28 - Therapeutic Bronchoscopy: Interventional Techniques

Abstract

The role of therapeutic bronchoscopy in the era of evolving and advancing technology has expanded across disease categories. Malignant central airway obstruction remains the most common etiology managed by therapeutic rigid and flexible bronchoscopy. Multiple modalities of tumor ablation, tumor destruction, mechanical tumor debulking, and airway stenting are available to restore airway patency. Most important, these interventions have been shown to result in improved quality-adjusted survival and overall health-related quality of life. Such procedures are also successful in the management of nonmalignant central airway obstruction. During the past 20 years, treatment guidelines of other pulmonary diseases, such as end-stage emphysema, asthma, and prolonged postsurgical air leak, have included bronchoscopic procedures among the list of their therapeutic options. In this chapter we will focus on the role of bronchoscopy in the management of central airway obstruction. Treatment of advanced emphysema with bronchoscopic lung volume reduction, severe persistent asthma treatment with bronchial thermoplasty, and management of prolonged air leaks using endobronchial valves will also be reviewed.