings between neurologists, ophthalmologists, interventional neuroradiologists, neurosurgeons and other health professionals to discuss complex cases and coordinate treatment  Follow upThe monitoring of IIH patients is crucial and includes:  Regular vision monitoring: by an ophthalmologist to detect any deterioration.  Neurological monitoring: to assess the effectiveness of treatment and make adjustments when necessary.  Regular weight evaluations: plus dietary advice for overweight patients.Regular imaging examinations: to monitor intracranial pressure and the condition of brain structures.The follow up is carried out by a multidisciplinary team to optimise the clinical results and improve the quality of life of patients.  Discover our Interventional NeuroRadiology Department Our specialists Prendre rendez-vous

The support center for smokers is made up of tobacco specialists whose role is to inform patients who wish to quit smoking, help them prepare, and support them throughout the process.Make an appointmentTel: 02 555 3773Responsible physicianProf. Jean-Paul Van VoorenTobacco specialistJacques DumontNurse, Pulmonology DepartmentTel: 02 555 3420E-mail: jacques [dot] dumont [at] hubruxelles [dot] be

What is COPD? Chronic Obstructive Pulmonary Disease (COPD) is a common and potentially fatal respiratory disease that in most cases is linked to smoking.   It is characterised by a permanent and progressive obstruction of the airways that is the result of the combination of two mechanisms, present to varying degrees depending on the patient: Chronic bronchitis: the airways become increasingly narrow due to chronic inflammation Emphysema: the pulmonary alveoli (that part of the lung that enables oxygen to enter the blood) are destroyed progressively . The establishing of an obstructive breathing disorder by spirometry (breathing test) permits a COPD diagnosis.  What are the causes of COPD? Smoking  is the most frequent cause of COPD in developed countries. One in five smokers and a half of all those who smoke at the age of 65 suffer from COPD. Nevertheless, other factors  (environmental, immune and/or genetic) can play a role and render certain subjects  more susceptible to developing COPD. The best known, albeit rare, genetic cause is  alpha-1-antitrypsin deficiency. When to be screened? What are the symptoms? This disease often starts with a cough and bringing up phlegm in the morning. These symptoms are often ignored by the smoker who regards them as “normal” consequences of smoking. Progressively, the sufferer experiences shortness of breath on exertion that can pose a problem in everyday life, causing the patient to move around less and less. This in turn results in a loss of physical fitness that aggravates the shortness of breath.   Early screening for COPD (breathing capacity test) should be carried out for smokers with COPD-like symptoms, such as coughing, persistent bringing up of phlegm and/or shortness of breath and indeed for all smokers aged over 40. COPD care at the Erasmus Hospital Once a diagnosis has been established, the Erasmus Hospital proposes a number of supplementary checks: A thoracic scan to screen for emphysema and suspicious shadows (lung cancer is more common among COPD patients) A heart ultrasound to rule out the presence of a cardiac effect of the lung disease and/or an associated heart disease   An exercise assessment (bicycle ergospirometry and/or walking test) to assess capacity during exercise A blood test to evaluate the degree of inflammation in the blood and to screen for a potential genetic cause (alpha-1-antitrypsin insufficiency) An early and comprehensive blood test is necessary in order to:  Prevent the COPD from progressing Relieve symptoms Improve lung capacity during exercise and quality of life Prevent and treat exacerbations (episodes of aggravated respiratory problems, primarily due to infections) Reduce mortality First-line treatment includes: Stopping smoking.  This is the best way of preventing the disease from developing further. A smokers’ assistance centre (CAF) is available at the Erasmus Hospital    Flu and pneumococcal vaccination, designed to avoid infections that are more often fatal among COPD patients  A pharmacological treatment consisting essentially of bronchodilators Respiratory rehabilitation which consists of a set of care measures (bike/carpet retraining and muscular retraining; nutritional and psychosocial accompaniment; education) given by a multidisciplinary team (doctor, physiotherapist, occupational therapist and others) The administration of oxygen in the long term for severe cases in whom COPD is resulting in respiratory insufficiency   Leading edge treatment In patients with an advanced stage of COPD despite a maximum of care, second-line treatment is proposed at specialised centres such as the Erasmus Hospital:     Interventions to reduce lung volume  (endoscopic or surgical) for patients with severe emphysema: The placing of endobronchial valves  that are positioned in the most damaged  bronchi to prevent the air from entering there, consequently enabling the less damaged zones to benefit from more air Surgery to reduce lung volume that, according to the same principle, removes the least efficient and most diseased zones of the lung to enable the rest of the lung to function better A lung transplant can be envisaged for patients at a terminal stage of COPD aged no more than 65 and with no other major associated illnesses (comorbidities).     Our specialists Services

What is diabetes? Diabetes is characterised by an excessively high level of sugar in the blood (glycaemia). Eventually, without appropriate treatment, this chronic hyperglycaemia increases the risk of cardiovascular disease: coronary thrombosis, stroke, etc. Other complications of diabetes can affect the eyes, kidneys and nerves.  Image There are several kinds of diabetes and they require sometimes different medical treatment. The most frequent are: Type 1 diabetes, treated at the Convention du diabète [Diabetes Convention] centres;Type 2 diabetes, with first-line treatment by GPs (Trajet de Démarrage) [Start-Up Pathway] and/or in a hospital environment, in the framework of a Trajet de soins [Care Pathway) or a Convention du diabète ;Gestational diabetes, treated at Convention du diabète  centres;MODY type diabetes  and other rarer genetic diabetes can also be treated at   Convention du diabète centres Care A multidisciplinary teamThe H.U.B Diabetology Clinic consists of a multidisciplinary team of medical, paramedical and nursing staff who are dedicated to optimal care for all diabetes patients in line with their specific needs.  In addition to the acts and services foreseen by the Care Pathways and the Diabetes Convention (in particular therapeutic education on insulin treatment), the Diabetology Clinic proposes specialised consultations for diabetic foot, gestational diabetes and hypoglycaemias. Learning to manage your diabetesOptimal diabetes care means autonomy for the diabetes patient in regard to their treatment. In this respect the H.U.B’s Diabetology Clinic has been a pioneer in therapeutic education. We consider the person with diabetes  as a genuine partner in his or her care. Our team organises group sessions for treatment education, covering: the particularities of diabetes, diet management and, above all, how to (effectively) manage treatment with insulin.    Diabetic footWith its myriad of small blood vessels and nerves, the foot is a zone that is particularly vulnerable to diabetes complications. This can result in desensitization and wounds or sores that do not heal. The persons concerned can make an appointment at the diabetic foot consultation, recognised as a reference centre by the INAMI [National Institute for Sickness and Disability Insurance]. Depending on their needs, patients are seen by a diabetes specialist, a nurse specialising  in wound care, a chiropodist and, if necessary, a shoemaker. A vascular surgeon is also a member of the team.      Gestational diabetesWomen who develop diabetes during their pregnancy are at increased risk of certain complications during childbirth. They are also at a greater risk of developing type 2 diabetes later in life. These patients are treated jointly by the Diabetology Clinic and gynaecologists at the H.U.B’s Obstetrics Department both during and after their pregnancy.   (Non) diabetic hyperglycaemiasThe H.U.B’s Diabetology Clinic diagnoses and treats hypoglycaemias. These (sudden) falls in blood sugar levels can, in their severe form, lead to behavioural disorders or even a loss of consciousness. A badly managed diabetes, an insulimona (rare tumour of the pancreas) or obesity surgery (bypass, gastroplasty) can result in severe hypoglycaemias. Advice If you are diabetic, as your GP if you can benefit from  a Trajet de Démarrage,a ”Type 2 diabetes” Trajet de soinsor a Convention du diabète.These programmes entitle you to services, specialised consultations and additional reimbursements. Focus As a centre of excellence, the H.U.B Diabetology Clinic has signed a number of conventions with the INAMI so as to be able to offer persons treated with insulin access to the latest diabetes monitoring technologies. Most notably: different types of blood sugar sensors (for type 1 and type 2 diabetes), conventional insulin pumps and “patch” pumps without tubing (for type 1 diabetes). Some people with type 1 diabetes can also benefit from insulin treatment in a closed circuit. This automated “artificial pancreas” system consist of connecting a blood sugar sensor to an insulin pump. This system then effects the insulin injections semi- automatically. Research The H.U.B Diabetology Clinic participates in and/or initiates clinical trials on future medicines and new technologies for treating diabetes.  Our specialists Services