UH Division of Pulmonary, Critical Care and Sleep Medicine employs treatments to help patients with asthma, interstitial lung disease and lung cancer
Division of Pulmonary, Critical Care and Sleep Medicine - May 2018
BENJAMIN YOUNG, MD
Director of Bronchoscopy, Division of Pulmonary, Critical Care and Sleep Medicine, UH Cleveland Medical Center; Assistant Professor of Medicine, Case Western Reserve University School of Medicine
BRONCHIAL THERMOPLASTY FOR TREATMENT OF ASTHMA
Most of the 23 million people in the United States who suffer from asthma achieve a lessening of symptoms and a reduction in the risk of future incidents through treatment with inhaled corticosteroids and by addressing environmental factors. However, until recently, treatment options were limited for the 5 to 10 percent of patients with severe, persistent symptoms. That’s beginning to change.
In 2010, the Food and Drug Administration approved bronchial thermoplasty for patients with uncontrolled, severe and persistent asthma. Bronchial thermoplasty uses a catheter inserted through a flexible bronchoscope to deliver controlled thermal energy to decrease airway smooth muscle in asthmatic patients.
“So far, the follow-up data show that bronchial thermoplasty is safe and effective,” says Benjamin Young, MD, Director of Bronchoscopy in the Division of Pulmonary, Critical Care and Sleep Medicine, University Hospitals Cleveland Medical Center. “Eighty percent of patients have a positive response. What that means is they have fewer symptoms, fewer hospitalizations and visits to the emergency room, fewer missed days of work or school and fewer requirements for additional steroids to help them manage their disease.”
Dr. Young says although the procedure is as safe as standard bronchoscopy, it tends to exacerbate the patient’s asthma in the short term. There’s a slight risk that patients will need additional treatment in the first week and approximately 3 percent may require hospital admission. The idea, Dr. Young says, is that patients will enjoy long-term benefits despite the short-term exacerbations.
Clinicians can refer severe asthmatics to UH for evaluation for bronchial thermoplasty.
CRYOBIOPSY FOR THE DIAGNOSIS OF INTERSTITIAL LUNG DISEASE
“Interstitial Lung Disease (ILD) can be difficult to diagnose,” Dr. Young says. “There’s overlap between the different types of ILD and each has different causes. Sometimes, you need a lung biopsy to put the pieces together to get a diagnosis.”
This spring, UH will begin offering cryobiopsy, which uses a probe to freeze tissue to obtain a biopsy. It can replace transbronchial biopsy, which often doesn’t yield a large enough piece of tissue to make a diagnosis, and surgical biopsy, which has associated surgical risks.
“Cryobiopsy allows a bigger sample to be obtained via a bronchoscope and preserves some of the architecture for the pathologist to look it,” Dr. Young explains. “It’s been found to be helpful to diagnose ILD.”
Cryobiopsy does have more risks than a standard bronchoscopy, so it’s not right for every patient. However, Dr. Young says, “When you have questions and things don’t add up, and it’s going to make a difference in ILD treatment, that’s the right patient for cryobiopsy.”
ROBOTIC BRONCHOSCOPY AND LUNG CANCER
Robotic bronchoscopy represents the future of bronchoscopy for accessing the peripheral lung, Dr. Young says. The technology combines improved visualization with the ability to finely control a small scope, allowing pulmonologists to see almost all the way across the lung.
“Instead of trying to find a lesion with other tools that approximate where the target is, we can now drive out and see what’s there,” he says.
This is good news for lung cancer patients. “We can diagnose lesions that were more difficult or not possible in the past,” Dr. Young says. “With new treatments available based on molecular testing of tissue samples, this will translate into better care for patients.”
Robotic bronchoscopy also offers the potential for diagnosing and treating early stage lung cancers, in one procedure, directly through the scope. “The technology is right around the corner,” he says.
Interventional pulmonology can play an important role in the multidisciplinary management of lung cancer.
“Because of the advances in technology over the last 10 years, we are able to access lesions safely and accurately that we couldn’t in the past,” Dr. Young explains. “With bronchoscopy, we are often able to get all the answers we need to make a diagnosis, stage the patient in one procedure and move them along with timely care.”
The techniques include ablating a tumor in the airway or placing a stent to hold the airway open while the patient undergoes other treatments or gets healthy enough to undergo more aggressive treatment.