Treatment

What are Interventional Pulmonology?

Interventional Pulmonology (IP) is a subspecialty of pulmonary medicine that focuses on minimally invasive procedures to diagnose and treat conditions related to the lungs and airways. It blends advanced techniques like endoscopy, bronchoscopy, and other catheter-based interventions to provide therapeutic options for lung-related disorders. These procedures help reduce the need for invasive surgeries and are particularly beneficial for patients with complex lung diseases.

Symptoms That Lead to IP Evaluation

IP is typically sought for patients experiencing respiratory symptoms that indicate underlying issues in the lungs or airways. Common symptoms include:

• Chronic cough: A persistent cough lasting more than eight weeks.
• Shortness of breath (dyspnea): Difficulty breathing or feeling breathless, which may worsen with exertion.
• Hemoptysis: Coughing up blood, often a sign of serious lung issues such as infections or tumors.
• Wheezing: High-pitched sounds during breathing, often indicating airway obstruction.
• Chest pain: Unexplained pain in the chest area, particularly during inhalation.
• Unexplained weight loss: Accompanied by respiratory symptoms, this can suggest malignancy.

These symptoms might not point directly to one specific disease but serve as red flags for further evaluation via interventional pulmonology techniques.

Causes of Conditions Treated by IP

The underlying causes of the symptoms treated through IP are varied, ranging from benign conditions to life-threatening diseases:

• Lung cancer: One of the leading causes prompting IP procedures. Lung nodules or masses may require biopsy or tumor debulking.
• Chronic obstructive pulmonary disease (COPD): Progressive lung diseases, including emphysema and chronic bronchitis, that cause breathing difficulties.
• Pulmonary fibrosis: A condition characterized by the scarring of lung tissue, making it harder to breathe.
• Airway obstructions: Can be caused by foreign bodies, tumors, or strictures (narrowing of airways).
• Pleural effusions: Accumulation of fluid between the lungs and chest wall, often associated with infections, heart failure, or malignancy.
• Pneumothorax: A collapsed lung that might result from injury or spontaneously due to weakened lung tissue.
• Asthma: In severe cases, asthma can lead to complications that require IP interventions for better airway control.

Diagnostic and Therapeutic Procedures in IP

Interventional Pulmonology uses various diagnostic and therapeutic procedures that are crucial for identifying and treating lung conditions.

Diagnostic Procedures

• Flexible bronchoscopy: A thin, flexible tube with a camera is inserted through the nose or mouth to view the airways and collect tissue samples (biopsy) or washings for laboratory analysis. It helps in diagnosing lung cancer, infections, and interstitial lung disease.
• Endobronchial ultrasound (EBUS): A specialized form of bronchoscopy that uses ultrasound to visualize structures adjacent to the airways, such as lymph nodes. EBUS-guided biopsies are often performed for lung cancer staging.
• Thoracoscopy: A minimally invasive procedure for examining the pleura (the lining of the lungs) and taking biopsies from pleural abnormalities. It is useful for diagnosing pleural effusions and pleural cancers like mesothelioma.

Therapeutic Procedures

• Airway stenting: If there is a blockage in the airway (due to a tumor or scarring), a stent can be placed to keep the airway open, improving breathing and quality of life.
• Balloon dilatation: This technique is used to widen narrowed airways, restoring airflow in patients with airway strictures due to scarring or tumors.
• Tumor debulking: For patients with obstructive tumors in the airways, tumor debulking procedures remove part of the mass to alleviate symptoms, improving airflow and reducing discomfort.
• Pleurodesis: A procedure that adheres the lung to the chest wall, preventing recurrent pleural effusions. This is often used for patients with recurring fluid accumulation due to cancer.
• Cryotherapy: This procedure involves the application of extreme cold to freeze and destroy abnormal tissue, often used in the treatment of tumors or precancerous cells.
• Thoracentesis: The removal of excess fluid from the pleural space, helping patients with pleural effusion to breathe more comfortably.