Breathing Easier with Interventional Pulmonology

Interventional pulmonology provides minimally invasive techniques to help diagnose and treat lung diseases.

Your lungs bring oxygen into the body and remove carbon dioxide waste. Many different diseases impair lung function and diminish a person’s quality of life. The Interventional Pulmonology (IP) program at Inova Schar Cancer Institute provides minimally invasive procedures and therapies to diagnose and treat these conditions.

“We want to detect disease early without the invasiveness of surgery,” said Amit “Bobby” Mahajan, MD, medical director of the IP program at Inova Schar Cancer Institute. “We do most everything from the inside using a bronchoscope, a long camera that goes into the airway, without cutting.”

The IP program brings together a team of specialists with expertise in thoracic surgery, oncology, radiation oncology and respiratory therapy. These specialists work together to address a variety of conditions that impact the lungs and airway.

“At most hospitals, the IP and thoracic programs are separate, and people are passed back and forth to various doctors. This can be incredibly frustrating for someone who wants a diagnosis,” said Dr. Mahajan. “At Inova Schar, the IP and thoracic programs work together to get you seen by the right person the first time.”

Faster diagnosis and treatment for incidental lung cancer

In terms of diagnosing and treating lung cancer, Inova Schar is unique. The institute maintains a program that scans all the computerized tomography records conducted at Inova emergency rooms to pick up the term “nodule” in the radiology reports. The IP team reaches out to those patients to ensure they follow up with a physician to evaluate the nodule, which could be cancerous. By following up on these incidental lung nodule findings, cancers can be detected early – before they spread to other parts of the body.

“Typically, only 30% of incidental nodules are followed up correctly,” said Dr. Mahajan. “In our system, 90% are followed up, and we have diagnosed more than 40 cancers in the last few years because we have identified and treated them quickly.”

The IP team uses various advanced technologies, including endobronchial ultrasound EBUS and electromagnetic navigation bronchoscopy to evaluate abnormal areas of the lung. These noninvasive procedures use small cameras that are passed down the windpipe to produce image-guided biopsies of structures throughout the chest.

If cancer is identified, the team has several techniques to address the disease. They can place fiducial markers, which are tiny metal objects, near a tumor to pinpoint where to target radiation during treatment. Radiofrequency ablation aims high-energy radio waves at the tumor to heat and kill cancer cells, and electrocautery applies heat produced by an electrical current to destroy cancer cells. Conversely, cryotherapy uses liquid nitrogen to freeze cancer cells.

The IP team also provides patients with information about ongoing clinical trials at the facility and discusses how the study treatments could address their particular cancers.

New approaches for emphysema and pleural effusion

Emphysema

Emphysema is a condition that weakens the small air sacs inside the lungs, reducing the surface area for oxygen intake. The most common cause of emphysema is cigarette smoking. Long-term smoking causes the lungs to become overinflated. As a result, the breathing muscles work ineffectively, and a person may experience shortness of breath and impaired lung function.

“Emphysema is a terrible disease, and treatments are generally limited to medical therapies, like inhalers, or more invasive ones, like a lung transplant,” said Dr. Mahajan. “We offer something in between.”

The IP team can perform a procedure called bronchoscope lung volume reduction that places small one-way valves (endobronchial valves) into the airways. The valves allow secretions and trapped air to escape but prevents air from entering this section of the lungs. This minimally invasive procedure alleviates shortness of breath and improves lung function.

Pleural effusion

Pleural effusion is a condition where fluid accumulates between the lungs and chest cavity. The fluid prevents breathing muscles from expanding and limits lung function. As a result, a person may experience chest pain, shortness of breath, cough and rapid breathing.

The IP team can perform a procedure called a thoracentesis, which involves placing a catheter through the chest wall with a needle. The catheter allows the excess fluid to drain from around the lungs. When the procedure is over, the catheter is removed. A more permanent procedure, called tunneled pleural catheters, leaves the catheter in place, allowing the patient to drain the cavity at home as needed using sterile supplies.

“At the end of the day, it boils down to a discussion with the patient,” said Dr. Mahajan. “Our care team have the specialists in place to provide the options available and help patients decide on the best course of treatment to help them breathe better.”