Diseases of the Central Airways: A Clinical Guide

385 Pages·2016·10.03 MB·English

by  Atul C. Mehta

Respiratory Medicine
Series Editor: Sharon I.S. Rounds
Atul C. Mehta
Prasoon Jain
Thomas R. Gildea Editors
Diseases of
the Central
Airways
A Clinical Guide
Respiratory Medicine
Series editor
Sharon I.S. Rounds, Providence, RI, USA
More information about this series at http://www.springer.com/series/7665
Atul C. Mehta Prasoon Jain
(cid:129)
Thomas R. Gildea
Editors
Diseases of the Central
Airways
A Clinical Guide
Editors
Atul C. Mehta,MD, FACP, FCCP ThomasR. Gildea, MD, MS,FCCP, FACP
Professorof Medicine Pulmonary, Allergy, Critical CareMedicine
Lerner Collegeof Medicine andTransplantCenter
Buoncore Family EndowedChair Respiratory Institute, Cleveland Clinic
inLung Transplantation Cleveland, OH
Respiratory Institute, Cleveland Clinic USA
Cleveland, OH
USA
PrasoonJain, MBBS,MD, FCCP
PulmonaryandCritical Care
LouisA JohnsonVAMedical Center
Clarksburg, WV
USA
ISSN 2197-7372 ISSN 2197-7380 (electronic)
Respiratory Medicine
ISBN978-3-319-29828-3 ISBN978-3-319-29830-6 (eBook)
DOI 10.1007/978-3-319-29830-6
LibraryofCongressControlNumber:2016931430
©SpringerInternationalPublishingSwitzerland2016
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To my teachers who taught me how to hold
the bronchoscope
—Atul C. Mehta
To my mother and father
—Prasoon Jain
To my patients
—Thomas R. Gildea
Foreword
Openuponeofthemajortextbooksofpulmonarymedicine,anditreadilybecomes
apparent that the central airways of the lung garner little attention beyond an
obligatory chapter. Comprised of the trachea and proximal bronchi, the central
airways are viewed largely as a conduit for airflow. As such, they tend to become
clinically relevant when there is critical narrowing, as occurs in the setting of
neoplastic disease or iatrogenic strictures from prior endotracheal or tracheostomy
tubes.Thosemostfamiliarwiththecentralairwaysaremembersoftheburgeoning
field of interventional pulmonology, who on a daily basis venture into the central
airways to biopsy, dilate, laser, stent, and ultrasound, place valves and coils, and
applythermalenergy.Itisthesepractitionerswhohavecalledattentiontothemany
and varied disorders that can affect the central airways, beyond the tumors and
strictures that have conventionally populated the textbook chapters.
This scholarly monograph highlights the full spectrum of inflammatory,
autoimmune, infectious, neoplastic, and idiopathic disorders that affect the central
airways. The editors of this monograph, all practitioners of interventional pul-
monology, are to be commended for focusing on the cognitive rather than the
technical aspects of their field. Their message is clear: Those who hold a bron-
choscope must be diagnosticians first and technicians second. Importantly, this
monograph is relevant not only to those who practice interventional pulmonology
butforallclinicianswhowanttolearnfromtheinsightsthatthisfieldhasprovided
into the diversity of disorders that affect the central airways.
Robert M. Kotloff
Department of Pulmonary Medicine
Respiratory Institute, Cleveland Clinic
Cleveland
OH, USA
Herbert W. Wiedemann
Respiratory Institute, Cleveland Clinic
Cleveland
OH, USA
vii
Preface
As2016dawns,InterventionalPulmonologyhasbecomeanessentialcomponentof
pulmonarymedicine, asvital and aswidely accepted asInterventional Cardiology.
This subspecialty is extremely attractive to most pulmonologists, and the estab-
lishmentofnationalandinternationalorganizations,myriadscholarlycontributions
totheliterature,andwell-attendedscientificseminarsprovidedefinitiveevidenceof
its worldwide favor. One possible reason for this widespread interest is that
endobronchial procedures often yield important results and positively impact
patients’ well-being. For example, a successful lung transplantation cannot be
achievedwithoutthecontributionsofabronchoscopist.Similarly,thereisnodoubt
aboutthecontributionsbronchoscopehasmadeinthediagnosisandstagingoflung
cancer.Infact,thereareonlyahandfulofpulmonaryailmentsthatabronchoscope
cannot diagnose, palliate, or cure.
Interventional pulmonary medicine thrives within the penumbra of multiple
specialties: Bronchoscopists provide the transitional step from the unknown to the
known, from lesion to cancer, from wheezes to granulomatosis with polyangiitis,
and from treatment to palliation. Interventional pulmonologists are uniquely posi-
tionedtoimprovemanyfields becausebronchoscopy offersthebestaccesstolung
tissue.
The modern day interventional pulmonologist has a dual commitment: to be a
competent endoscopist and to demonstrate a thorough knowledge of diseases
involvingthe central airways, as well as other systemicdiseases that can affect the
central airways. This body of knowledge must also include the understanding of
symptoms that are not associated with airways disease.
The objective of this monograph is to illuminate the fact that Interventional
Pulmonology offers more than mere interventions. The bronchoscopist should be
abletorecognizeaspirationintheabsenceofaforeignbodyandperhapsdiagnose
inflammatory bowel disease before it involves the gastrointestinal tract. The
interventional pulmonologist should be able to differentiate when a cardiac or
pulmonaryembolismevaluationshouldbeconsidered,ratherthanabronchoscopy.
One must consider the patient as an individual, not an endobronchial tree. With
ix
x Preface
appropriate training, anyone can perform a procedure, but the editors strongly
believethat“agoodbronchoscopististheonewhoknowswhennottoperformthe
procedure.”
Theoptimalapplicationofbronchoscopyarisesfromthecoalescenceofmedical
science and prudence, and the editors vehemently assert that reducing the cost of
health care is a civic responsibility. However, the current directives of
InterventionalPulmonology,toasignificantdegree,arebaseduponexpertopinion,
not evidence. In addition, the cost-effectiveness of new elective bronchoscopy
procedureshasnotbeenwelldocumented.Therefore,theinterventionalistmustrise
above his or her technical abilities and consider noninvasive therapeutic options,
thenperformanunnecessaryprocedure.Thebronchoscopistshouldbeatechnology
savant, not a technology servant.
We, the editors, have made a sincere effort to focus only on the conditions that
require limited or no technical interventions within the purview of Interventional
Pulmonology. Although we do not claim this book encompasses the subject in its
entirety, we offer our attempt to illuminate the noninterventional aspects of our
subspecialty. We applaud all the authors for their support and timely contributions
tothisproject;thecreditistheirstoclaim.Ourultimateobjectiveisthewell-being
of patients suffering with central airways diseases, through the safe and
cost-effective practice of Interventional Pulmonology.
Atul C. Mehta
Prasoon Jain
Thomas R. Gildea
Contents
1 Diseases of Central Airways: An Overview . . . . . . . . . . . . . . . . . 1
Prasoon Jain and Atul C. Mehta
2 Sarcoidosis of the Upper and Lower Airways . . . . . . . . . . . . . . . 71
Daniel A. Culver
3 Airway Complications of Inflammatory Bowel Disease. . . . . . . . . 87
Shekhar Ghamande and Prasoon Jain
4 Airway Involvement in Granulomatosis with Polyangiitis. . . . . . . 107
Sonali Sethi, Nirosshan Thiruchelvam and Kristin B. Highland
5 Tracheobronchomalacia and Excessive Dynamic
Airway Collapse. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133
Erik Folch
6 Tracheobronchial Amyloidosis . . . . . . . . . . . . . . . . . . . . . . . . . . 147
Gustavo Cumbo-Nacheli, Abigail D. Doyle and Thomas R. Gildea
7 Tracheobronchopathia Osteochondroplastica. . . . . . . . . . . . . . . . 155
Prasoon Jain and Atul C. Mehta
8 Endobronchial Tuberculosis. . . . . . . . . . . . . . . . . . . . . . . . . . . . 177
Pyng Lee
9 Endobronchial Fungal Infections . . . . . . . . . . . . . . . . . . . . . . . . 191
Atul C. Mehta, Tanmay S. Panchabhai and Demet Karnak
10 Recurrent Respiratory Papillomatosis. . . . . . . . . . . . . . . . . . . . . 215
Joseph Cicenia and Francisco Aécio Almeida
11 Parasitic Diseases of the Lung . . . . . . . . . . . . . . . . . . . . . . . . . . 231
Danai Khemasuwan, Carol Farver and Atul C. Mehta
xi