Interventional Pulmonology

Abstract

Interventional pulmonology is relatively new field within pulmonary medicine focused on use of advanced bronchoscopy methods and interventional techniques in diagnosis and therapy of respiratory diseases. Various respiratory disorders may result in central airway obstruction (CAO), and central airway obstruction can cause significant morbidity and mortality. Exact data on incidence and prevalence of central airway obstruction are not available, but epidemiological studies investigating lung cancer are suggesting that CAO is frequent and significant part of morbidity and mortality in lung cancer patients. These studies suggest that 20-30% of lung cancer patients are experiencing complications due to CAO, and that 40% of lethal outcomes are related to CAO. The treatment of patients with CAO requires not only understanding of etiology, physiology, diagnostic and therapeutic procedures but also availability of multidisciplinary team composed of interventional pulmonologists, thoracic surgeons, pulmonologists, oncologists, anesthesiologists and radiologists. Evaluation of procedures and their efficacy is extremely difficult; randomization of studies in this field is extremely complicated. In one hand it is difficult to find patients with comparable disorder and comorbidity, on the other hand all of the patients are critically ill and randomization in this case is unethical. That is the reason why the majority of studies are retrospective analyses. One thing is for certain—the use of novel technology and interventional procedures leads to improvement in survival and quality of life of patients with CAO. The primary question is no more “Is therapy helpful?” but “Which therapy is best for particular patient?”.