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Dr. Zsuzsanna TengelyiInterviews with our physicians

Interview with Dr. Zsuzsanna Tengelyi, pediatric pulmonologist

You also started practicing at the clinic after the reopening and expansion of the pediatric department. What kinds of issues, problems, or concerns might patients bring to you?

Since this is a pediatric pulmonology clinic, I deal with all types of respiratory illnesses. This includes persistent coughs, asthma, allergies, croup symptoms, and everything related to the bronchi and lungs.

How can parents determine whether they should consult an ENT specialist or a pulmonologist?

In the case of an upper respiratory illness, where a child has a persistent cough, an enlarged adenoid can cause prolonged respiratory symptoms or possibly sinusitis. In such cases, an ENT specialist can be helpful. However, if the ENT specialist cannot find an upper respiratory cause for the persistent cough, they will refer the patient to me. A cough accompanied by wheezing and difficulty breathing is specifically a pulmonological issue. It is important that such cases be referred to a pediatric pulmonology clinic by the pediatrician.

Increasingly, parents are also coming to me on their own because they suspect allergies. Asthma symptoms can appear as early as infancy and are often associated with upper respiratory infections and viral illnesses. Fortunately, not all cases develop into true “asthma” later on; these are known as infant and toddler viral-induced wheezing, which children may “outgrow.” However, their treatment is similar to that for true asthma.

How curable are these diseases, or is it more about symptomatic treatment?

Nowadays, these diseases can be treated very effectively with good medications. In many cases, asthma is caused by a non-viral, non-bacterial airway inflammation, which can be resolved or at least alleviated by inhalation treatments if therapy is started at the right time.

Unfortunately, we are seeing an increasing number of young children with asthma, allergies, and croup.

Indeed, air pollution significantly contributes to these conditions. More and more children, often at a very young age, are coming to me with these issues, sometimes as early as infancy and toddlerhood. This is a condition that children will have to live with, and they need to understand that it is a “lifetime” condition that is manageable. It is the doctor’s responsibility to achieve the longest possible symptom-free state with the appropriate treatment.

Why did you choose pulmonology within the field of pediatrics?

My father was an adult pulmonologist, and he inspired my interest in this specialty. He introduced me to the intricacies of adult pulmonology and familiarized me with the interesting aspects of bronchoscopy. After completing my pediatric specialization, I decided to focus on pediatric pulmonology. I began my career at the Szent Rókus Hospital (formerly Semmelweis Hospital) and gained thorough experience in pediatric pulmonology at various departments of the Svábhegyi Children’s Sanatorium. Later, I worked at the Pediatric Department of the Törökbálint Lung Institute. I have been a general pediatrician for 27 years and continue to practice pediatric pulmonology.

Is there a fundamental difference between adult and pediatric pulmonology?

Fortunately, in children—unlike in adults—there are very few cases of cancer. This is a fundamental difference. However, we do encounter developmental abnormalities, but our primary focus is on treating asthma and allergic conditions.

Which of these conditions require the most attention?

Asthma management requires a lot of attention. In the past, children often had to return to the hospital with severe asthma attacks, but fortunately, modern medications and inhalation (steroid) treatments have made these difficult situations increasingly rare, allowing asthma symptoms to be well managed. It’s important to pay close attention to differential diagnosis during care. For example, recurring pneumonia might be due to developmental abnormalities or even the aspiration of a foreign object. This is quite common in children. Parents might not even notice when a child accidentally inhales a small toy part or seeds—often peanuts or sunflower seeds—during play. This can cause coughing, which may later decrease, but the foreign object can insidiously remain in the lung. X-rays may only reveal a shadowy foreign object or inflammation in the surrounding area.

What are the most common and the most severe problems in your practice?

Fortunately, severe asthma cases are becoming increasingly rare. It is always challenging when a child is on multiple medications; it’s crucial to ensure proper use and that the medications are not forgotten. The application of inhalation systems can be problematic, and often even the parents are not familiar with them. Teaching and monitoring the correct use of these systems is definitely the doctor’s responsibility. It is necessary to check every three months to ensure that the devices are being used correctly. We also need to monitor lung function, which can be difficult in children under six and later in teenagers as well. Often, it is a challenge to communicate effectively with adolescents, which is not an easy task, but I enjoy it.

What would you like to make sure to tell parents?

The risk of foreign body aspiration is significant in children under six years old. It’s crucial to be very careful with eating oily seeds! If a child must have peanuts, they should not be running around while eating. It’s also not advisable to eat such things in the car or to chew gum.

Parents often find it difficult to accept that allergy testing is not useful for children under three years old, as the results are unreliable and skin tests are not evaluable. Blood tests can provide more reliable information, but even then, everything can change in the child’s body.

Parents might think that allergy testing should be done immediately when allergic symptoms appear. However, it is important to know that testing during the season when symptoms occur is not ideal. It is best to wait until the pollen season ends before conducting tests. If the therapy applied to the symptoms is successful, it already indicates the presence of an allergy.

It is very important to avoid taking antihistamines at least a week before the allergy test, as they can distort the results.

In many cases, the test may not match the symptoms; we treat the symptoms rather than the type of allergy indicated by the test. So, if someone is symptom-free during the period when the test shows a positive result, treatment might not be necessary; instead, it’s better to wait.

Similarly, blood tests often show false positives, so everything should be evaluated based on the symptoms. The situation is equally complex with food allergies.

And one more request for patients: it is essential for the medical history of the child to have a meeting with the parents. Therefore, please make sure that either the mother or father comes along with the child.

To what extent can respiratory allergies be traced back to psychological causes?

A significant part of asthma is influenced by emotional balance. Therefore, psychological support is very important for this group of diseases as well. Boys are more likely to “outgrow” asthma by adolescence or adulthood compared to girls, due to both hormonal and psychological factors. Even with simple hay fever, it can be observed that the condition is more stubborn and harder to control in patients who are under stress.

To conclude with a more personal question: What do you do in your free time, and how do you unwind?

My family mostly occupies my free time, as I have three grown children and five grandchildren. I would like to paint and draw, but I currently have little time for these activities. I really enjoy reading.

Thank you for the conversation!

ZSUZSANNA TENGELYI, M.D.

Pediatric pulmonologist

Tuesday: 16:00 - 18:00

ZSUZSANNA TENGELYI, M.D.

Pediatric pulmonologist

Tuesday: 16:00 - 18:00