Interventional Pulmonology

The field of interventional pulmonology (IP) is primarily focused on the evaluation and management of patients with central airway obstruction, pleural disease, mediastinal/hilar adenopathy, and lung nodules/masses. It includes the use of advanced and minimally invasive diagnostic techniques such as endobronchial ultrasound (EBUS) and thoracoscopy, as well as therapeutic techniques including rigid bronchoscopy and tunneled pleural catheters. The dramatic growth in IP over the last decade is attributable to both technologic advances and the attainment of a “critical mass” of physicians and researchers dedicated to clinical and translational investigation. Whereas IP literature previously consisted of case series and “how I do it” publications, we are now seeing large, multicentered randomized trials focused on patient-centered outcomes.

In this issue of Seminars in Respiratory and Critical Care Medicine, we have brought together international experts to discuss recent advances in the field. We start the issue discussing the evolution and variability of procedural training in the United States as well as lessons learned from our colleagues as they evolved subspecialty training. The utility of convex probe EBUS for the evaluation of mediastinal/hilar adenopathy is followed by a discussion on the use of radial probe EBUS and electromagnetic/virtual bronchoscopic navigation for the evaluation of parenchymal nodules. The use of bronchoscopy for nonmalignant disease is not limited to identifying infection, lung allograft rejection, or sarcoidosis. There has been a great deal of interest in the bronchoscopic treatment of patients with severe asthma and emphysema, and these topics are discussed in detail by Dr. Chen and colleagues. The rigid bronchoscope is perhaps the tool that defines the interventional pulmonologist. The indications, technique, and anesthetic considerations are discussed in detail, followed by a comprehensive review of ablative techniques to manage obstruction of the central airways.

The theme of the issue then shifts gears to the evaluation and management of patients with pleural disease, first with a review of the importance of using ultrasound to guide pleural procedures. The management of pneumothorax and prolonged air leaks, malignant pleural effusion, and parapneumonic effusion/empyema are then discussed in detail. We then conclude the issue with a review of IP procedures typically performed in the intensive care unit (percutaneous tracheostomy and gastrostomy tube placement) and the pediatric population and finally with a vision of the future of the field.

As guest editors, we are grateful for the enthusiasm, hard work, and expertise of the authors, as well as to Dr. Lynch and the staff of Seminars for their efforts to bring this issue to fruition. We are confident that the readers will have a more comprehensive understanding of this broad field and be able to use this gained knowledge to improve the care of their patients.