Reopening the airway: Fast methods

Abstract

Central airway obstruction can occur secondary to a number of lung primary or secondary malignancy and benign processes presenting as vegetation, infiltration, or compression. Approximately 30% of lung cancer patients develop central airway obstruction. The technique of endobronchial coagulation and disobstruction plays a pivotal role in all these situations, since conventional treatment with chemo- and radiotherapy is often performed with unsatisfactory results with regard to the endobronchial component of the tumor. Palliative airway treatments are essential to permit ventilation and control hemorrhage and to improve quality and length of life. Rigid bronchoscopy has proven to be an excellent tool to provide airway access for these therapies: the degree of obstruction and severity of symptoms, the nature of the disease, and the patient’s overall prognosis and quality of life impact the choice of intervention. The number and scope of therapeutic options have increased dramatically; they can be divided into “slow methods” such as photodynamic therapy, cryotherapy, and brachytherapy or fast methods: laser, argon plasma coagulation, and electrocautery. Laser therapy more often integrates rigid bronchoscopic resection; this procedure is worldwide known as laser-assisted mechanical resection (LAMR) and represents the safest and more effective way to obtain all potential effects of laser in bronchoscopy.