Advanced Pulmonology Treatments | Complete Respiratory Care

At PACE Hospitals, we offer comprehensive treatment for a wide range of pulmonary diseases, focusing on restoring lung function and improving respiratory health. Our pulmonary care includes advanced therapies, personalized treatment plans, and respiratory support to manage chronic conditions, improve breathing, and enhance the overall quality of life.

Non-Pharmacological Management

These approaches are supportive, preventive, and lifestyle-based.

• Smoking cessation: Quitting smoking is the most important step in treating lung diseases, particularly chronic obstructive pulmonary disease (COPD) and emphysema. Smoking is the main cause of these diseases, and stopping helps prevent further damage to the lungs and improves breathing, reducing the risk of exacerbations and complications. 
• Pulmonary Rehabilitation: It helps improve the lung function, endurance, and quality of life in individuals with chronic lung diseases. It focuses on strengthening respiratory muscles, improving physical activity tolerance, and educating techniques to manage symptoms.
• Oxygen Therapy: Oxygen therapy involves providing supplemental oxygen to patients with low blood oxygen levels, which is frequent in advanced lung diseases like COPD and pulmonary fibrosis. It helps reduce shortness of breath, improve exercise tolerance, and prevent complications such as heart failure.
• Vaccinations: Vaccines, such as the flu vaccine, pneumococcal vaccine, influenza, pneumococcal, and COVID-19, are essential in preventing respiratory infections, which can worsen lung diseases. These infections can lead to exacerbations, hospitalizations, or even death, so vaccinations reduce the risk of such events and help maintain lung health.
• Environmental control: Managing environmental factors such as air pollution, allergens, and irritants can improve lung health. Avoiding exposure to harmful substances helps reduce inflammation and prevents the worsening of lung conditions, particularly in those with asthma, COPD, or allergies. 
• Airway clearance techniques: These techniques, such as chest physiotherapy, help clear mucus from the airways in individuals with conditions like cystic fibrosis or chronic bronchitis. 
• Lifestyle modification: Adopting healthy habits, such as a balanced diet, regular exercise, and stress management, can play a crucial role in managing lung diseases. Maintaining a healthy weight, avoiding pollutants, and staying active help keep the lungs in better shape and reduce the strain on the respiratory system.
  

Pharmacological Management

Medication-based treatment targeting inflammation, infection, airway obstruction, or other lung pathology:

Bronchodilators: Bronchodilators relax airway muscles, opening the airways to ease breathing. These include:

• Short-acting β2 agonists (SABA) are quick-relief medications that work by relaxing the muscles around the airways, helping to open them up and improve airflow. These are typically used during asthma attacks or sudden worsening of COPD.
  
• Long-acting β2 agonists (LABA) are used for long-term control in asthma and COPD. They work in a similar way to SABAs but have a prolonged effect, helping to maintain open airways for longer periods.
  
• Anticholinergics block the action of acetylcholine, which reduces airway constriction. These are especially useful in COPD, where they help to relax the muscles in the lungs, improving airflow and reducing symptoms like wheezing and shortness of breath.

Corticosteroids: Corticosteroids reduce airway inflammation and swelling, improving breathing in asthma, COPD, and other inflammatory lung diseases. This includes:

• Inhaled corticosteroids: These are commonly used in asthma and COPD to reduce inflammation in the airways. By decreasing inflammation, these medications help prevent airway narrowing, reduce mucus production, and improve breathing. 
  
• Systemic corticosteroids: This may be used during severe flare-ups of asthma, COPD, or other lung conditions to control more widespread inflammation. Corticosteroids quickly reduce lung inflammation during flare-ups but are used for the short term due to serious side effects.

Anti-infectives: These agents fight lung infections by targeting bacteria, viruses, or fungi, helping restore normal respiratory function.

• Antibiotics: These are used when bacterial infections, such as pneumonia or bronchitis, complicate lung diseases. These medications help treat infections by killing or inhibiting the growth of bacteria in the lungs, improving symptoms and preventing further damage to the airways.
• Antivirals: These are used when viral infections, such as influenza or respiratory syncytial virus (RSV), are present. These drugs help reduce the severity and duration of viral infections, which can otherwise exacerbate lung conditions like asthma or COPD.
  
• Antifungals: These are prescribed if fungal infections, such as Aspergillus or histoplasmosis, affect the lungs. Fungal infections can cause chronic inflammation and damage to the lungs, especially in individuals with compromised immune systems or preexisting lung diseases.

Antifibrotics: These are used to treat progressive fibrotic lung diseases, particularly idiopathic pulmonary fibrosis (IPF). These medications help slow the progression of fibrosis (scarring) in the lungs, which can significantly impair lung function.

Pulmonary Vasodilators: These are used to treat pulmonary hypertension (PH), a condition where the blood pressure in the arteries of the lungs becomes abnormally high, leading to difficulty in breathing, fatigue, and heart strain.

Anticoagulants/thrombolytics: These are used in lung diseases like pulmonary embolism to prevent clot formation and dissolve existing clots, improving blood flow in the lungs.

• Anticoagulants: These are used to prevent further clotting. They don’t dissolve the existing clot, but they prevent new clots from forming, helping to stop the progression of the embolism and reduce the risk of further complications, such as another clot.
• Thrombolytics: These are used in severe or life-threatening cases of pulmonary embolism. These drugs work by dissolving the existing blood clot quickly. Thrombolytics are typically used in emergency situations where the clot causes significant damage or risk to the patient’s life.
  
  

Biologic Therapies 

Biologic therapies are targeted treatments used for severe asthma, especially when traditional treatments like inhalers and steroids are not effective. These therapies are designed to target specific molecules involved in the inflammation process, particularly in eosinophilic asthma, where high levels of eosinophils (a type of white blood cell) cause airway inflammation and obstruction. These biologic drugs reduce asthma exacerbations, improve symptom control, and can help reduce the need for oral steroids in patients with severe or uncontrolled asthma.

Mucolytics: Mucolytics are medications that help treat lung diseases by breaking down and thinning mucus in the airways, making it easier to clear the mucus from the lungs. This is particularly helpful in conditions where thick mucus builds up and obstructs airflow, such as in COPD, cystic fibrosis, bronchitis, and other respiratory conditions.

Leukotriene Modifiers: Leukotriene modifiers are a class of anti-inflammatory drugs used primarily in the treatment of asthma and sometimes allergic rhinitis. They work by blocking the action or production of leukotrienes, which are chemical mediators that cause airway inflammation, bronchoconstriction, mucus production, and swelling in the lungs.

Minimally Invasive Procedures

Minimally invasive procedures are used to diagnose and treat pulmonary conditions without major surgery.

• Bronchoscopy: Bronchoscopy is a procedure used to look inside the lung airways (trachea and bronchi) and to identify the cause of lung problems. It helps detect signs of infection, tumours, bleeding, excess mucus in the airways, and blockages. The pulmonologist inserts a thin tube (bronchoscope) with a camera through the nose or mouth into the airways. By viewing the camera, they can examine internal passages and identify abnormalities such as blood, mucus, or tumours. Before the procedure, local anaesthesia is used to numb the airways, and sedation may be given to make the patient comfortable. There are several types of bronchoscopies performed to treat lung diseases, which include:
  
• Flexible bronchoscopy: This is one of the most common procedures in pulmonology. It involves inserting a flexible bronchoscope through the nose or mouth into the airways to detect abnormalities. The bronchoscope has a working channel that allows the pulmonologist to perform procedures such as biopsy, suction of secretions, and removal of foreign material.
  
• Rigid Bronchoscopy: In this procedure, a long, rigid metallic bronchoscope is inserted into the trachea and main bronchi. This procedure is performed under general anaesthesia, similar to a surgical operation, and is mainly used for the removal of large obstructions, control of bleeding, and tumour management.
  
• Balloon Bronchoscopy (Balloon Dilation): In this technique, a deflated balloon is inserted into a narrowed or abnormal part of the airway. The balloon is then inflated with fluid, which helps widen the airway and improve airflow. This procedure is often performed before placing an airway stent to maintain airway patency.
  
• Electromagnetic Navigational Bronchoscopy (ENB): This is a flexible bronchoscope that is guided into the lungs to inspect abnormal areas, and biopsies can be taken. This procedure is commonly used when lung nodules are detected on a CT scan or chest X-ray, especially when evaluating conditions like lung cancer.
  
• Robotic Bronchoscopy: Robotic bronchoscopy is an advanced technique in which the pulmonologist controls the bronchoscope using a robotic system for greater precision. It is mainly used for the biopsy of lung nodules and the early detection of diseases such as lung cancer.
  
• Endobronchial Ultrasound (EBUS): This interventional procedure involves using a bronchoscope, a thin tube with a bright light inserted through the patient's mouth and down to the windpipe and bronchi. The bronchoscope has a small camera that allows a pulmonologist to visually examine the airways, blood vessels, lungs, and lymph nodes on an ultrasound monitor. Additionally, a needle is attached to the bronchoscope to extract fluid and tissue samples from the patient's lungs and surrounding lymph nodes. This procedure is referred to as transbronchial needle aspiration.
  
• Thoracentesis: Thoracentesis is a procedure performed to diagnose or treat pleural effusion, which is the buildup of fluid in the pleural space around the lungs. During the procedure, a needle is inserted through the chest wall into the pleural space, usually under ultrasound guidance to improve safety and accuracy. A catheter may then be advanced over the needle to drain the excess fluid. The fluid is either collected for diagnostic analysis or removed to relieve symptoms such as breathlessness. After drainage, the catheter or needle is removed, and a sterile dressing is applied to the site.
  
• Pleurodesis: For patients experiencing recurring pleural effusions, a medical procedure called pleurodesis is often recommended. During this procedure, a pulmonologist makes an incision in the chest wall and inserts a plastic tube into the chest cavity. An irritating chemical is then sprayed around the lung, causing the inflamed pleura to stick tightly to the chest wall, preventing the re-accumulation of fluid around the lung.
  
• Laser Therapy and Photodynamic Therapy:These are used to treat lung cancer and conditions causing airway obstructions. 
• Laser Therapy: This therapy is used to remove or shrink tumors and clear airway blockages in the lungs. A laser fiber is introduced through a bronchoscope to focus concentrated laser light on the obstructed tissue. The laser generates tremendous heat, which reduces or vaporises tumours or removes blockages. This technique is particularly useful in treating lung cancer, where tumors block the airways, as well as conditions like chronic bronchitis or emphysema that cause airway obstructions.
  
• Photodynamic Therapy (PDT): This is used to treat early-stage lung cancer and precancerous lesions in the lungs. In this procedure, a light-sensitive drug is given intravenously, which accumulates in abnormal or cancer cells. After a few days, a specific light is delivered to the affected area through a bronchoscope. The light activates the drug, producing a reaction that destroys the abnormal cells. PDT is useful for localized tumors and can also help relieve symptoms like airway blockage in advanced cases.
  
• Stent Placement (bronchial stent): When cancer or certain other conditions affect a bronchus (airway tube), it can become compressed or narrow, resulting in coughing, breathing difficulties, and the pneumonia. A pulmonologist can use a bronchoscope to insert a wire mesh stent into the affected airway to alleviate these symptoms. This stent expands to open up the airway and relieve constriction.
  
• Indwelling Pleural Catheter: A pleural catheter is used as an alternative to pleurodesis for treating recurrent pleural effusion (fluid around the lung). This procedure involves the insertion of a plastic catheter under the skin and into the chest cavity, with its tip placed inside. As fluid builds up around the lung, a healthcare professional can use sterile supplies to drain the indwelling pleural catheter at home.
  
• Endobronchial Ultrasound (EBUS-TBNA): This interventional procedure involves using a bronchoscope, a thin tube with a bright light inserted through the patient's mouth and down to the windpipe and bronchi. The bronchoscope has a small camera that allows a pulmonologist to visually examine the airways, blood vessels, lungs, and lymph nodes on an ultrasound monitor. Additionally, a needle is attached to the bronchoscope to extract fluid and tissue samples from the patient's lungs and surrounding lymph nodes. This procedure is referred to as transbronchial needle aspiration.
  
• Percutaneous Tracheostomy: Percutaneous dilational tracheostomy is a frequently used medical procedure for critically ill patients. It is typically performed on those experiencing short-term respiratory failure and requiring prolonged mechanical ventilation. This procedure involves creating a surgically generated airway that remains open with a breathing or tracheostomy tube inserted directly into the trachea through a neck incision. A flexible bronchoscope is necessary during the procedure to ensure proper positioning of the oral endotracheal tube.
  
• Bronchoscopic Cryobiopsy: A new procedure has been developed for identifying lung diseases by taking a sample of lung tissue. It involves using a bronchoscope with a flexible cryoprobe tool to reach inside the lung. The process can be done with a specialized cryoprobe or cryotherapy spray in the airway. The cryoprobe works by freezing tissue to collect a sample that can be evaluated further.
  
• Bronchoscopic Thermoplasty: Thermoplasty is a respiratory procedure designed for individuals with severe asthma who do not respond to medication. During a bronchoscopy, a pulmonologist uses a heat probe to apply heat to the airway walls. This heat eliminates a layer of smooth muscle responsible for the constriction that leads to asthma symptoms.

Surgical Treatments

Surgical options are typically reserved for more severe pulmonary diseases or when other treatments have failed.

• Lobectomy: A lobectomy may be necessary when one part of a lung is damaged or diseased. This surgical procedure removes the affected lobe, leaving the remaining healthy tissue to function normally. Conditions requiring a lobectomy include tuberculosis, emphysema, lung abscess, fungal infections, and lung cancer.
  
• Pneumonectomy: Pneumonectomy is a surgical procedure involving removing one of a patient's lungs due to trauma, cancer, or other diseases. The most common reason for this procedure is lung cancer, and other conditions may include congenital lung disease, traumatic lung injury, tuberculosis, and bronchiectasis. Usually, healthcare professionals aim to remove some lung tissue.
  
• Thoracotomy: This is an open surgical procedure where a large incision is made in the chest wall to access the lungs for the treatment of lung cancer, infections, or trauma.
  
• Bullectomy: This type of surgical procedure is performed to remove lung air pockets. The lungs contain various tiny air sacs known as alveoli that can grow into larger spaces called bullae when they are damaged. Bullae are significant lung air pockets that can develop due to certain medical conditions like emphysema and COPD. Pulmonologists may suggest removing bullae when they cause breathing difficulties or other health problems.
  
• Lung Volume Reduction Surgery (LVRS): Patients suffering from severe emphysema or end-stage chronic obstructive pulmonary disease may undergo lung volume reduction surgery (LVRS) to improve their lung capacity, breathing ability, and overall quality and quantity of life. This surgery can be performed using open sternotomy, video-assisted thoracoscopic surgery, or thoracotomy.
  
• Pulmonary Endarterectomy: Pulmonary thromboendarterectomy is a complicated surgical procedure that involves removing scar tissue and old blood clots from the pulmonary arteries in the lungs. The procedure helps to eliminate the blockages, which restores normal blood pressure and blood flow in the lungs while reducing the strain on the right side of the heart. By removing these clots, the heart and lungs can function better, leading to a general improvement in well-being.
  
• Pulmonary Wedge Resection: It is a surgical procedure to remove a wedge-shaped small piece of tissue from the lung. It is typically done for individuals with early-stage lung cancer, metastatic tumours, bullous lung disease, tuberculosis, and lung nodules or lesions. This procedure is most effective when the cancer or disease is identified early and only affects a small area.
  
• Lung Transplant: A lung transplant is a surgical procedure in which one or both diseased lungs are replaced with healthy donor lungs. It is used for end-stage lung diseases such as COPD, pulmonary fibrosis, cystic fibrosis, and severe pulmonary hypertension when other treatments fail. The transplant restores lung function, improves oxygenation, reduces symptoms like breathlessness, and enhances quality of life. Patients require lifelong immunosuppressive therapy to prevent rejection and are monitored for infections and complications.
  

Consult our pulmonology specialists for a free second opinion on respiratory diseases.

At PACE Hospitals, we are committed to providing our patients with the best possible care, and that includes offering second medical opinions with super specialists for treatment or surgery. We recommend everyone to get an expert advance medical second opinion, before taking decision for your treatment or surgery.