What is Interventional Pulmonology?

Interventional Pulmonology is an entirely new field of diagnosis and treatment for patients with airway disorders, lung cancer and different pleural diseases. Since the traditional treatment procedures are extremely invasive, this new treatment technique, i.e. interventional pulmonology, has become a very common and popular way of diagnosing and treating the pulmonary difficulties. The advantages of interventional pulmonology in comparison to the traditional surgical methods are reduction in recovery time, reduced discomfort associated with the more invasive procedures and also decreased rate of complications.

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15 Techniques & Procedures of Interventional Pulmonology

There are different diagnostic techniques that are also useful treatment techniques of Interventional Pulmonology. The diagnostic procedures are performed by pulmonologists or lung specialists, with special training in performing these less invasive and non-surgical procedures. The different procedures in interventional pulmonology include: bronchoscopy, thoracentesis, indwelling pleural catheter, pleurodesis and bronchoscopic thermoplasty. Each interventional pulmonology technique is used for different purposes and in different ways.

The most commonly done interventional pulmonology procedure is bronchoscopy. In this interventional pulmonology procedure, the doctor looks into the lungs to diagnose lung cancer, tuberculosis and different types of pneumonia, by inserting a bronchoscope through the airway. It helps the doctor to diagnose the patient, without going for a surgical procedure. The doctor uses a bronchoscope or an endoscope that has a thin channel at its tip. Through this channel, different tools can be passed and the doctor can perform further diagnostic and treatment techniques of Interventional Pulmonology.

The various interventional pulmonology techniques are described as follows:

Bronchoalveolar Lavage:

In this interventional pulmonology bronchoscopic procedure, sterile water is injected into the lung, through the bronchoscope or endoscope. This sterile water or fluid is then suctioned back, to send the sample to the laboratory to further diagnose and test it. This procedure is done in order to diagnose cancer, bleeding and infection of the lungs.

Bronchial Stent or Airway Stent

The bronchus or airway tube is compressed and constricted, when the certain medical conditions, such as advanced level of cancer blocks the airway. In such conditions, breathing difficulties, pneumonia and cough becomes difficult problems. The doctor advances a wire mesh stent using a bronchoscope into the narrowed airway. As the doctor expands the stent, the symptoms that are caused by constriction and compression of the airway are reduced significantly.

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Biopsy of Lung or Lymph Node

In this interventional pulmonology procedure, the doctor collects a small piece of tissue from the lymph nodes near the lungs or from the lungs, using a needle or a forceps. The sample tissues are then sent for biopsy tests for diagnosing sarcoidosis, infection or cancer. Those, who have lung cancer or other cancers, this interventional pulmonology technique can help in detecting the cancer accurately and also identify if the cancer has spread to the lymph nodes or not. Thus, unnecessary surgical procedures can be avoided and also the proper treatment method can be determined by the doctor with the use of this form of interventional pulmonology.

Balloon Bronchoplasty or Dilatation

In this interventional pulmonology procedure, a deflated balloon is inserted through the bronchoscope or endoscope right into the section of the airway that is abnormally narrowed. The balloon is then filled with water to expand the airway and thus, omit the symptoms associated with narrowed airway. This interventional pulmonology procedure is performed mostly prior to the airway stent placement procedure and it helps in expanding the bronchus.

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Rigid Bronchoscopy

In this interventional pulmonology procedure, a rigid bronchoscope or a long metal tube is inserted into the main airway or windpipe of the person. Since the diameter of the rigid bronchoscope is broader, it helps the doctor to insert some more sophisticated tools. This interventional pulmonology procedure requires general anaesthesia and assisted breathing and is almost similar to a surgical procedure.

Foreign Body Removal

In order to remove inhaled foreign objects from the blocked airway, this interventional pulmonology technique is used. Either the flexible or rigid bronchoscopy is used in this process to remove the foreign particles.

Bronchial Thermoplasty

When asthma patient with severe asthma attacks are not treated with the standard treatment and medication procedures like inhaled corticosteroids and long-acting beta agonists, this interventional pulmonology technique is used for treating them. In this interventional pulmonology process, the doctor uses radiofrequency energy to heat and thin the smooth muscle walls of the airway. This destroys the constrictions that cause the asthma attacks.

Radial Probe Ultrasound (REBUS) and Endobronchial Ultrasound (EBUS)

In both these interventional pulmonology procedures, the doctor uses a special bronchoscope, which has an ultrasound attached to it at the tip. As the doctor can see the needle attached to it, it helps him to make sure that the blood vessels are not damaged. This interventional pulmonology procedure helps the doctor to perform biopsies in multiple areas. As the results are more accurate in these interventional pulmonology procedures, the doctors rely on it more than other procedures.

Pleuroscopy

Pleuroscopy or medical thoracoscopy is a kind of laparoscopy test in which the doctor makes a small incision in the chest and inserts a small instrument with camera on its tip. This interventional pulmonology procedure helps the doctor to diagnose chest diseases and perform therapeutic procedures inside the chest.

Cryotherapy:

This interventional pulmonology technique is used to destroy the airway tumours. The doctor applies a super-cooled probe repeatedly over the tumor tissue and destroys the tumour by freezing it.

Argon Plasma Coagulation (APC):

In this interventional pulmonology process, tumours are destroyed and bleeding is stopped by applying heat from an electric current. This interventional pulmonology procedure helps to apply the heat and destroy tumour over large areas and thus shortens the procedure time.

Electromagnetic Navigational Bronchoscopy:

This is an image guided interventional pulmonology technique that helps the doctors to access the mediastinal lymph nodes and peripheral lung lesions. This interventional pulmonology procedure is suitable for those patients who cannot undergo surgery. Even patients with lung cancer can be benefited from this interventional pulmonology technique, as it helps the oncologists to target the lung tumours by placing radio markers.

Thoracentesis:

In this interventional pulmonology procedure, fluids from the lungs are drained by inserting a needle into the chest wall. The fluid is suctioned out by advancing a plastic catheter over the needle. As the fluid is suctioned out, the catheter is removed and discarded.

Pleurodesis:

Patients with recurring pleural effusions are diagnosed and treated with this interventional pulmonology procedure. In this process, the doctor makes an incision in the chest wall and inserts a plastic tube through it. The doctor then sprays an irritating chemical around the lungs. As a result, the pleura or the lung lining tightly adheres to the chest wall, preventing the fluid from re-accumulating.

Indwelling pleural catheter

When pleural effusion is recurrent, this interventional pulmonology treatment procedure is considered to be the most appropriate alternative. A plastic catheter is tunnelled into the chest cavity, beneath the skin. Using special sterile supplies, the person can drain the pleural fluid in this catheter.

Risks and Limitations of Interventional Pulmonology

The interventional pulmonology and all its procedures and techniques are far more useful than other invasive treatment and diagnostic procedures. Most of these interventional pulmonology techniques are done with care and have minimal risks and limitations associated with them. However, it cannot be said that interventional pulmonology procedures are completely risk free. The complications and risks that may occur with interventional pulmonology techniques are:

  • Bleeding.
  • Collapsing of lungs or pneumothorax.
  • Over-sedation.

It is always safer to use these interventional pulmonology techniques and procedures and when compared to other surgical methods, the interventional pulmonology techniques promote faster recovery than the surgical ones. However, there are many conditions that are diagnosed and treated best with the surgical procedures also.

Pramod Kerkar

Written, Edited or Reviewed By:

, MD,FFARCSI

Pain Assist Inc.

Last Modified On: January 30, 2019

This article does not provide medical advice. See disclaimer

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