Unique interventional pulmonology book highlights diagnostic, therapeutic case studies

Dr Jamalul Azizi Abdul Rahaman, a consultant pulmonologist (respiratory physician) at Sultan Idris Shah Serdang Hospital, and Dr Tinku Joseph, chief of Interventional Pulmonology at Amrita Institute of Medical Sciences in India, edited a book titled “A Case-Based Approach to Interventional Pulmonology: A Focus on Asian Perspectives.” The book was launched in conjunction with the 9th Asian Pacific Congress on Bronchology and Interventional Pulmonology, held at Le Meridien Hotel, Putrajaya, in May 2023. Here, they provide a summary of the book and answer questions posed by MIMS Doctor.

The book primarily focuses on various aspects of Interventional Pulmonology (IP). To ensure an easy learning process, many interesting diagnostic and therapeutic airway and pleural procedure cases have been included. Leading experts in the field of IP from Asia, Canada and the US contributed various chapters.

Over the past 10 years, many diagnostic and therapeutic innovations have taken place paving the way for a significant boom in IP. The contents in the book have been divided into four different sections with a primary aim of case-based scenarios and solutions.

Section A consists of diagnostic IP procedures such as linear and radial EBUS, navigation bronchoscopy, cryobiopsy of the lungs and cone beam computed tomography (CT). Newer diagnostic modalities such as Cellvizio® and robotic bronchoscopy have also been included.

Section B focuses on therapeutic rigid bronchoscopy procedures. Besides airway stenting and laser bronchoscopy, recent interventions such as bronchial thermoplasty, bronchoscopic lung volume reduction, 3D printed airway stenting, and microwave ablation have also been included.

Section C is dedicated to pleural procedures with the addition of the more recent ones such as indwelling pleural catheter (IPC) and fibrinolytic agents.

Section D is dedicated to common pediatric IP procedures.

The purpose of this book is not to provide the principles, theory, or evidence of clinical practice of these procedures but to present actual case scenarios. Each case is presented with the history, including clinical, radiological, bronchoscopic/ pleuroscopic findings and final outcome. Many of these cases also have video illustration. Learning points have been highlighted at the end of each case presentation.

 

Q: What is the definition of IP?

A: IP is defined as the art and science of medicine as related to the performance of diagnostic and invasive therapeutic procedures that require additional training and expertise beyond that provided in a standard pulmonary medicine training program. In simple terms, IP refers to minimally invasive procedures for diagnosis and treatment of complex airway and pleural diseases. IP procedures are often performed by pulmonologists or thoracic surgeons. In Malaysia, IP procedures are mostly performed by interventional pulmonologists.

 

Q: What are the conditions that can be managed using IP?

A: Tuberculosis, lung cancer, pleural diseases, asthma, chronic obstructive pulmonary disease (COPD), interstitial lung disease and many other complex airway diseases can be managed using IP.

Diagnostic:

●                    Linear EBUS – For diagnosing etiology of mediastinal adenopathy (cancer, tuberculosis, sarcoidosis, etc).

●                    Radial EBUS – To sample lung nodules with very minimum complication risk.

●                    Lung cryobiopsy: To diagnose etiology of interstitial lung disease and obtain a larger biopsy to diagnose various lung pathologies.

Therapeutic:

●                    Debulking of trachea-bronchial tumors

●                    Airway stenting to maintain patency of trachea/bronchus in malignant and benign conditions.

●                    Post-intubation tracheal stenosis repair

●                    Thoracoscopy for diagnosis of pleural disorders

●                    Endobronchial valves and thermal vapor ablation for treatment of COPD/emphysema.

 

Q: What is the objective of publishing “A case-based approach to interventional pulmonology: A focus on Asian perspectives”?

A: To raise awareness among doctors on the conditions that can be managed via IP as well as to create an awareness among young interventional pulmonologists on how to approach various complex airway and pleural disorders.

 

Q: What is the inspiration for publishing the book?

A: IP has been around in Malaysia since 2007 (16 years), but there are no books in Malaysia written about IP to raise an awareness or provide a guide to doctors. This is the first time a book on IP has been published in Malaysia.

It also represents the passion to teach the next generation/young interventional pulmonologists in a structured way of how to approach different complicated pulmonary conditions.

Q: How long did it take to publish the book from the moment of inception to completion?

A: The project started in September 2020 and was completed in May 2023 (2 years 7 months).

 

Q: How many people were involved in the project?

A: There were 78 contributors from Malaysia, Singapore, Hong Kong, India, USA, and Canada.

 

Q: What is the target readership of the book?

A: Practicing pulmonologists, thoracic surgeons, oncologists, and pulmonary trainees in different countries in Asia, Europe, and Africa.

 

Q: What is/are the most memorable or unique case/s published in the book?

A: The first memorable case involved the usage of an endobronchial valve for the treatment of advanced emphysema, persistent air leak and giant bullae. It is unique because the valve can be used for three different kinds of conditions through a minimally invasive procedure. The patients showed good response to the valve treatment, which is available in Malaysia.

The second memorable case included the application of bronchial thermoplasty for asthma. It is unique because for many years, asthma treatment mostly revolved around inhalers. This procedure is the only treatment for uncontrolled asthma that does not respond to inhalers and is available in Malaysia.

 

Q: What is the advice to doctors with interest to specialize in IP?

A: They need to become a general physician first, then enter the pulmonology fellowship training for 3 years followed by at least another 1 year in IP training at a high-volume center. They need to be hardworking and dedicated to IP.