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European Respiratory Review : An... Mar 2023Endobronchial stenting is an important aspect of the practice of interventional pulmonology. The most common indication for stenting is the management of clinically... (Review)
Review
Endobronchial stenting is an important aspect of the practice of interventional pulmonology. The most common indication for stenting is the management of clinically significant airway stenosis. The list of endobronchial stents available on the market continues to grow. More recently, patient-specific 3D-printed airway stents have been approved for use. Airway stenting should be considered only when all other options have been exhausted. Due to the environment of the airways and the stent-airway wall interactions, stent-related complications are common. Although stents can be placed in various clinical scenarios, they should only be placed in scenarios with proven clinical benefit. The unwarranted placement of a stent can expose the patient to complications with little or no clinical benefit. This article reviews and outlines the key principles of endobronchial stenting and important clinical scenarios in which stenting should be avoided.
Topics: Humans; Bronchoscopy; Stents; Airway Obstruction
PubMed: 36889785
DOI: 10.1183/16000617.0189-2022 -
Revista Chilena de Pediatria Dec 2020Stridor is an abnormal respiratory sound caused by obstruction or collapse of the laryngotracheal airway, either acutely or chronically. There are different causes, both... (Review)
Review
Stridor is an abnormal respiratory sound caused by obstruction or collapse of the laryngotracheal airway, either acutely or chronically. There are different causes, both congenital and acquired, that can produce shortness of breath which may be severe and potentially life-threatening. The clini cal diagnosis must be complemented with an endoscopic airway assessment and sometimes with imaging, to try to determine the areas involved and possible associated malformations. Treatment should be individualized, considering the patient's overall condition, stridor etiology, its impact on breathing and swallowing, prognosis, and technical capacity of the managing team, among others. Alternatives may include observation, non-pharmacological measures, local or systemic medications, endoscopic and open surgeries, or a temporary or long-term tracheostomy. A thorough understan ding of the pathophysiology and etiopathogenesis of persistent pediatric stridor is essential for the correct management of these complex patients, ideally in a multidisciplinary manner.
Topics: Airway Obstruction; Child; Endoscopy; Humans; Prognosis; Respiratory Sounds; Tracheostomy
PubMed: 33861835
DOI: 10.32641/rchped.vi91i6.2115 -
Thoracic Surgery Clinics Aug 2020Interventional pulmonology is a dynamic and evolving field in respiratory medicine. Advances have improved the ability to diagnose and manage diseases of the airways. A... (Review)
Review
Interventional pulmonology is a dynamic and evolving field in respiratory medicine. Advances have improved the ability to diagnose and manage diseases of the airways. A shift toward early detection of malignant disease has generated a focus on innovative diagnostic techniques. With patient populations living longer with malignant and benign diseases, the role for interventional bronchoscopy has grown. In cancer groups, novel immunotherapies have improved the prospects of clinical outcomes and reignited a focus on optimizing patient performance status to enable access to anticancer therapy. This review discusses current and emerging diagnostic modalities and therapeutic approaches available to manage airway diseases.
Topics: Airway Obstruction; Bronchoscopy; Cone-Beam Computed Tomography; Fluoroscopy; Humans; Laser Therapy; Lung; Lung Neoplasms; Pulmonary Medicine; Stents; Ultrasonography
PubMed: 32593365
DOI: 10.1016/j.thorsurg.2020.04.001 -
Expert Review of Respiratory Medicine Jul 2018Lung cancer is the leading cause of cancer-related deaths in the United States. Nearly 85% of all lung cancers are diagnosed at a late stage, with an associated... (Review)
Review
Lung cancer is the leading cause of cancer-related deaths in the United States. Nearly 85% of all lung cancers are diagnosed at a late stage, with an associated five-year survival rate of 4%. Malignant central airway obstruction and malignant pleural effusions occur in upwards of 30% of these patients. Many of these patients are in need of palliative interventions for symptom control and to help improve their quality of life. Areas covered: This review covers the treatment modalities of malignant central airway obstruction and malignant pleural effusion. PubMed was used to search for the most up to date and clinically relevant articles that guide current treatment strategies. This review focuses on rigid bronchoscopy and the tools used for the relief of central airway obstruction, as well as intra-pleural catheter use and pleurodesis for the management of malignant pleural effusions. Expert commentary: There are multiple treatment modalities that may be used to help alleviate the symptoms of malignant central airway obstruction and pleural effusion. The modality used depends on the urgency of the situation, and specific patient's goals. An open dialog to understand the patient's end of life goals is an important factor when choosing the appropriate treatment strategy.
Topics: Airway Obstruction; Argon Plasma Coagulation; Bronchoscopy; Catheters, Indwelling; Cryosurgery; Dilatation; Dyspnea; Electrocoagulation; Humans; Laser Therapy; Lung Neoplasms; Palliative Care; Photochemotherapy; Pleural Effusion, Malignant; Pleurodesis; Radiotherapy; Stents; Thoracentesis
PubMed: 29883216
DOI: 10.1080/17476348.2018.1486709 -
A&A Practice Jun 2023Airway obstruction during anesthesia is a common occurrence with potentially serious outcomes. Increasingly, patients are older, heavier, and more likely to have...
Airway obstruction during anesthesia is a common occurrence with potentially serious outcomes. Increasingly, patients are older, heavier, and more likely to have obstructive sleep apnea-all heightened risk factors for airway complications. These patients undergo procedures where distal pharyngeal tissues can relax, obstructing the airway. As a result, there is a need for airway devices that can stent open distal pharyngeal tissues to maintain adequate ventilation. To physically address this problem, the new distal pharyngeal airway (DPA) prevents airway obstruction and enables providers to maintain ventilation.
Topics: Humans; Pharynx; Sleep Apnea, Obstructive; Respiration; Airway Obstruction; Anesthesia
PubMed: 37335861
DOI: 10.1213/XAA.0000000000001691 -
International Journal of Chronic... 2017It is increasingly acknowledged that delays in the diagnosis of chronic inflammatory lung conditions have hampered our understanding of pathogenesis and thus our ability... (Review)
Review
It is increasingly acknowledged that delays in the diagnosis of chronic inflammatory lung conditions have hampered our understanding of pathogenesis and thus our ability to design efficacious therapies. This is particularly true for COPD, where most patients are diagnosed with moderate-to-severe airflow obstruction and little is known about the inflammatory processes present in early disease. There is great interest in developing screening tests that can identify those most at risk of developing COPD before airflow obstruction has developed for the purpose of research and clinical care. Landmark pathology studies have suggested that damage to the small airways precedes the development of airflow obstruction and emphysema and, thus, presents an opportunity to identify those at risk of COPD. However, despite a number of physiological tests being available to assess small airways function, none have been adopted into routine care in COPD. The reasons that tests of small airways have not been utilized widely include variability in test results and a lack of validated reference ranges from which to compare results for some methodologies. Furthermore, population studies have not consistently demonstrated their ability to diagnose disease. However, the landscape may be changing. As the equipment that delivers tests of small airways become more widely available, reference ranges are emerging and newer methodologies specifically seek to address variability and difficulty in test performance. Moreover, there is evidence that while tests of small airways may not be helpful across the full range of established disease severity, there may be specific groups (particularly those with early disease) where they might be informative. In this review, commonly utilized tests of small airways are critically appraised to highlight why these tests may be important, how they can be used and what knowledge gaps remain for their use in COPD.
Topics: Airway Obstruction; Disease Progression; Humans; Lung; Predictive Value of Tests; Pulmonary Disease, Chronic Obstructive; Pulmonary Emphysema; Respiratory Function Tests; Risk Factors
PubMed: 28848335
DOI: 10.2147/COPD.S138540 -
Respiration; International Review of... 2022Malignant central airway obstruction (CAO) is a debilitating complication of primary lung cancer and pulmonary metastases. Therapeutic bronchoscopy is used to palliate... (Review)
Review
BACKGROUND
Malignant central airway obstruction (CAO) is a debilitating complication of primary lung cancer and pulmonary metastases. Therapeutic bronchoscopy is used to palliate symptoms and/or bridge to further therapy. Microwave ablation (MWA) heats tissue by creating an electromagnetic field around an ablation device. We present a pilot study utilizing endobronchial MWA via flexible bronchoscopy as a novel modality for the management of malignant CAO.
METHODS
Therapeutic bronchoscopy with a flexible MWA probe was performed in 8 cases. We reviewed tumor size, previous ablative techniques, number of applications, ablation time, amount of energy delivered, rate of successful recanalization, complications, and 30-day follow-up.
RESULTS
Successful airway recanalization was achieved in all cases. No complications were noted. In 1 case, tumor in-growth within a silicone stent was ablated with no damage to the stent.
DISCUSSION
Endobronchial MWA is a novel technique for tumor destruction while maintaining an airway axis. The oven effect and air gap around a tumor allow for safe and effective tissue devitalization and hemostasis without a thermal effect on structures surrounding the airway.
Topics: Airway Obstruction; Bronchoscopy; Humans; Lung Neoplasms; Microwaves; Pilot Projects
PubMed: 35316812
DOI: 10.1159/000522544 -
Anesthesiology Nov 2017
Topics: Adult; Airway Obstruction; Bronchoscopy; Female; Humans; Lingual Thyroid
PubMed: 28617707
DOI: 10.1097/ALN.0000000000001743 -
Paediatric Respiratory Reviews Jan 2017Obstruction of the central airways is an important cause of exercise-induced inspiratory symptoms (EIIS) in young and otherwise healthy individuals. This is a large,... (Review)
Review
Obstruction of the central airways is an important cause of exercise-induced inspiratory symptoms (EIIS) in young and otherwise healthy individuals. This is a large, heterogeneous and vastly understudied group of patients. The symptoms are too often confused with those of asthma. Laryngoscopy performed as symptoms evolve during increasing exercise is pivotal, since the larynx plays an important role in symptomatology for the majority. Abnormalities vary between patients, and laryngoscopic findings are important for correct treatment and handling. The simplistic view that all EIIS is due to vocal cord dysfunction [VCD] still hampers science and patient management. Causal mechanisms are poorly understood. Most treatment options are based on weak evidence, but most patients seem to benefit from individualised information and guidance. The place of surgery has not been settled, but supraglottoplasty may cure well-defined severe cases. A systematic clinical approach, more and better research and randomised controlled treatment trials are of utmost importance in this field of respiratory medicine.
Topics: Airway Obstruction; Breathing Exercises; Exercise; Exercise Test; Humans; Laryngeal Diseases; Laryngoplasty; Laryngoscopy; Patient Education as Topic; Respiratory Therapy
PubMed: 27492717
DOI: 10.1016/j.prrv.2016.07.003 -
Clinical Chemistry and Laboratory... Sep 2023Over 3% of asthmatic patients are affected by a particularly severe form of the disease ("severe asthma", SA) which is often refractory to standard treatment. Airway... (Review)
Review
Over 3% of asthmatic patients are affected by a particularly severe form of the disease ("severe asthma", SA) which is often refractory to standard treatment. Airway remodeling (AR), which can be considered a critical characteristic of approximately half of all patients with SA and currently thought to be the main mechanism triggering fixed airway obstruction (FAO), seems to be a key factor affecting a patient's outcome. Despite the collective efforts of internationally renowned experts, to date only a few biomarkers indicative of AR and no recognizable biomarkers of lung parenchymal remodeling have been identified. This work examines the pathogenesis of airway and lung parenchymal remodeling and the serum biomarkers that may be able to identify the severe asthmatic patients who may develop FAO. The study also aims to examine if Krebs von den Lungen-6 (KL-6) could be considered a diagnostic biomarker of lung structural damage in SA.
Topics: Humans; Lung Diseases, Interstitial; Biomarkers; Asthma; Airway Obstruction; Mucin-1
PubMed: 36989607
DOI: 10.1515/cclm-2022-1323