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Montefiore in the News

December 12, 2019

ALI SADOUGHI, MDBy Ali Sadoughi, M.D., Contributor Dec. 12, 2019, at 6:00 a.m.

Each year, almost 30% of the 200,000 people diagnosed with lung cancer in the U.S. will suffer from difficulty breathing due to airway narrowing.

Lung cancer can affect breathing in different ways. The inability to steadily breathe is one of the most common symptoms of lung cancer. Respiratory distress can make it impossible for people to complete daily activities or even get out of bed. It's scary and incredibly uncomfortable. Alarmingly, respiratory distress can even cause people suffering from cancer to have to stop treatments such as surgery, chemotherapy, radiation and immunotherapy.

Identifying Respiratory Distress

What are the causes of respiratory distress, one might ask? Sometimes fluid accumulates in the space between the lung and rib cage. This can cause a lung to be compressed or even collapse. Other times, the cancer can cause bleeding inside the airways or narrow a person's airways. Each year, almost 30% of the 200,000 people diagnosed with lung cancer in the U.S. will suffer from difficulty breathing due to airway narrowing.

Airway complications caused by lung cancer do not always occur because a cancer is advanced, or because someone is suffering from a large tumor. People might not even feel the cancer growing in their airways until their trachea (or windpipe) are narrowed significantly. Like so many things in life, it's all about the location. Also, like many things in life, you need the right specialist for the job.

Lung cancer-associated airway complications are underrecognized and can be deadly. Therefore, when looking for the best treatment, one should look to an interventional pulmonologist. Interventional pulmonology is a relatively new specialty that has come about in the last decade. These doctors are experts in the anatomy of the respiratory system, and they often use minimally invasive procedures for diagnosing and treating lung diseases. The referral to an interventional pulmonologist can be made by a primary care provider or an oncologist.

Breathing Easier by Clearing the Airways

To treat lung cancer-associated airway complications, there are numerous techniques an interventional pulmonologist may use, including lasers, cryo-therapy (cold energy) and electrocautery (hot energy). An interventional pulmonologist may also opt to excise tumors inside the airways and place stents there to keep the windpipes open. These minimally invasive techniques are safe options and effectively alleviate symptoms of respiratory distress.

After careful evaluation by an interventional pulmonologist, the decision will be made about which form of treatment can best help the person who is suffering from difficulty breathing. There are different advanced procedures to open the airways, including the removal of tumors that block the airways and even shaving tumors from inside the windpipes. These procedures are helpful especially if a person cannot tolerate surgery to remove the cancer. In addition to the removal of a tumor or shaving of a tumor, a person is typically offered chemotherapy, radiation or immunotherapy. Sometimes, however, blockages of the airways make people feel like they are suffocating and not getting enough air.

Advanced Bronchoscopy Tools

A bronchoscopy is a common procedure that lets doctors look at the lungs and air passages. During a bronchoscopy, a thin tube goes through a person's nose or mouth and down the throat and into the lungs. Traditionally, these procedures were used to diagnose lung cancer; however, there are now advanced bronchoscopy tools that – in the hands of interventional pulmonologists – can treat airway obstructions.

These procedures are usually done while a person is sedated and can occur both within and outside a hospital. The best part is that they provide immediate relief. Patients in my practice at Montefiore Health System commonly report a significant improvement in their breathing status, as well as relief from choking sensations. Some people even say they feel like they got a new lung and can go back to their daily life activities. This feeling is not only very satisfying to my patients, but also very rewarding to me as a physician.

If you're suffering from difficulty breathing, ask for help! Especially if you have lung cancer, or a history of cancer in your family, setting up a care team of the right specialists is key.

An interventional pulmonologist might not be a specialty you've heard of before, but the number of us nationwide is growing – and we're exploring new minimally invasive ways to diagnose and treat an array of conditions in the lungs, like the use of advanced bronchoscopy tools.

Most people can return home on the day of these procedures – and symptoms can generally be relieved quickly – so don't wait until it's too late. Whether it's the shaving of tumors from the inside of your lungs or use of other advanced bronchoscopy tools, there are more tools now than ever to improve a person's ability to breathe.

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Ali Sadoughi, M.D., Contributor

Dr. Ali Sadoughi is the director of Interventional Pulmonology and Bronchoscopy at ontefiore. An expert evaluates whether this type of therapeutic massage help reduce prostate cancer risk.