Interventional pulmonology: an update for internal medicine physicians

Abstract

Interventional pulmonology is a subspecialty that uses advanced diagnostic and therapeutic procedures to care for patients with benign and malignant diseases of the lung, airways and pleura. There has been a rapid proliferation of new pulmonary procedural technologies over the last decade. Common diagnostic applications include endobronchial ultrasound, guided bronchoscopy and a number of pleural disease interventions. Endobronchial ultrasound is performed with a specially design flexible bronchoscope and allows safe and accurate sampling of intrathoracic structures through the airway wall under direct visualization. Guided bronchoscopy methods are granting significant improvement in the diagnostic yield of flexible bronchoscopy. Virtual bronchoscopy, radial probe endobronchial ultrasound and electromagnetic navigational bronchoscopy are examples of these methods. Interventional pulmonologists can also be trained to perform ultrasound guided thoracentesis, closed-needle pleural biopsy and medical thoracoscopy to help in the diagnosis of different pleural pathologies. Therapeutic applications can be used to efficiently bring symptomatic relief of benign and malignant central airway obstruction by using a myriad of flexible and rigid bronchoscopy techniques. Airway stenting and ablative techniques such as laser, electrocautery, cryosurgery and microdebrider techniques are example of resources that can be used by interventional pulmonologists for therapeutic purposes. A number of effective therapies for the management of malignant pleural disease have been studied in recent years, including chemical pleurodesis and tunnelled pleural catheters, greatly adding to our understanding of which therapy to use in which patient. In addition, flexible bronchoscopy approaches to more common disease, such as asthma and chronic obstructive pulmonary disease are currently available or are being developed. This update aims to provide the internal medicine physician with a brief overview of some of the common clinical procedures performed by interventional pulmonary specialists and the current indications and evidence for their use.