Interventional Pulmonology: The Basics

What is Interventional Pulmonology?

Interventional pulmonology (IP) is a medical specialty for diseases of the lungs and chest. IP providers use an endoscope and other tools to do minimally invasive procedures. A minimally invasive procedure uses fewer (or no) incisions (surgical cuts) and needs less healing time than an invasive procedure. These procedures are used to diagnose and treat problems in the lungs and nearby areas.

IP teams are made up of an interventional pulmonologist who is a doctor who has training in doing IP procedures. Other team members can include Nurse Practitioners (NP), Physician Assistants (PA), Nurses, Respiratory Therapists, and Coordinators.

What are IP procedures used for?

IP procedures may be used to:

• Diagnose cancer or other health problems. This can be done by taking a sample of a tumor in the lungs, or the nearby lymph nodes, using an endoscope. This might help avoid major surgery.
• Help you breathe better if a tumor is blocking your lungs or you have damage from cancer treatment.
• Help treat cancer that has spread from another part of the body to the lungs.

How are IP procedures done?

An interventional pulmonologist’s main tool is a type of endoscope called a bronchoscope. A bronchoscope is a small tube that can be passed through the nose or mouth, down into the lungs. It has a camera and light on the end, letting the provider see into the lungs. The provider passes small tools through the bronchoscope. These tools may include small tweezers to take a biopsy (tissue sample), a laser to remove tissue blocking an airway, or a stent or balloon to open a blocked airway.

IP Procedures

Some IP procedures are done in the office or your hospital room, while others are done in the operating room. Some procedures use a numbing medicine to make you comfortable, while for others you need to have anesthesia or sedation to help you sleep during the procedure. Your provider will tell you which procedure is best for you.

• Airway stent placement: Cancer in the lung can block or press on your airway, making it hard to breathe. This can lead to cough and pneumonia. A stent, which is often made of metal, silicone, or a mixture of these, is put in the airway to hold it open.
• Balloon: A deflated balloon is passed through the bronchoscope and pumped up in a narrowed airway. This opens the airway, making it easier for you to breathe.
• Lung or lymph node biopsy: A bronchoscope can be used to reach areas in the lung for biopsy. A biopsy takes a small tissue sample, which is sent to the lab to look for cancer. The bronchoscope can also be used to biopsy the lymph nodes in the middle of the chest. This is a common place for lung cancer to spread.
• Thoracentesis: A thoracentesis is done to drain extra fluid from around the lungs. Fluid buildup in the lining of the lung is called pleural effusion. This fluid puts pressure on the lungs, making it hard for you to breathe. Thoracentesis can be done as needed for comfort.
• Pleural catheter: The IP team can put in a catheter (tube) that stays in place in the lining of the lung. This allows you to drain the pleural fluid at home, as needed.
• Pleurodesis: This procedure is used when a pleural effusion keeps collecting fluid after you have had a thoracentesis. In pleurodesis, the fluid is drained, and a chemical is infused into the pleural space. This chemical irritates the lung lining and causes swelling. Over some time, the outer lining of the lung and the inside lining of the chest stick together. This stops the fluid from coming back to that spot.
• Endobronchial ultrasound (EBUS): In this procedure, a bronchoscope with an ultrasound tool at the end of it is used. This helps the provider do more accurate biopsies.

What are the benefits and risks of IP procedures?

IP procedures may help a patient avoid major surgery. IP procedures have a shorter recovery time than surgery.

The main risks of IP procedures are bleeding, infection, and pneumothorax. A pneumothorax happens when the lung is nicked by a needle and loses air. The air collects in the pleural space around the lung. This puts pressure on the lung, making it hard to breathe. If you have a pneumothorax, you may need to stay in the hospital. A tube will then be placed in the chest to remove the air which will let the lining of the lung heal.

Talk with your care team about whether interventional pulmonology will be a part of your plan and be sure to ask any questions you may have about the procedure you are having.