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Panminerva Medica Sep 2019Bronchial thermoplasty (BT) is an innovative non-pharmacological endoscopic treatment for patients with severe persistent asthma based on controlled heat release with a... (Review)
Review
Bronchial thermoplasty (BT) is an innovative non-pharmacological endoscopic treatment for patients with severe persistent asthma based on controlled heat release with a device called Alairâ„¢ Catheter (Boston Scientific, Natick, MA, USA). The Alairâ„¢ system is the first device that works by delivering radiofrequency or thermal energy to selectively reduce the amount of airway smooth muscle (ASM) in bronchi. Literature showed significant improvement in clinical outcomes such as symptom control, severe exacerbation rate, hospitalization, quality of life, and number of working or school days lost for asthma. Besides smooth muscle effects changes in inflammatory pattern after BT have been documented. Bronchial thermoplasty requires an experienced physician who had a proficiency training in bronchoscopy and had rigor, dexterity and a thorough knowledge of the airway anatomy. Furthermore, right selection of severe asthma patient is crucial in order to have best response after BT. This article reviews BT device description and how to perform the procedure. Criteria for right selection and management of patient before and after BT will be discussed.
Topics: Asthma; Bronchi; Bronchial Thermoplasty; Bronchoscopes; Bronchoscopy; Clinical Competence; Humans; Pulmonary Medicine; Radio Waves
PubMed: 30486619
DOI: 10.23736/S0031-0808.18.03582-6 -
Journal of Thoracic Disease Jan 2017Tracheal and bronchial injury, including iatrogenic injury and traumatic injury, the former usually occurred in the operation, intubation or bronchoscopy. The latter was... (Review)
Review
Tracheal and bronchial injury, including iatrogenic injury and traumatic injury, the former usually occurred in the operation, intubation or bronchoscopy. The latter was occurred in a variety of blunt trauma, often combined with a variety of complex injuries. The therapeutic approach can be differentiated, surgical or conservative, no criteria has been universally accepted. Successful treatment of tracheobronchial injuries requires early diagnostic evaluation. This article aims to review the indications and therapeutic options for tracheal and bronchial injuries.
PubMed: 28203437
DOI: 10.21037/jtd.2017.01.19 -
Respiratory Medicine Apr 2018A persistent air leak (PAL) can be caused by either an alveolar-pleural fistula (APF) or bronchopleural fistula (BPF). Complications from PAL lead to an increase in... (Comparative Study)
Comparative Study Review
A persistent air leak (PAL) can be caused by either an alveolar-pleural fistula (APF) or bronchopleural fistula (BPF). Complications from PAL lead to an increase in morbidity and mortality, prolonged hospital stay, and higher resource utilization. Pulmonary physicians and thoracic surgeons are often tasked with the difficult and often times frustrating diagnosis and management of PALs. While most patients will improve with chest tube thoracostomy, many will fail requiring alternative bronchoscopic or surgical strategies. Herein, we review the bronchoscopic and surgical diagnostic and treatment options for PAL as it pertains to the field of interventional pulmonology and thoracic surgery.
Topics: Bronchial Fistula; Bronchoscopy; Chest Tubes; Fistula; Humans; Length of Stay; Pleural Diseases; Pleurodesis; Randomized Controlled Trials as Topic; Septal Occluder Device; Thoracostomy
PubMed: 29605207
DOI: 10.1016/j.rmed.2018.03.017 -
Diagnostic and Interventional Radiology... Jul 2022PURPOSE We aimed to determine the safety and feasibility of transradial access (TRA) in bronchial artery and non-bronchial systemic artery (NBSA) embolization in...
PURPOSE We aimed to determine the safety and feasibility of transradial access (TRA) in bronchial artery and non-bronchial systemic artery (NBSA) embolization in patients with non-massive hemoptysis. METHODS This retrospective study was approved by the Institutional Review Board. Among the 300 patients treated for hemoptysis with bronchial artery and NBSA embolization between April 2018 and July 2019, 19 procedures in 19 patients were conducted by TRA and were retrospectively analyzed. TRA was considered when the bronchial artery or NBSA originated from the arch vessel or its tributaries. The exclusion criteria of TRA included Barbeau C or D waveform and a radial artery diameter of less than 1.8 mm on ultrasound. TRA was also avoided in cases of the high-origin bronchial artery (i.e., T4 or higher level of the aorta). The hemoptysis-free time was estimated using the Kaplan-Meier method. RESULTS The technical success (i.e., embolization of all target artery with TRA) rate was 94.7% (18 out of 19 patients). In terms of the target arteries, embolization with TRA was technically successful in treating 47 out of 48 arteries (97.9%). The 1-month and 6-month hemoptysis-free rates were 89.5% (17/19) and 73.7% (14/19), respectively. The only adverse event was iatrogenic dissection of the bronchial artery with little clinical significance in 1 patient. No access site complications were identified on post-procedure day 1 ultrasonography. CONCLUSION With proper patient selection, TRA offers a safe and effective approach to embolize the bronchial arteries and NBSAs in patients with hemoptysis.
Topics: Bronchial Arteries; Embolization, Therapeutic; Hemoptysis; Humans; Retrospective Studies; Treatment Outcome
PubMed: 35950280
DOI: 10.5152/dir.2022.201100 -
Japanese Journal of Clinical Oncology May 2021Previous reports on transarterial treatment for lung cancer were reviewed. The bronchial arterial infusion therapy has a long history since 1964. Better local control... (Review)
Review
Previous reports on transarterial treatment for lung cancer were reviewed. The bronchial arterial infusion therapy has a long history since 1964. Better local control with less doses of anti-neoplastic agents was warranted by trying transarterial administration to lung and mediastinal tumors. It is reported that both primary and metastatic tumors are fed by bronchial or other systemic arteries. The bronchial arterial embolization for hemoptysis has been introduced for clinical practice since 1973. Hemoptysis by not only benign but also malignant diseases has been well controlled by embolization. In recent decades, the technical elements for transarterial treatments have markedly improved. They make it possible to carry out precise procedures of selective catheter insertion to the tumor relating arteries. Current concepts of transarterial treatment, technical aspects and treatment outcomes are summarized. Tentative result from chemo-embolization for advanced lung cancer using recent catheter techniques was also described. It provides favorable local control and survival merits. It is considered that a population of lung cancer patients can benefit from transarterial management using small doses of anti-neoplastic agents, with less complications and less medical costs.
Topics: Bronchial Arteries; Catheterization, Peripheral; Disease Progression; Embolization, Therapeutic; Hemoptysis; Humans; Lung; Lung Neoplasms; Treatment Outcome
PubMed: 33855367
DOI: 10.1093/jjco/hyab050 -
Allergologie Select 2018Knowledge about the immunological mechanisms underlying asthma bronchiale is a prerequisite for development of new (causal) interventions. A large number of studies has... (Review)
Review
Knowledge about the immunological mechanisms underlying asthma bronchiale is a prerequisite for development of new (causal) interventions. A large number of studies has proven asthma to be a complex disease with subtypes with different immunological features. Cytokines and chemokines, which are secreted by immune cells as well as structural cells play an important role not only in maintenance and amplification but have significant impact in the initiation of pulmonary inflammations - the asymptomatic sensitization phase. This article describes important immunological mediators in the context of the pulmonary sensitization phase. Moreover chances and constraints of intervention strategies aiming at these mediators are discussed. Several new aspects like classification of immunological phenotypes in bronchial asthma for individualized strategies and taking the sensitization phase into account, reveal possible targets among both "old acquaintances" like IL-4 and newly identified mediators (e.g. IL-17, IL-33).
PubMed: 31826038
DOI: 10.5414/ALX1480E -
Canadian Respiratory Journal 2020. Hemoptysis is a rare but often life-threatening condition in pediatric patients. Massive hemoptysis can easily lead to asphyxia, respiratory failure, shock, and even...
. Hemoptysis is a rare but often life-threatening condition in pediatric patients. Massive hemoptysis can easily lead to asphyxia, respiratory failure, shock, and even death. The most common causes of severe hemoptysis are lower respiratory tract infection, vascular malformation, and bronchial foreign body. We present an unusual case of massive hemoptysis caused by malformation of the bronchial artery, which includes bronchial artery hypertrophy, bronchial-pulmonary artery fistula, and ectopic bronchial artery. . An 11-year-old boy was admitted to the hospital with mild hemoptysis lasting for the two preceding days. He did not report any discomfort, such as fever or chest pain. His complete blood count and coagulation function were normal. Chest X-ray documented lower right pneumonia. Massive hemoptysis occurred on the night of the admission. . Bronchial arteriography revealed that the right lower bronchial artery and the ectopic bronchial artery from the renal artery were the responsible vessels for hemoptysis. . The boy underwent a successful bronchial artery embolization and bronchoscopy to remove the blood clot from the airway. . After bronchial artery embolization and bronchoscopy, the boy recovered without complications. Hemoptysis and chest pain disappeared, and chest radiographs returned to normal. . Bronchial arterial bleeding often presents as life-threatening massive hemoptysis. Patients should immediately receive hemostatic treatment and undergo chest CTA, bronchial arteriography, BAE, and bronchoscopy according to their condition. Rapid identification of the etiology and symptomatic treatment are critical to saving the lives of children.
Topics: Bronchial Arteries; Bronchoscopy; Child; Computed Tomography Angiography; Embolization, Therapeutic; Hemoptysis; Humans; Male; Pneumonia; Radiography, Thoracic; Severity of Illness Index; Treatment Outcome; Vascular Fistula; Vascular Malformations
PubMed: 32587644
DOI: 10.1155/2020/6414719 -
Medicine Oct 2022Bronchial schwannomas are extremely rare among the benign tracheobronchial tumors and little are known about its epidemiology and optimal clinical management. Here, we... (Review)
Review
RATIONALE
Bronchial schwannomas are extremely rare among the benign tracheobronchial tumors and little are known about its epidemiology and optimal clinical management. Here, we report a case of bronchial schwannoma in a young Japanese man and clinical implications about epidemiology, symptom, diagnosis, and treatment of bronchial schwannoma.
PATIENTS CONCERN
A 37-year-old man visited our department with a nodule incidentally found on his chest radiograph during a routine medical checkup.
DIAGNOSIS
The tumor was diagnosed as a bronchial schwannoma after pathological evaluation. Microscopically, the tumor consisted of spindle cell proliferation characterized by an alternating highly ordered cellular Antoni A component with occasional nuclear palisading and a loose myxoid Antoni B component. Tumor cells were immunoreactive for S100 but not for smooth muscle actin or KIT.
INTERVENTIONS
A video-assisted right middle and lower bilobectomy was performed.
OUTCOME
He remains under observation without recurrence.
LESSONS
In our review, many reports have come from Asian countries. Bronchial schwannoma can occur within a wide range of age groups and in both men and women. No difference in incidence was observed between right and left bronchial tree. Bronchial schwannoma is sometimes difficult to differentiate from malignant diseases. We should include bronchial schwannoma as one of the differential diagnoses of primary bronchial tumors.
Topics: Actins; Adult; Bronchial Neoplasms; Diagnosis, Differential; Female; Humans; Male; Neurilemmoma; Pneumonectomy
PubMed: 36221358
DOI: 10.1097/MD.0000000000031062 -
Therapeutic Advances in Respiratory... 2018Asthma is a common chronic inflammatory condition of the airways. Conventional therapy comprises inhaled corticosteroid and bronchodilators as well as trigger avoidance... (Review)
Review
Asthma is a common chronic inflammatory condition of the airways. Conventional therapy comprises inhaled corticosteroid and bronchodilators as well as trigger avoidance and management of comorbid conditions. A small group remain symptomatic despite these strategies and novel therapies have been developed. Bronchial thermoplasty is a nonpharmacological therapy which targets airway smooth muscle to improve asthma control. Clinical trials to date have shown the efficacy and safety of bronchial thermoplasty with a persistent effect on extended follow up. Questions remain regarding the exact mechanism of action of bronchial thermoplasty, the cost effectiveness of the procedure and the ideal criteria for patient selection.
Topics: Airway Remodeling; Asthma; Bronchi; Bronchial Hyperreactivity; Bronchial Thermoplasty; Bronchoconstriction; Bronchoscopy; Disease Progression; Humans; Risk Factors; Severity of Illness Index; Treatment Outcome
PubMed: 30132377
DOI: 10.1177/1753466618792410 -
European Respiratory Review : An... Sep 2015Tracheal or bronchial proximal stenoses occur as complications in 20-30% of lung cancers, resulting in a dramatic alteration in quality of life and poor prognosis.... (Review)
Review
Tracheal or bronchial proximal stenoses occur as complications in 20-30% of lung cancers, resulting in a dramatic alteration in quality of life and poor prognosis. Bronchoscopic management of these obstructions is based on what are known as "thermal" techniques for intraluminal stenosis and/or placement of tracheal or bronchial prostheses for extrinsic compressions, leading to rapid symptom palliation in the vast majority of patients. This invasive treatment should only be used in cases of symptomatic obstructions and in the presence of viable bronchial tree and downstream parenchyma. This review aims to clarify 1) the available methods for assessing the characteristics of stenoses before treatment, 2) the various techniques available including their preferred indications, outcomes and complications, and 3) the integration of interventional bronchoscopy in the multidisciplinary management of proximal bronchial cancers and its synergistic effects with the other specific treatments (surgery, radiotherapy or chemotherapy).
Topics: Airway Obstruction; Bronchial Diseases; Bronchoscopes; Bronchoscopy; Combined Modality Therapy; Critical Pathways; Cryosurgery; Electrocoagulation; Humans; Laser Therapy; Lasers; Lung Neoplasms; Palliative Care; Patient Selection; Photochemotherapy; Risk Factors; Stents; Tracheal Stenosis; Treatment Outcome
PubMed: 26324799
DOI: 10.1183/16000617.00010014