Pulmonology | Jaslok Hospital
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022 66573010 / 40173010
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022-2354 2354 / 40173333
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022-66573434 / 40173434
specialtydetail
About the Department
Facilities & Services
Our Specialists
- About the Department
The Department of Respiratory Medicine caters to diagnosis and treatment of all respiratory disorders. The department runs a daily outpatient clinic and inpatient services, which include intensive care management of patients on ventilators and in wards. The department has many achievements to its credit, among them are studies conducted to establish normal parameters for lung function, etiology of interstitial lung disease, and estimation of serum angiotensin converting enzyme (ACE) in Indian patients. The department was amongst the first to start ACE level estimation in Western India.

The department, over the period of 10 to 14 years, was involved in International Studies for Asthma and Allergies in Childhood (ISAAC), wherein it was the Regional Coordinator for Southeast Asia. Numerous papers have been published in international journals regarding prevalence of rhinitis, eczema and asthma in children, based on ISAAC study. Our Pulmonary Function Lab is fully equipped with state-of-the-art technology for all lung function tests, exercise testing and sleep studies.

Bronchology section has fibreoptic videobronchoscope for routine and ICU bronchoscopies. Interventional bronchoscopes for transbronchial lung biopsies and endobronchial ultrasound (EBUS) for mediastinal node sampling are also available. Bronchoscopy has become the most commonly performed invasive procedure by chest physicians. EBUS is a technique that uses ultrasound along with bronchoscope to visualize airway wall and the structures adjacent to it.

Types of EBUS

Radial Probe EBUS
The system has an ultrasound processor and a balloon catheter that are attached to the probe. The balloon is fixed at the tip of the probe. The 20 MHz miniature radial probe is the standard probe.

Convex Probe EBUS
Currently available CP-EBUS bronchoscope has a linear curved array ultrasonic transducer of 7.5 MHz at the distal tip, which has the capability of displaying B-mode and color Doppler mode.

Interventional Pulmonology
It is a specialised subspecialty of pulmonary medicine, which deals with advanced diagnostic and therapeutic manoeuvre for the management of various lung disorders. The main application of interventional pulmonology is in the diagnosis, staging and palliative treatment of patients with lung cancer. In addition, dilation of benign tracheobronchial strictures, management of unclassified pleural disorders and temporary percutaneous tracheostomies for chronic airway management also fall under the realm of this subspecialty of pulmonary medicine.

Procedures

Flexible bronchoscopy - Bronchoscopy is the most common interventional pulmonology procedure. During bronchoscopy, the doctor advances a flexible endoscope (bronchoscope) through a person's mouth or nose into the windpipe and the airways in each lung, checking for problems. Images from inside the lung are displayed on a video screen.

The bronchoscope has a channel at its tip, through which the doctor can pass small tools and perform several other procedures.

Bronchoalveolar lavage - This procedure is performed during bronchoscopy. Sterile water is injected through the bronchoscope into a segment of the lungs. The fluid is then suctioned back and sent for tests. Bronchoalveolar lavage can help diagnose infection, cancer, bleeding and other conditions.

Biopsy of lung or lymph node - During bronchoscopy, the doctor may collect a small piece of tissue from either the lungs or a nearby lymph node. The interventional pulmonologist advance a needle or forceps through the bronchoscope to get a sample of the tissue. Biopsies can detect cancer, infection, sarcoidosis and other conditions.

For people with lung cancer or other cancers, interventional pulmonology biopsies can often accurately identify spread of cancer into lymph nodes. This can prevent unnecessary surgery or help determine the best choice for treatment.

Airway stent (bronchial stent) - Advanced cancer or certain other conditions can constrict or compress the airway tube (bronchus). If the bronchus becomes blocked, difficulty breathing, cough, and pneumonia can result.

Using a bronchoscope, the doctor can advance a wire mesh stent into the narrowed airway. Expanding the stent can open the bronchus and relieve symptoms caused by the constriction.

Balloon bronchoplasty - The doctor advances a deflated balloon into a section of abnormally narrowed airway. By inflating the balloon with water, the airway is expanded, potentially relieving symptoms. Balloon bronchoplasty may be performed prior to airway stent placement to help expand a bronchus.

Rigid bronchoscopy - In rigid bronchoscopy, a long metal tube (rigid bronchoscope) is advanced into a person’s windpipe and main airways. The rigid bronchoscope’s large diameter allows the doctor to use more sophisticated surgical tools and techniques. Rigid bronchoscopy requires general anaesthesia (unconsciousness with assisted breathing), similar to a surgical procedure.

Foreign body removal/Control of bleeding - Bronchoscopy is the preferred interventional pulmonology procedure to remove inhaled foreign objects that are lodged in the airway. The doctor may be able to remove the object using flexible bronchoscopy, or else, rigid bronchoscopy may be required. Also, bleeding from the lungs can be controlled by using various techniques under vision.

Medical thoracoscopy/pleuroscopy - It is a minimally invasive procedure that allows access to the pleural space using a combination of viewing and working instruments. It allows for basic diagnostic (undiagnosed pleural fluid or pleural thickening) and therapeutic procedures (pleurodesis) to be performed safely.

Ablation of endobronchial tumours - It allows for removal or debulking of tumours which are blocking the main airways and causing symptoms like bleeding or difficulty in breathing.

These technologies include:

o Endobronchial ultrasound
o Autofluorescence and narrow-band imaging
o Thermal techniques including argon plasma coagulation (APC), electrocautery, laser and cryotherapy
o Photodynamic therapy
o Electromagnetic navigational bronchoscopy
o Endobronchial brachytherapy
o Silicone, metallic, and hybrid airway stents
o Flex-rigid pleuroscope

It is a relatively new subspecialty, which has opened new horizons in the field of pulmonary medicine and eliminates the need for surgical treatment in the subgroup of relatively ill patients with significant co-morbidities.

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