Interventional Pulmonology Offers Promise for Lung Disease
Emerging as an important subspecialty of Pulmonary and Critical Care Medicine, interventional pulmonology incorporates advanced technologies into promising new diagnostic and treatment options for patients with lung disease. NYU’s Interventional Pulmonology program has opened a new bronchoscopy suite, with state-of-the-art capabilities including:
- electromagnetically-guided bronchoscopy using CT imaging;
- autofluorescence imaging using confocal miniprobes to assist with bronchoscopy (visualizing the connective tissue matrix of the lung in real time);
- cryotherapy (a method of destroying abnormal tissue by freezing and refreezing the cells);
- Electrocautery (use of a small, heated probe to burn away diseased tissue or stop hemorrhaging)
- Argon plasma coagulation (which uses high-frequency electrical current delivered via ionized argon gas to destroy hard-to-remove tumors);
- Rapid onsite cytology evaluation
- Molecular techniques for the rapid diagnosis of pulmonary infections
- Jet ventilation to facilitate rigid bronchoscopy
The NYU Interventional Pulmonology program also participates in important clinical trials; among them two recently launched initiatives aimed at helping patients with advanced emphysema through the use of minimally invasive techniques. To date, there have been limited treatment options for emphysema, which is estimated to affect more than three million people in the U.S. alone. Smoking cessation remains the most important first step. Medical therapies can help relieve shortness of breath and improve day-to-day function, but cannot reverse the damage that has been done. For those with advanced disease, lung transplantation and lung volume reduction surgery (LVRS) can be effective, but both have high complication rates and limited long-term impact.
Both technologies in the clinical trials at NYU’s Interventional Pulmonology program represent innovative ways of approaching this complex problem, although they differ in the details and the patient populations being served:
- Airway bypass: Emphysema is characterized by the destruction of alveoli and the supporting architecture of the lung. As a result, the small airways collapse during expiration, trapping air in the lung and leading to a condition called hyperinflation that requires the patient to expend more effort to breathe.
Applying techniques analogous to those frequently used in cardiac catheterization labs, the airway bypass approach uses a drug-eluting stent called Exhale®, from Broncus technologies, Inc., which is inserted to allow trapped air to escape. This effectively deflates the lung back to normal size, making it easier to for the patient to breathe. This minimally invasive procedure has the potential to offer real relief to patients with emphysema.
- One-way Valves: Some patients with emphysema have predominantly localized disease. The lungs of these patients may have very severely affected areas, while other areas are relatively normal. The diseased areas become hyperinflated, compress the good lung, and impair respiratory mechanics. The goal of LVRS is to remove these diseased areas and it is effective for those whose disease is predominantly in the upper lobe. However, it involves major surgery and has a high complication rate.
The Interventional Pulmonology program at NYU is participating in a clinical trial of the Spiration IBV® Valve System, a small one-way device that allows air to escape, but not enter, the diseased areas. Thus, most of a patient’s breath is shunted to the healthier parts of the lungs, allowing gas exchange to take place in a more efficient manner.
For more information, please contact David Ost, M.D., at 212-263-7951.
