Interventional Pulmonology
is a Newfield with in pulmonary medicine focused on the use of advanced bronchoscopic and pleuroscopic techniques for the diagnosis and treatment of a spectrum of airways and pleural disorders.

Interventional pulmonology procedures

• Bronchoscopy
• Medical Thoroscopy (Pleuroscopy)
  
• Pleurocentesis
• Pleural biopsy (closed pleural biopsy)
  
• Pleurodesis
• Intercostal Drainage (ICD)
• Transthoracic  fine needle Aspiration (FNA)
  

Bronchoscopy

Bronchoscopy can be defined as a diagnostic and therapeutic procedure that permits direct visualization of the tracheo bronchial lumen with the help of the bronchoscope a specialized device.

Bronchoscopy is the most commonly used invasive procedure in clinical pulmonology.

Bronchoscopy permits collection of respiratory secretion from the tracheo bronchial tree as well as tissue samples from the airway mucusa, lung parenchyma and lympnedes and other masses located immediately adjacent to but out side the tracheo bronchial lumen.

Bronchoscopy is also used as a theropeutic tool to treat the airway luminal obstruction caused by various diseases, bleeding from respiratory structures and several pulmonary disorders.

Diagonostic Indications

• Unexplained Cough
  
• Unexplained Hemoptysis
  
• Localised Wheeze
  
• Stridor
  
• Unexplained Chest Radiography Opacity.
  
• Pulmonary infection
  
• Localised
  
• Diffuse
  
• Immuno Compromised
  
• Diffuse lung diseases Non-infections
  
• Intra thoracis Lympthadenopathy
  
• Mass pulmonary
  
• Nodule Bronchogenic carcinoma
  
• Foreign body
  
• Burns
  
• Chest injury
  
• Vocal cord & Diaphragm Palsy
  
• Broncho Pleural Fistula
  

Therapeutic Indications

• Removal of airway secretions, mucus plugs, clots and necrotic debris
• Atelectasis
• Foreign body
• Neoplasms
• Laser
• Electro cautery 
• Endobronchial ultrasound
• Argon Plasma Cogulation ( APC)
• Cryotheraphy
• Stenting
• Dilatation
• Lavage
  

Medical Thoracoscopy
Medical Thoracoscopy or pleuroscopy is an invasive technique to visualise the pleural cavity under local anesthesia.

Indications:

• Pleural effusion of unknown etiology
• Staging of lung cancer
• Staging of diffuse malignant mesothelioma
• Pleurodesis by talc powderage
• Pleuroscopy or medical Thoroscopy helps in draining the pleural fluid and to take the biopsies from chest wall diaphragm, mediastinum and lung.
  The commonest respiratory system disorders are Asthma, TB, COPD, Lung Cancer, Pneumonia, Pleural Effusion and sleep related breathing disorders.
  

Pulmonary Tuberculosis (TB)
TB is a completely curable disease. It is due to mycobacterium tubercle bacilli causing cough, fever, weight loss etc. The diagnostic tests are sputum test for AFB and chest radiography. Treatment consists of 6-9 months with anti TB therapy.
TB can manifest as hemoptysis (coughing out of blood), Fever of unknown origin, pleural effusion etc.,

Bronchial Asthma

Asthma is a chronic inflammatory disorder of the airways characterized by recurrent episodes of wheezing, breathlessness, chest tightness and coughing, particularly at night or in the early morning. Spirometry (PFT) is a breathing test to confirm asthma.

COPD (Chronic Obstructive Pulmunory Disease)

COPD consist of chonic bronchits and emphysema due to smoking, pollution, dust etc., The symptoms are cough, breathing difficulty and sputum production. Pulmonary function test confirms COPD. Treatment consist of smoking cessation, avoidance of pollution and regular use of inhaled medications.

Lung Cancer

This is the leading cause of cancer death in the world. Early diagnosis is important to prevent morbidity and mortality. Symptoms are cough, breathlessness, hemoptysis, chest pain and weight loss. Diagnostic tests are chest radiography, sputum test, CT scan, bronchoscopy and biopsy. Treatment depends on the stage of the disease. The various modalities of treatment are surgery, chemotherapy and radiotherapy.

Sleep Disorders

Sleep Apnea and hypoapena syndrome is characterised by snoring, day time sleepiness, witnessed apneas confirmed by sleep test called polysomnogram. Treatment of choice is CPAP (Continous Positive Airway Pressure).
CPAP improves the quality of life and prevent sequlae of sleep disorders like heart attack, stroke diabetes and hypertension.

Speciality Chest

• Asthma Clinic
  
• Allergy Clinic
  
• COPD clinic
  
• Lung Cancer Clinic
  
• Sleep Clinic
  
• TB Clinic
  
• Smoking Cessation Clinic
  
• Pulmonary Rehabilitation Clinic
  
• HIV Clinic
  
• Pulmo Check (CBC, CR, PFT)

Facilities Available

• Pulmonary Function Test (PFT) (Spirometry)
  
• Bronchoscopy
  
• Thoracoscopy
  
• Pleural Biopsy
  
• Pleural Tapping
  
• Pleuro Desis
  
• Trans Thoracic Needle aspiration and biopsy
  
• Polysomnography (Sleep Study)
  
• Respiratory Therapy (Chest Physical Therapy)
  
• Intensive Respiratory Care Unit (IRCU).
  

Bronchoscopy can be defined as a diagnostic and therapeutic procedure that permits direct visualisation of the tracheo bronchial lumen with the help of the bronchoscope a specialised optical device.

Bronchoscopy is the most commonly used invasive procedure in clinical pulmonology.

Bronchoscopy permits collection of respiratory secretions from the trache bronchial tree as well as tissue samples from the airway mucosa, lung parencyma and

lymph nodes and other masses located immediately adjacent to but out side the tracheo bronchial lumen.

Bronchoscopy is also used as a therapeutic tool to treat the airway luminal obstructions caused by various diseases, bleeding from respiratory structure and several pulmunary disorders.

Indications for Diagnostic Bronchoscopy

• Unexplained Cough
  
• Unexplained Hemoptysis
  
• Locaised wheeze
  
• Strindor
  
• Unexplained chest radiography opacity-pulmonary infections (Localised) ( Diffuse) ( Immuno com promised)
  
• Diffuse lung disease (non-infections)
  
• Interstitial Lung Disease
  
• Drug Induced lung Disease
  
• Intra thoracic lymphadenopathy / mass, pulmonary nodule
  
• Bronchoginic carcinoma.
  

Positive / Suspicious sputum cytology, staging of bronchigenic carcinoma.

• Metastetic Carcinoma Endo bronchial or Parenchymal.
• Eosophageal and mediastinal tumors
• Foreign body in the airways.
  

Tracheo bronchial strictures and stenosis. Chemical and thermal burns of tracheo bronchual tree Chest trauma.

• Vocal cord paralysis and hoarsness
• Diaphragmatic paralysis, pleural effusion, Persistent pneumothorax Miscellaneous
• Tracheo Oesophageal Fistula.
  

Broncho pleural fistula, postop assessment of tracheo bronchial anastomosis.

Indications for therapeutic bronchoscopy

Airway secretion, muscus plugs, Clots and necrotic debris.

Atelectasis

Mucoid Impaction Syndrome - Plastic Bronchities, Asthma, Cystic Fibrosis

Foreign body in the tracheo broncial tree. Neoplams of the tracheo bronchial tree. Bronchoscipic dibridement, Laser therapy, Argon Plastma Coagalation, Electro cautery, Cryo therapy, Brachy therapy, Balloon dilatation.

Placement of tracheobranchial stent

Strictures and Stenosis : Branchoscopy dilation, laser, elecro cautary, argon plasma congulation, balloon dilation, stent placement

Bronchoscopic drainage : Mediatistina cysts, Bronchogenic Cyst, Lung Abscess

Bronchoscopy therapy : Pneumothorax (Persistent), Broncho Pleural Fistula

Bronchoscopic Intubation, Intralesional injection, thoracic trauma, therapeutic lavage for Pulmonary alveolar proteinosis.

Medical Thoracoscopy :

Pleuroscopy or medical thoracoscopy is an invasive technique to visualise the pleural cavity under local anesthesia.

Indications Are :

Pleural effusion of unknown etiology, Staging of Lung cancer, Staging of diffuse malignant mesothelioma, Pleurodesis by talc poudrage, Pleuroscopy or medical Thoracoscopy helps in draining the pleaural fluid and to take the biopsies from chestwall diaphragm, media-stinum and Lung.