Complex airway diseases represent a therapeutic challenge and require
multidisciplinary input including the interventional pulmonologist and thoracic
surgeon. Surgery, if feasible, remains the definitive modality. However, minimally
invasive endobronchial techniques have resulted in symptom control and, in selected
patients, long-term improvements in quality of life. These techniques are, in general,
safe and well tolerated when performed by experienced operators. Endobronchial laser
therapy, cryotherapy, electrocautery or argon plasma coagulation and photodynamic
therapy have been used successfully.
Despite the introduction of new technologies, the rigid bronchoscope remains the
method of choice for the treatment of both benign and malignant central airway
obstruction. It allows rapid and safe dilation, mechanical debulking, foreign body
removal and silicone stent placement. However, it has limited use if lesions are located
in the upper lobes or lung periphery but significant technological advances allow for
effective treatments using the flexible bronchoscope. Rigid and flexible bronchoscopes
should be seen as complementary procedures and most cases will require the use of
both modalities.
Keywords: Airway compression, Airway stenosis, Airway stenting, Bronchial
stenosis, Bronchoscopy, Central airway obstruction, Flexible bronchoscopy,
Foreign body, Interventional bronchoscopy, Interventional pulmonology, Laser,
Lung cancer, Lung transplantation, Rigid bronchoscopy, Silicone stent, Tracheal
stenosis.