Chest
Volume 131, Issue 1, January 2007, Pages 261-274
Journal home page for Chest

Recent Advances in Chest Medicine
State of the Art: Interventional Pulmonology

https://doi.org/10.1378/chest.06-0975Get rights and content

Abstract

Interventional pulmonology (IP) provides comprehensive care to patients with structural airway disorders and pleural diseases. A growing armamentarium of diagnostic and therapeutic tools has expanded the interventional pulmonologist's ability to care for pulmonary patients with complex abnormalities, often in concert and close collaboration with physicians in other specialties, such as thoracic surgery. Innovative technologies promise to have an impact on diseases and clinical entities not traditionally treated by invasive pulmonary interventions, such as asthma, COPD, and the solitary pulmonary nodule. Training, credentialing, reimbursement, and scientific validation remain key necessities for the continued growth of IP, and require a concerted effort by chest physicians and their professional organizations.

Section snippets

Therapeutic Bronchoscopy

Therapeutic bronchoscopy was the nidus for the growth of the IP field. The introduction of laser technology into the tracheobronchial tree and the advent of airway stents in the early 1990s sparked an interest among pulmonologists to gain more experience in the diagnosis and management of airway disorders, and caused a resurgence of rigid bronchoscopy (RB).

The main indication for therapeutic bronchoscopy is the presence of airway disorders resulting in central airway obstruction (CAO) [ie,

New Developments and Concepts in Evaluation

New innovations are continually fueling the growth of IP; while some are adopted from other fields and are tailored to pulmonary applications, others represent new pioneering concepts.

Training and Certification

IP is constantly growing and integrating new technologies. Acquiring the various skills and maintaining competence is a challenging undertaking. Current venues for training consist of dedicated 1-year IP fellowships, extended sabbaticals in IP centers, and 1- to 3-day condensed courses in selected procedures that are offered throughout the world.

There is an intense debate over whether a dedicated additional year of training is required or advanced skills can be obtained during the traditional

Summary

IP focuses on the diagnosis and treatment of malignant and nonmalignant airway and pleural disorders. A variety of new scopes, debulking modalities, and technological innovations have energized the field, and have extended its reach beyond the traditional limits of pulmonary medicine. The future growth of IP will depend on overcoming key issues impeding its progress through the regulation of training and credentialing, petitioning for fair financial reimbursement, and the conduct of rigorous

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    Dr. Wahidi or his employer has received unrestricted grants for CME activities or research from Pentax, Denver Biomedical, and Olympus. He serves as a principal investigator on studies for endoscopic lung volume reduction and asthma treatment. Dr. Ernst or his employer has received unrestricted education grants for CME or research activities from Alveolus, Boston Scientific, Bryan, Cook, Denver Biomedical, Olympus, Storz, and Superdimension. He has served or serves as a principal investigator for studies on autofluorescense, endobronchial ultrasound, endoscopic lung volume reduction, and asthma treatment. Dr. Herth or his employer has received unrestricted education grants for CME or research activities from Alveolus, Boston Scientific, Bryan, Cook, Olympus, Storz, Wolf, and Superdimension. He has served or serves as a principal investigator for studies on autofluorescence, endobronchial ultrasound, and endoscopic lung volume reduction.

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