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The first interventional bronchoscopy (also referred to as therapeutic bronchoscopy throughout this chapter) was performed by Gustav Killian in 1897 when he removed a pork bone from the right mainstem bronchus of a patient. For nearly 70 years bronchoscopy was predominantly a therapeutic procedure performed for foreign body extraction. Two events shifted the landscape of bronchoscopy—the lung cancer epidemic and the development of flexible bronchoscopy by Shigeto Ikeda in 1967. Following an escalation in lung cancer incidence, malignant airway obstruction requiring therapeutic intervention became much more common than foreign body extraction. As a result, new tools were developed to address malignant airway obstruction based upon a minimally invasive bronchoscopic approach. In addition, bronchoscopy-based technology has been developed to address chronic obstructive pulmonary disease (COPD) and asthma. Application of the technology has entered clinical trials and may alter the therapeutic options for these diseases processes. This chapter presents an overview of interventional bronchoscopy modalities that can be utilized for benign and malignant airway obstruction, COPD, and asthma.

Indications for Interventional Bronchoscopy

Many potential indications for interventional bronchoscopy have been recognized, including malignant airway obstruction, benign airway obstruction, and foreign body extraction, among others. (Table 36-1). The majority of therapeutic bronchoscopies performed today are undertaken for management of malignant airway obstruction, most commonly from lung cancer. It is estimated that up to 40% of patients with lung cancer develop symptomatic airway obstruction at some point during their disease process. Although lung cancer is the most common source of malignant airway obstruction, any primary thoracic malignancy, or any malignancy with pulmonary metastases, may result in symptomatic airway obstruction. Regaining airway patency to palliate symptomatic dyspnea and other respiratory symptoms may have significant impact on the quality of life of patients with advanced malignancy.

Table 36-1Indications for Interventional Bronchoscopy

Benign airway obstruction etiologies are listed in Table 36-2 and consist of a variety of localized inflammatory and systemic conditions. Although the etiologic airway process is benign and not malignant, the interventions and management of these complex processes is far from benign to the patient. Interventional bronchoscopy techniques can often correct the presenting symptoms; however, the stenosis and symptoms often recur and patients may require repeat procedures to maintain airway patency. Selected patients may need to proceed with airway resection of the benign stenotic airway segment.1

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