Clinic for Allergology, Obstructive Lung Diseases and Respiratory Infections
Head
Assist. Prof. Dr. Sci. Med.
Sanja Hromiš, MD
Head Nurse
Master of Medical Nursing
Jelena Vojnović, Assistant
Deputy Head Nurse
Specialized Nurse
Jovana Palalić
Our Clinic is among the leading national centers for the diagnosis, treatment, and monitoring of patients with allergic, obstructive, infectious, and rare lung diseases. Annually, we manage over 2,000 patients with severe exacerbations of underlying conditions as well as patients with unclear and undiagnosed lung diseases, performing more than 7,000 initial and follow-up outpatient examinations, including the care of patients in the Day Hospital. In addition to patients from Serbia, we often provide services to patients from the region, which confirms our leading role.
At the Clinic, we oversee acute respiratory infections (ARI) and influenza-like illnesses (ILI) in the territory of the Autonomous Province of Vojvodina, and since June 2020, we have become the Center for Cystic Fibrosis for adult patients in Serbia.
The work of the Clinic is also reflected in close collaboration with the National Association of Patients with Severe Asthma (OTA: https://teskaastma.rs), the European Registry for Severe Asthma (Severe Heterogeneous Asthma Research Collaboration, Patient centred, ERS CRC – SHARP), the National Association of Patients with Cystic Fibrosis (CF), as well as the European Registry for Cystic Fibrosis for pediatric and adult patients (European Cystic Fibrosis Society Patient Registry – The ECFSPR).
Our work is based on modern diagnostics, national and international guidelines, and a multidisciplinary approach, with individualized therapy and continuous patient education. In this way, we ensure rapid diagnosis, optimal disease control, and improvement of quality of life.
Head of Department: Prof. Dr. Med. Mirna Đurić
Clinical Physicians: Dr. Sci. Med. Dušan Škrbić, Prim.; Dr. Med., Spec. Jelena Papović, Prim.
Resident: Dr. Med. Karla Mutibarić
Head Nurse of the Department: Registered Nurse Jelena Trifunović
The department is focused on the diagnosis and treatment of patients with acute lower respiratory tract infections (Acute Lower Respiratory Tract Infections – ALRTI), which include acute bronchitis, acute exacerbations of bronchiectasis, and community-acquired pneumonia (Community Acquired Pneumonia – CAP). The department also diagnoses and treats other conditions of the lower respiratory tract, including pleural effusions, infiltrative lung changes of unclear origin, rare lung diseases, and cystic fibrosis.
Diagnostics include:
- radiological and imaging methods (chest radiograph, computed tomography (CT) of the chest, ultrasound examination of the upper abdomen, chest, and pleura, pulmonary perfusion scintigraphy)
- inflammatory markers, biochemical and immunological analyses
- microbiological analyses (bacteriological, virological, mycological, parasitological)
- pulmonary function tests and arterial blood gas analyses
- preparation for invasive procedures (pleural puncture, bronchoscopy, transthoracic needle aspiration (TTP), video-assisted thoracoscopic surgery (VATS), thoracotomy)
The department participates in the surveillance of acute respiratory infections (ARI) and influenza-like illnesses (ILI) in the territory of the Autonomous Province of Vojvodina, enabling timely recognition of trends and optimization of therapeutic protocols. We are included in the European registry for bronchiectasis, which allows for trend monitoring and the application of modern therapeutic protocols.
Treatment in the department is conducted in collaboration with centers for radiology, microbiology, virology, and immunology, as well as with laboratory diagnostics services, pathophysiology of respiration, bronchoscopy, pathology, and respiratory rehabilitation, and with the Clinic for Thoracic Surgery. This multidisciplinary approach ensures rapid and accurate diagnostics and optimal therapeutic treatment.
Why do patients choose our department?
Our department is distinguished by a highly specialized team with many years of experience in the treatment of severe respiratory infections and cystic fibrosis, modern diagnostics that enable rapid and precise identification of the causes of disease, as well as a multidisciplinary approach.
Therapeutic plans are individualized and based on the latest European and global recommendations, with continuity of care – from outpatient monitoring to hospital treatment and rehabilitation. The specially organized Center for Adult Cystic Fibrosis represents a unique structure in terms of expertise and organization.
Head of Department: Dr. Sci. Med. Dušan Škrbić, Prim.
Nurse of the Department: Medical Nurse Jelena Živanov
For over twenty years, adults with cystic fibrosis (CF) have been treated and monitored in the department. By the decision of the Ministry of Health of the Republic of Serbia on June 12, 2020, the Institute for Lung Diseases of Vojvodina (IPBV) in Sremska Kamenica was designated as the Center for Adult Cystic Fibrosis.
The CF center has numerous tasks and responsibilities.
- diagnosis,
- organizing patient transitions,
- maintaining a registry,
- outpatient controls (during stable phases of the disease every 3 or 12 months or more frequently if necessary),
- hospitalization during exacerbation phases of the disease,
- collaboration with:
- reference international centers for the diagnosis and treatment of CF,
- other healthcare institutions,
- patient associations,
- networks of European and global professional associations and organizations for CF,
- continuous education on CF and optimal treatment methods,
- improving the diagnosis and treatment of patients with CF.
In 2019, a Day Hospital for CF was established, through which patients undergo basic laboratory, radiological, and microbiological examinations as part of the implementation and monitoring of inhaled antibiotic therapy and CFTR (cystic fibrosis transmembrane conductance regulator) modulator therapy.
The Center provides a multidisciplinary approach. The multidisciplinary team (MDT) consists of: pulmonologist, endocrinologist, gastroenterologist and hepatologist, otorhinolaryngologist, ophthalmologist, cardiologist, physiatrist, psychologist, psychiatrist, nutritionist, radiologist, gynecologist, urologist, thoracic surgeon, microbiologist, medical biochemist, geneticist, nurse, social worker. The MDT is essential as each specialist treats the patient from their perspective, collaborating with one another, thus ensuring comprehensive treatment and continuous monitoring.
Within the Center for Adult Cystic Fibrosis, the transition of patients with CF from pediatric facilities is being implemented. A Commission for the transition of patients with CF from pediatric to adult facilities (IPBV) has been formed according to the recommendations of the European Cystic Fibrosis Society (ECFS). The task of the Commission is comprehensive collaboration in the treatment of patients with CF during the transition process from the Institute for Health Care of Children and Youth of Vojvodina (IZZZDiOV) and the Institute for Health Care of Mother and Child (IMD) of Serbia
A Council for Cystic Fibrosis of pediatric and adult patients has been formed, consisting of physicians from the Institute for Health Care of Children and Youth of Vojvodina and IPBV, which meets at least once a month to improve the quality of care, treatment, and protection of patients with CF.
The center is a member of the European Cystic Fibrosis Society Patient Registry for pediatric and adult patients (European Cystic Fibrosis Society Patient Registry – The ECFSPR).
Active collaboration is established with the National Association of Patients with CF, which includes education, counseling, and support activities, thereby further enhancing the quality of care and understanding of patient needs.
Center Structure
- Cystic Fibrosis Outpatient Clinic
- Cystic Fibrosis Day Hospital
- The center has a dedicated hospital unit exclusively for patients with CF, in accordance with the principles of CF Center organization of the European Cystic Fibrosis Society (European Cystic Fibrosis Society – ECFS)
Therapeutic Approach
Standards and principles for the treatment and management of patients with CF are applied, along with the recommendations and guidelines of the European Cystic Fibrosis Society (European Cystic Fibrosis Society – ECFS), which are essential for the quality of care and the success of teamwork.
The therapeutic approach includes:
- the use of innovative medications and evaluation of treatment efficacy
- the application of inhaled antibiotic therapy
- early detection of complications – regular quarterly and annual patient check-ups
- management of pulmonary disease exacerbations
- eradication and treatment of chronic colonization by bacteria (P. aeruginosa, etc.)
- maintenance therapy for lung function
- advanced respiratory rehabilitation
- monitoring and treatment of liver disease and disorders of other digestive organs
- management of diabetes associated with CF (cystic fibrosis related diabetes – CFRD) and complications of the endocrine system
- management of genitourinary system disorders, counseling regarding fertility
- monitoring of fertility and high-risk pregnancies
- coordination of multidisciplinary team members
- continuous education for patients and families
Head of Department: doc. dr sci. med. Sanja Hromiš, prim
Clinical Physicians: dr med., spec. Jelena Crnobrnja, dr med., spec. Marija Dugajlić
Residents: dr med. Suzana Mandić, dr med. Dunja Tušek
Head Nurse of the Department: struk. med. sestra Jovana Palalić
The Department of Respiratory Allergies and Asthma manages acute exacerbations of patients with allergic diseases of the respiratory tract, including asthma, hypersensitivity pneumonitis, eosinophilic granulomatosis with polyangiitis (EGPA), and other unclear allergic and immunological conditions associated with respiratory symptoms.
Our approach is based on the latest national and international guidelines, multidisciplinary collaboration, and individualized therapeutic plans. Our goal is to provide accurate diagnosis, optimal disease control, and the best possible outcomes.
In our clinical work, we collaborate with other centers and clinics, which allows us to provide comprehensive diagnostics and treatment, including:
- Assessment of lung function: spirometry, plethysmography, bronchodilator and bronchoprovocation tests, diffusion capacity, exercise tests
- Assessment of airway inflammation: exhaled nitric oxide (FeNO), induced sputum with determination of eosinophil and neutrophil counts
- Bronchological procedures
- Allergy testing: skin prick tests, total and specific IgE
- Laboratory diagnostics: vitamin D, serum cortisol, immunological tests, PCR diagnostics, as well as all standard biochemical tests and inflammation markers
- Radiological diagnostics (X-ray, CT, ultrasound)
- Respiratory rehabilitation
The department has organized an Allergy-Pulmonology outpatient clinic as well as a Day Hospital for severe asthma.
Why do patients choose our department?
In daily clinical practice, we combine advanced diagnostics, modern therapy, and individualized care. Thanks to the close collaboration of pulmonologists, allergists, psychologists, physiatrists, radiologists, and other specialists in managing multimorbidity, rapid diagnostics, adequate therapy, and better disease control are ensured. The department actively involves nurses and physiotherapists, responsible for educating and supporting our patients.
Patients receive continuity of care – from outpatient diagnostics to inpatient treatment and day hospital – which ensures better outcomes, a significant reduction in exacerbations, a decrease in the risk of adverse effects from overtreatment, and an improvement in quality of life.
Head of Department: Dr. med., spec. Jelena Crnobrnja
The Allergology and Pulmonology Clinic provides specialist examinations, diagnostics, treatment, and monitoring of patients with allergic and respiratory diseases.
In the clinic, we perform:
- specialist examinations
- diagnostics, treatment, and monitoring of asthma
- allergy testing (skin prick test, total and specific IgE)
- pulmonary function testing (spirometry, plethysmography, bronchodilator tests, direct and indirect bronchoprovocation tests)
- patient counseling and education
- preventive examinations and follow-ups
- The clinic conducts asthma control assessments, analysis of exacerbating factors, and long-term therapy planning in accordance with international guidelines.
Head of Department: Assoc. Prof. Dr. Sci. Med. Sanja Hromiš, Specialist
Department Nurse: Nurse Sanja Bukarica
The day hospital is intended for patients with severe and poorly controlled asthma and other allergic and immunological respiratory diseases that require more frequent monitoring and the application of modern therapeutic protocols.
The day hospital conducts:
- precise diagnosis and phenotyping of asthma
- optimization of therapy, including the application of biological therapy for severe asthma and eosinophilic granulomatosis with polyangiitis (EGPA)
- transition of patients with severe asthma from pediatric facilities
- multidisciplinary management of comorbidities
- monitoring outcomes using standardized instruments
- education of patients and healthcare professionals on breathing techniques, proper therapy application, and avoidance of triggers
- maintaining a registry of severe asthma and participation in research
The work is conducted through multidisciplinary collaboration with psychologists, rehabilitation specialists, physiotherapists, ENT specialists, gastroenterologists, endocrinologists, and cardiologists, enabling a comprehensive assessment and alignment of therapy with the individual needs of patients.
Within the Day Hospital, a Council for Severe Asthma has been established, which is a professional body responsible for:
- making decisions on the indication of biological therapy,
- monitoring the effects of therapy and any changes in the therapeutic regimen,
- evaluation of complex cases and comorbidities.
The consultative team holds regular meetings, consisting of specialists with experience in the diagnosis and treatment of severe asthma and a trained nurse specialized in working with these patients.
We closely collaborate with the National Association of Patients with Severe Asthma (OTA: https://teskaastma.rs) through education, counseling, and support programs, thereby further enhancing the continuity of care and quality of life for patients.
Monitoring of patients with severe asthma is also achieved through collaboration with the European registry for severe asthma (Severe Heterogeneous Asthma Research Collaboration, Patient centred, ERS CRC – SHARP).
Therapeutic approach
In daily practice, the principles of good clinical practice are adhered to, with therapy guided by national and international guidelines for the treatment of severe asthma, eosinophilic granulomatosis with polyangiitis, and hypereosinophilic lung diseases, thereby ensuring a high standard of healthcare, monitoring the effects of biological therapies, and rationalizing the use of oral corticosteroids.
Head of Department: Prof. Dr. Med. Biljana Zvezdin
Clinical Physicians: Prof. Dr. Med. Violeta Kolarov, Doc. Dr. Med. Maja Bogdan, Spec. Dr. Med. Lidija Vrtunski More, Prim.
Resident: Dr. Med. Lucija Vasović
Head Nurse of the Department: Med. Sest. Suzana Tolimir
The department provides comprehensive diagnosis, treatment, and monitoring of patients with chronic obstructive pulmonary disease (COPD) and other obstructive airway disorders. The goal of our procedures is to ensure a reduction in the frequency and intensity of symptoms and exacerbations of the disease, improvement of pulmonary function and quality of life, with an individualized therapeutic approach based on modern professional recommendations.
The department manages patients with:
- acute exacerbation of COPD
- respiratory failure
- complications of obstructive lung diseases
- the need for intensive diagnostics and optimization of therapy
In hospital conditions, we conduct:
- modern bronchodilator and anti-inflammatory therapy
- substitutional oxygen therapy
- respiratory rehabilitation
- assessment and treatment of comorbidities and conditions (cardiovascular diseases, metabolic syndrome, anxiety, depression, osteoporosis…)
- education on the proper use of inhalers, smoking cessation, and all non-pharmacological measures.
In selected cases, an assessment of the indication for surgical procedures (lung volume reduction, bullectomy) is performed.
Why do patients choose our department?
The department adheres to and implements modern and best recommendations for the individual treatment of each patient, with continuous education for both staff and patients. In this way, with a friendly and professional approach, patients experience fewer symptoms, less frequent exacerbations, better quality of life, fewer complications, and improved survival (longer and better quality of life)
Head of Department: spec. Dr. Med. Lidija Vrtunski More, Prim.
The clinic specializes in the diagnosis, treatment, and management of patients with COPD and other obstructive airway disorders.
The clinic conducts:
- assessment of the severity and type (“phenotype”) of COPD
- pulmonary function tests (spirometry, plethysmography, diffusion capacity)
- bronchodilator tests
- laboratory tests (alpha-1 antitrypsin,..)
- planning and optimization of long-term therapy
- assessment of the need for rehabilitation and oxygen therapy
- education and verification of inhaler use (commonly referred to as “pump”)
- education on procedures during exacerbations, lifestyle, nutrition, and physical activity.
The clinic collaborates with the Rehabilitation Service, cardiologist, nutritionist, psychologist, and other specialties, as needed.
Head of Department: Dr. med., Spec. Dragan Veličković
Clinical Physician: Dr. med., Spec. Branislav Tušek
Resident: Dr. med. Sonja Tomić
Head Nurse of the Department: Nurse Marija Janković
The department specializes in the diagnosis, treatment, and monitoring of patients with obesity hypoventilation syndrome, severe forms of obstructive lung disease, as well as those requiring non-invasive respiratory support (non-invasive ventilation support and high-flow nasal oxygen therapy – HFNC) and non-invasive hemodynamic monitoring. Our goal is to ensure stable respiratory function, reduce the risk of exacerbation, and improve quality of life, utilizing the latest therapeutic protocols and a multidisciplinary approach.
The department is involved in the management of patients with:
- severe exacerbations of chronic obstructive pulmonary disease (COPD)
- complications of obstructive lung disease
- obesity hypoventilation syndrome (OHS)
- acute gas exchange disorders requiring non-invasive mechanical ventilation (NIV).
In hospital settings, we perform:
- initiation and titration of NIV ventilators
- correction of gas exchange disorders
- bronchodilator and anti-inflammatory therapy
- respiratory rehabilitation
- diagnosis and treatment of comorbidities of chronic obstructive pulmonary disease (cardiovascular diseases, obesity, sleep disorders, metabolic syndrome)
- patient education on long-term disease management
- home application of non-invasive mechanical ventilation
Why do patients choose our department?
Our department combines advanced respiratory support, personalized therapy, and multidisciplinary care, with continuous monitoring and patient education. A team with extensive experience in treating obesity hypoventilation syndrome, severe forms of COPD, and asthma ensures a high level of expertise and safety.
Patients achieve faster stabilization of symptoms, optimization of NIV in hospital and home settings, reduced need for invasive ventilation, better control of chronic lung diseases, continuity of care (hospital treatment – intensive care – NIV outpatient clinic), and significant improvement in quality of life.
This model of operation is fully in accordance with the latest recommendations and represents the standard of modern respiratory medicine.
Head Nurse: Nurse Dragana Milanović
The unit is intended for patients with severe respiratory failure who require continuous non-invasive monitoring and advanced respiratory support.
Treatment focus:
- NIV as first-line therapy
- high-flow nasal oxygen therapy (HFNC)
- monitoring of vital parameters and gas exchange
- preventing the need for invasive mechanical ventilation
- stabilization of acute exacerbations of COPD, OHS, asthma ….
- multidisciplinary assessment of comorbidities
This treatment model is in accordance with the latest GOLD recommendations (evidence level 1A).
The clinic is intended for patients who are using or need to start NIV in home settings.
The clinic provides:
- assessment of the need for NIV
- adjustment of ventilator parameters for NIV
- education of patients and families on the proper use of ventilators for NIV
- monitoring of therapy effectiveness and tolerance
- tracking long-term outcomes and complications
- assessment of comorbidities that may affect the outcome of NIV application.
The clinic closely collaborates with the rehabilitation center, cardiologist, endocrinologist, and pulmonary teams.
| Name and Surname | Position | Note / Professional Qualification |
|---|---|---|
| Vojnović Jelena | Senior Nurse in Other Hospital Departments – Head Nurse of the Clinic | Master of Nursing |
| Savić Duško | Nurse in Other Hospital Departments (Therapist) | |
| Orbović Mirjana | Senior Nurse in Other Hospital Departments (Therapist) | Vocational Nurse |
| Kuburić Jasmina | Nurse in Other Hospital Departments (Therapist) | |
| Kijački Nataša | Senior Nurse in Other Hospital Departments (Therapist) | Bachelor of Health Care Organization |
| Trifunović Jelena – A Section | Senior Nurse in Other Hospital Departments – Head Nurse of the Department | Bachelor of Nursing |
| Živanov Jelena – A Section CF | Nurse in Other Hospital Departments | No solution for Head Nurse for CF |
| Palalić Jovana – B Section | Senior Nurse in Other Hospital Departments – Head Nurse of the Department | Vocational Nurse |
| Tolimir Suzana – C Section | Nurse in Other Hospital Departments – Head Nurse of the Department | |
| Janković Marija – D Section | Nurse in Intensive Care Level 2 – Head Nurse of the Department | |
| Gađan Jelena – D Section | Nurse in Intensive Care Level 2 – Head Nurse of the Section | |
| Bukarica Sanja | Nurse in Other Hospital Departments – Head Nurse DB | |
| Hansman Tamara | Nurse in Other Hospital Departments (Allergy Clinic) | |
| Milanović Dragana | Nurse in Other Hospital Departments (Allergy Clinic) | |
| Pavlović Snežana | Senior Nurse in Other Hospital Departments | Master of Nursing |
| Bereš Renata | Nurse in Other Hospital Departments | |
| Andrić Jovana | Nurse in Other Hospital Departments | |
| Rakita Saša | Nurse in Other Hospital Departments | |
| Trnić Milodrag | Nurse in Other Hospital Departments | |
| Božić Branka | Nurse in Other Hospital Departments | Vocational Nurse |
| Stanojević Milica | Nurse in Other Hospital Departments | |
| Đalinac Vuković Tijana | Nurse in Other Hospital Departments | Bachelor of Nursing |
| Furik Sara | Nurse in Other Hospital Departments | Vocational Nurse |
| Milinković Ivana | Nurse in Other Hospital Departments | |
| Dimić Jelica | Nurse in Other Hospital Departments | |
| Budisavljević Miloš | Nurse in Other Hospital Departments | |
| Piptorošević Zorana | Nurse in Other Hospital Departments | |
| Stojadinov Jovana | Nurse in Other Hospital Departments | |
| Vlaškalin Živojin | Nurse in Other Hospital Departments | |
| Živković Mateja | Nurse in Other Hospital Departments | |
| Stanaćev Radovan | Nurse in Other Hospital Departments | |
| Mladenović Lena | Nurse in Other Hospital Departments | |
| Kuruzović Daliborka | Nurse in Other Hospital Departments | |
| Zec Aleksandra | Nurse in Intensive Care Level 2 | |
| Dabić Stefan | Nurse in Intensive Care Level 2 | |
| Jakovljević Nina | Nurse in Intensive Care Level 2 | |
| Trišić Nikola | Nurse in Intensive Care Level 2 | |
| Radenković Đorđe | Nurse in Intensive Care Level 2 | |
| Anđelković Jelena | Nurse in Intensive Care Level 2 | |
| Obadović Aleksandra | Nurse in Intensive Care Level 2 | |
| Narandžić Milan | Nurse in Intensive Care Level 2 |
