Lung Care

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Overview

University of Louisville Hospital and the University of Louisville Brown Cancer Center offer a broad array of treatments and diagnostic capabilities for disorders of the lung.

With a team that features Kentucky’s only fellowship-trained interventional pulmonologist, UofL Hospital offers services that are the least invasive.

Our goal is to provide multidisciplinary, individualized, state-of-the art care to our patients.

We offer several minimally invasive lung procedures at UofL Hospital.

Diagnostic capabilities:

  • Navigational bronchoscopy
  • Rigid bronchoscopy, used for locating and retrieving foreign objects while protecting the airway
  • Bronchoplasty, surgical repair of a defect in the bronchus, the main airway to the lungs
  • Endobronchial ultrasound. This¬†may be performed during a bronchoscopy to help diagnose or determine the stage of a lung cancer
  • Transthoracic lung biopsies, a method to remove a piece of lung tissue for examination

Asthma

Bronchial Thermoplasty

Bronchial thermoplasty is a new treatment for ashthma. For most people with asthma, medicines usually open up lung airways enough to allow for normal activity. However, these medicines do not always work well in patients who have severe asthma. For these patients, University of Louisville Hospital offers bronchial thermoplasty.

What is bronchial thermoplasty?

A small tube designed to be inserted into your airway through your mouth mildly heats the airway walls. This heating may allow your airways to stay more open and help you breathe better.

Who can have this treatment?

Bronchial thermoplasty may be right for the treatment of severe, persistent asthma in patients 18 years and older whose asthma is not well controlled with inhaled corticosteroids and long-acting beta agonists.

Who cannot have this treatment?

You cannot have this treatment if you have:

  • An implant with electronics. Tell your doctor if you have any implants with electronics, such as a pacemaker. BT may keep the implant from working correctly.
  • Problems taking certain medicines. Tell your doctor if you have ever had a problem taking any kind of medicines.¬†
  • You are less than 18 years old. BT has not been tested in patients younger than 18 years.

You cannot have this treatment while the following conditions are present:

  • An active respiratory infection. Tell your doctor if you think you have an infection, fever¬†or your asthma is worse than usual.¬†
  • Have had an asthma attack or changed your oral corticosteroid dose in the last 2 weeks.¬†
  • A blood clotting problem. Tell your doctor if you take any drugs to keep your blood from clotting.¬†

Navigation Bronchoscopy

Electromagnetic navigation bronchoscopy, often called ‚ÄúENB‚ÄĚ, allows your physician to evaluate your lungs and navigate through small airway passages. This is helpful for diagnosing or treating a lung nodule that is in an area of a lung that would make traditional procedures,¬†such as bronchoscopy or surgery, too risky.

A lung nodule is a mass of abnormal tissue that can either be benign or malignant.

Similar to GPS technology, ENB guides the physician through the patient’s natural airways in regions of the lung that are not reachable with traditional bronchoscopy. Until now, physicians have relied on needle biopsy or surgery to take tissue samples, both of which can cause complications.

Why should I have an ENB procedure?

The most common reason for having an ENB procedure includes abnormal findings on a chest x-ray or CT-scan, such as a spot on the lung. ENB enables your physician to take tissue samples from very small nodules earlier and more safely than other methods, potentially detecting lung cancer earlier and enhancing treatment options.

How does it work?

Prior to the procedure, a¬†chest CT scan is loaded onto a computer creating a virtual ‚Äúroadmap‚ÄĚ of the lungs.

During the procedure, a bronchoscope is placed through the mouth and into the airways of the lungs.

Electromagnetic sensors then guide a catheter to the exact location where the physician wants to take a tissue sample or place fiducial markers.

A sample is taken and sent to a lab for diagnosis.

Who is eligible for an ENB procedure?

ENB can be used for a wide range of patients, including those who suffer from poor lung function or have had cancer surgery, chemotherapy or radiation therapy.

Using ENB to place markers for stereotactic radiotherapy in the lung

In addition to its capabilities to diagnose lung nodules, ENB can enable physicians to place gold or other types of metal markers in patients who will be undergoing stereotactic radiotherapy to treat tumors in the lung.

A fiducial marker is a small piece of metal about the size of a grain of rice, and comes in different shapes. It is used to mark tumors in the lung. Fiducial markers can be seen on X-ray and act as a tracking device for the stereotactic treatment machine to follow. Often, you will have one to four fiducial markers placed, and you cannot feel them. They are not magnetic or radioactive and cannot be removed.

Recovery and Risks

After the ENB procedure, you will be observed until you are awake enough to return home. The most common risk is pneumothorax (collapsed lung), which occurs in 2 percent to 3 percent of patients. This is comparable to a traditional bronchoscopy.

You may experience a mild sore throat, hoarseness or cough following the ENB procedure. If you feel chest pain or increased shortness of breath, contact your doctor immediately.

General lung disorders

  • Whole lung lavage, for pulmonary alveolar proteinosis, a rare disease in which a type of protein builds up in the air sacs of the lungs, making breathing difficult
  • Indwelling pleural catheter placement, for pleural effusion, excess fluid that builds up in the space that surrounds the lungs, impairing breathing
  • Transtracheal oxygen catheters¬†for hypoxemia, low blood oxygen

Emphysema

  • Placement of endobronchial valves, small, one-way valves implanted in an airway

Other

  • Lung cancer (learn more about treatment at the University of Louisville Brown Cancer Center)
  • Cryotherapy, uses extreme cold to freeze and destroy cancer cells
  • Stent placement
  • Holmium YAG laser, used for precise laser surgery treatments
  • Electrocautery photodynamic therapy, for treating early stage superficial squamous cell lung cancer
  • Marker placement for radiation therapy

Umair Gauhar, M.D.

Umair Gauhar, M.D., is board certified in pulmonary, critical care medicine and interventional pulmonology. He specializes in advanced diagnostic bronchoscopy, therapeutic bronchoscopy, pleuroscopy and other pleural procedures, as well as tracheal procedures. He specializes in the management of lung masses; pulmonary nodules; benign and malignant complex airways disorders; pleural effusions and pleural diseases; early diagnostic techniques for detection and staging of intra-thoracic malignancies; tracheal procedures; and bronchoscopic management of airways disorders such as asthma and COPD.

Dr. Gauhar has presented his work at national and international meetings. He is active in education and gives education talks and lectures to students, trainees, physicians and other health care professionals.

For more information on UofL Hospital's interventional pulmonology program, please call 502-852-5841 or 502-562-3378.