Book an Appointment
Emergency: 022-61305005
I want to find
My Health Records

Interventional Pulmonology

Management Team

Interventional Pulmonology

Overview

Interventional pulmonology is a sub-specialty of Pulmonary Medicine, which involves minimally invasive and percutaneous techniques for advanced diagnostic and therapeutic management of various lung disorders. This field has evolved dramatically over the years.

The primary application of interventional pulmonology is in the diagnosis, staging and palliative treatment (a medical approach that helps patients with serious illness live better) of patients with lung cancer. Dilatation of tracheo-bronchial strictures, stenting of the airways, removal of foreign bodies, management of unclassified pleural disorders and temporary percutaneous tracheotomies for chronic airway management also fall under the realm of interventional pulmonology.

  • Flexible bronchoscopy:  Bronchoscopy is the most common interventional pulmonology procedure. During bronchoscopy, a pulmonologist advances a flexible endoscope (bronchoscope) through a person’s mouth or nose into the windpipe. The doctor pushes the bronchoscope forward through the airways in each lung, to inspect for any abnormality and patency of the airways. Images from inside the lung are displayed on a video screen.
  • BAL: In this procedure, sterile water is injected through the bronchoscope into a segment of the lung. The fluid is then suctioned back and sent for tests. BAL helps in the diagnosis of infection, cancer, bleeding, and other conditions.
  • Endobronchial lung biopsy (EBLB): In this procedure, small pieces of tissue are collected from the bronchial wall or mucosa to diagnose various conditions like cancer, tuberculosis or sarcoidosis.
  • Transbronchial lung biopsy (TBLB): In this procedure, a small forceps is pushed down through the bronchoscope to remove small pieces of tissue from the lung periphery. TBLB is generally used to detect acute rejection in case of lung transplantation. Additionally, it can also be used to diagnose many pulmonary disorders, such as lung cancer, ILD, pulmonary infection and pneumonitis.
  • Brush biopsy: In this method, a small brush is used to take sample from the abnormal airway mucosa. 
  • Cryobiopsy: In this method, a cryoprobe is introduced into the airway through a bronchoscope, following which, compressed gas is shot from the probe tip to freeze the surrounding tissues. The biopsy samples obtained in this manner are larger and better preserved. Cryobiopsy is used to treat ILDs.
Filter Alphabet

Fractional Exhaled Nitric Oxide (FeNO)

Management Team

Fractional Exhaled Nitric Oxide (FeNO)

Overview

FeNO or fractional exhaled nitric oxide testing has become a valuable tool in the management of asthma, providing clinicians with additional information beyond traditional diagnostic methods.

  • Nitric Oxide (NO) Production: NO is produced by various cells in the respiratory tract, particularly epithelial cells, in response to inflammatory triggers, such as allergens or irritants. Most of the NO present in exhaled air originates from the nasal airways and it can be measured.
  • Airway Inflammation: In conditions like asthma, the levels of NO increase owing to the increased production of an enzyme called inducible nitric oxide synthase (iNOS) in inflamed airway epithelial cells and inflammatory cells (e.g., eosinophils).

The principle behind FeNO testing lies in the relationship between NO production and airway inflammation. Thus, when we breathe out, our breath can show if our airways are inflamed.

In FeNO testing, the amount of NO present in exhaled breath, which correlates with the degree of airway inflammation, is calculated. Elevated FeNO levels suggest ongoing inflammation, whereas lower levels may indicate controlled or less severe inflammation.

Monitoring: FeNO testing serves as a non-invasive method to monitor airway inflammation over time, guiding treatment adjustments and assessing the response to therapy.

Predicting Flare ups: High FeNO levels may indicate an increased risk of asthma flare ups, prompting the initiation of proactive management strategies.

FeNO testing is particularly useful in the following scenarios: 

  • Monitoring Treatment: Assessing the effectiveness of corticosteroid therapy and guiding step-up or step-down in treatment intensity.
  • Identifying Treatment Non-adherence: High FeNO levels despite symptoms can suggest poor adherence to the prescribed corticosteroids.

In asthma management, FeNO testing plays a crucial role in personalising treatment and tailoring medication dosages to the level of airway inflammation indicated by FeNO levels or considering alternative therapies with biologics. FeNO testing enhances the precision of asthma management by providing quantitative data on airway inflammation.

Filter Alphabet

Flexible Bronchoscopy

Management Team

Flexible Bronchoscopy

Overview

Flexible bronchoscopy is a vital procedure in Pulmonary Medicine, offering both diagnostic and therapeutic benefits.

Its use is recommended for a range of conditions, including persistent cough, unexplained lung infiltrates and haemoptysis. Flexible bronchoscopy is especially useful for assessing and biopsing suspicious lung lesions or masses, lung cancer diagnosis and staging, and investigating ILDs. Additionally, it aids in the detection of infectious diseases, such as tuberculosis and fungal infections.

Flexible bronchoscopy is a minimally invasive procedure for examining the airways and lungs. It involves the insertion of a thin, flexible tube called a bronchoscope through the nose or mouth, down the throat, and into the lungs. The bronchoscope is equipped with a light and a camera, allowing the doctor to view the airways on a monitor in real-time. Local anaesthesia is applied to the patient's throat, and they may receive a sedative to help them relax. It is a day-care procedure which shortens the duration of hospital stay.

  • The clinical outcomes of flexible bronchoscopy are highly favourable. The procedure boasts a high diagnostic yield for conditions, such as lung cancer, infections and Interstitial Lung Disease (ILD) s, leading to accurate diagnoses.

  • It can provide significant symptom relief for patients experiencing airway obstruction or haemoptysis.

  • Furthermore, the procedure’s ability to offer precise diagnostic information helps in forming specific treatment strategies and adjusting them based on disease extent and response.

  • In forming and adjusting treatment plans, flexible bronchoscopy is indispensable. The diagnostic insights gained from the procedure guide personalised treatment strategies, ensuring targeted therapies for conditions like lung cancer or appropriate antibiotics for infections.

  • Its therapeutic capabilities often reduce the need for more invasive surgeries, providing a minimally invasive management option.

  • Follow-up bronchoscopies are valuable in monitoring treatment effectiveness and guiding subsequent management steps.

  • For patients with advanced respiratory diseases, the procedure also offers palliative care options, significantly improving their quality of life.

Filter Alphabet

Precocious Puberty

Management Team

Precocious Puberty

Overview

Precocious puberty refers to the condition characterised by premature onset of puberty before the age of 8 in girls and before age 9 in boys. This can lead to rapid growth and development changes too early in life.

Hormonal imbalances, abnormalities in the central nervous system, or certain tumours. Early puberty can lead to emotional and social challenges, as well as an increased risk for short stature due to early closure of growth plates.

Blood tests to assess hormone levels, imaging studies, and sometimes a bone age assessment.

Aims to halt or reverse the early onset of puberty and can include medications like GnRH analogues, which delay further development until the appropriate age.

Filter Alphabet
P

Endobronchial Ultrasound (EBUS)

Management Team

Endobronchial Ultrasound (EBUS)

Overview

EBUS is a technique that uses ultrasound along with a bronchoscope to visualise the airway wall and structures adjacent to it.

  • Radial Probe EBUS
    This system has an ultrasound processor and balloon catheter attached to the probe. The balloon is fixed at the tip of the probe. It helps take biopsies from the peripheral parts of the lung, which are otherwise not accessible by routine flexible bronchoscopy.
  • Convex Probe EBUS
    In contrast to the radial probe, convex probe has the advantage of accessing central lesions that are in or adjacent to the lung (mediastinum). High-resolution, real-time ultrasound imaging enables direct visualisation of the needle as it penetrates the lymph node, which optimises the biopsy sample and makes the procedure relatively safe.

  • Assess the extent of airway invasion: EBUS has extended vision beyond the tracheobronchial wall. With EBUS, the delicate multilayer structure of the tracheobronchial wall can be analysed. This knowledge becomes decisive for the management of early cancer in the central airways.
  • Peripheral intrapulmonary lesions: Radial probe EBUS can be used to localise peripheral pulmonary nodules and sampling of the lesion can be done without fluoroscopy.
  • Analysis of mediastinal lesions: Assessment of mediastinal lymph nodes is important for lung cancer staging and planning appropriate treatment strategy. Once target lymph node is identified, linear probe EBUS allows real-time ultrasound guidance during needle insertion. EndoBronchial UltraSound-Guided TransBronchial Needle Aspiration (EBUS-TBNA) can be used in the evaluation of mediastinal adenopathy due to other aetiologies like sarcoidosis and tuberculosis.
  • Guidance of endobronchial therapy: EBUS provides useful additional information during various interventions, including resection of endobronchial lesions, stricture dilatation, airway stenting, laser therapy and argon plasma coagulation.

  • Life-threatening cardiac arrhythmias
  • Current or recent myocardial ischaemia
  • Poorly controlled heart failure
  • Severe hypoxemia
  • Uncooperative patient

Additional contraindications to EBUS-TBNA are related to bleeding risk and include following:

  • Current anti-platelet agents, such as Ecosprin and Clopidogrel
  • Current anticoagulant therapy, such as warfarin
  • Coagulopathy
  • Thrombocytopenia
  • Elevated blood urea nitrogen or serum creatinine levels

EBUS and EBUS-TBNA are usually safe. Some complications are agitation, cough, hypoxia, laryngeal injury, fever, bacteraemia and infection, bleeding, pneumothorax and broken equipment being stuck in the airway.

Filter Alphabet
E

Allergy Tests

Management Team

Allergy Tests

Overview

Allergy tests are conducted at specialised allergy clinics within the hospital. An allergy test is a diagnostic procedure conducted to identify specific substances or allergens that trigger allergic reactions in an individual. Allergies occur when the immune system reacts strongly to ordinarily harmless substances, such as pollen, dust mites, certain foods, or animal dander. The purpose of allergy testing is to identify these triggers, so that steps can be taken to avoid them or manage symptoms effectively.

 

There are several methods of allergy testing, each with its own advantages and limitations. Your doctor will decide which test is suitable for you depending on your history:

  • Skin Prick Test: This is the most common allergy test. A tiny amount of allergen extract is pricked into the upper layer of the skin, usually on the forearm. If a person is allergic to the substance, a small raised bump (called a wheal) surrounded by a red area will appear within 15‒20 minutes. It is a safe and painless test and is the gold standard for allergy testing all over the world.
  • Intradermal Test: It is similar to the skin prick test but involves injecting a small amount of allergen under the skin. It is more sensitive but carries a higher risk of causing an allergic reaction.
  • Blood Allergy Test (Specific IgE test): This test measures the amount of allergy-specific antibodies (IgE) in the blood. It is useful when skin testing is not possible or advisable, e.g., in case of patients with severe skin conditions or patients taking medications that interfere with test results.

 

Before conducting any allergy test, it is important to discuss the symptoms and medical history with the consultant doctor or allergist. They will determine the appropriate test based on the suspected allergens and the patient's health status.

Once the allergens are identified, the next steps involve educating the patient about avoidance and prevention strategies, and possibly prescribing medications (such as antihistamines) to manage allergic reactions. In some cases, allergen immunotherapy (allergy shots) may be recommended to desensitise the immune system over time.

Filter Alphabet
A

Short Stature

Management Team

Short Stature

Overview

Short stature refers to a height significantly below the average for a person’s age and sex. It can be caused by genetic factors, hormone deficiencies, chronic illnesses, or malnutrition. Children with short stature may face emotional and social challenges.

Assessing growth patterns, evaluating family history, and conducting tests to identify any underlying conditions.

Treatment depends on the cause. If a hormone deficiency is identified, growth hormone therapy might be prescribed to help stimulate growth. In cases wherein short stature is due to nutritional deficiencies or chronic illnesses, addressing these underlying issues is crucial.

Supportive care and counselling can also help children cope with the social and emotional aspects of short stature. If you have any worries about your child's growth or development, please consult our paediatric endocrinology department.

Filter Alphabet
S

Primary Aldosteronism

Management Team

Primary Aldosteronism

Overview

Primary aldosteronism occurs because of overproduction of aldosterone by the adrenal glands, causing high blood pressure and low levels of potassium.

Benign adrenal tumours or adrenal gland overactivity.

Muscle weakness, fatigue, and frequent urination.

Blood and urine tests to measure aldosterone and renin levels as well as imaging studies to identify gland abnormalities.

Medications to block aldosterone effects, lifestyle changes to manage blood pressure, and surgery to remove overactive glands or tumours. Early diagnosis and treatment are imperative to avoid complications like heart disease and kidney damage.

Filter Alphabet
P

Cushing’s Syndrome

Management Team

Cushing’s Syndrome

Overview

Cushing’s syndrome refers to a condition wherein there is excessive cortisol production (produced by the adrenal glands) in the body.

Prolonged use of corticosteroid medications or tumours that produce excess cortisol.

Weight gain, especially around the abdomen and face; high blood pressure; and mood changes.

Blood, urine, and saliva tests to measure cortisol levels as well as imaging studies to identify the cause.

Depends on causative factors and may include gradually reducing corticosteroid use, surgery to remove tumours, radiation therapy, or medications to control cortisol production. Managing Cushing’s syndrome requires regular monitoring to prevent complications.

If you are experiencing symptoms of Cushing’s syndrome, particularly while using glucocorticoid medications for conditions like arthritis, asthma, or inflammatory bowel disease, contact your healthcare provider for an evaluation.

Filter Alphabet
C

Benign Adrenal Tumours

Management Team

Benign Adrenal Tumours

Overview

Benign adrenal tumours are non-cancerous growths in the adrenal glands. They can sometimes produce excess hormones.

High blood pressure, weight gain, or changes in hair growth.

Blood and urine tests to evaluate hormone levels and imaging studies like CT or MRI.

Depends on the tumour type and whether it is causing symptoms. Some tumours may only require regular monitoring, while others may need surgical removal if they produce excess hormones or are at a risk of becoming cancerous. Management of benign adrenal tumours involves regular follow-up to ensure that they do not cause complications.

Filter Alphabet
B
Subscribe to Bottom to top