The role of interventional pulmonary procedures in the management of post-obstructive pneumonia

Abstract

Post-obstructive pneumonia is the result of airway obstruction, commonly due to lung cancer. The majority of patients with lung cancer are non-operable and incurable at initial presentation. The clinical course of these patients is steadily downhill with complicating events such as post-obstructive pneumonia, respiratory failure, pleural effusion, and severe debilitation. Non-invasive conventional options for post-obstructive pneumonia include broad-spectrum antibiotics, combined with attempts at relieving the obstruction using radiation therapy. There is scant literature on the natural course of post-obstructive pneumonia, disease resolution, and optimal treatment. With the recent surge in technologic advances in interventional pulmonology, multiple airway recanalizaton options are now available. In this paper, we describe the causes of post-obstructive pneumonia, and the role of interventional pulmonary procedures in -establishing an open airway.

Endobronchial Hamartoma as a Cause of Pneumonia

“…Post-obstructive pneumonia is difficult to treat with antibiotics alone because of poor drainage, and can lead to recurrent hospitalization, increased medical costs, and poor outcomes [1]. Actual incidence and cause of obstructive pneumonia has not been well elucidated; however, lung cancer has been considered as the most common cause of post-obstructive pneumonia, occurring in approximately 20% of the patients with proximal airway obstruction [1].…”

“…Actual incidence and cause of obstructive pneumonia has not been well elucidated; however, lung cancer has been considered as the most common cause of post-obstructive pneumonia, occurring in approximately 20% of the patients with proximal airway obstruction [1]. Benign diseases (e.g., foreign bodies, benign tumors, granulomatous diseases such as tuberculosis, or broncholithiasis) can obstruct the airways and induce post-obstructive pneumonia [1–5]. Jhun et al reported that 31% of the patients with benign endobronchial tumors exhibited obstructive pneumonia on chest CT scan [3].…”

“…Post-obstructive pneumonia occurs in the presence of airway obstruction, usually caused by lung cancer [1]. However, there are cases of bronchial obstruction due to benign origin such as foreign bodies and benign endobronchial tumors, which are often misdiagnosed.…”

The Microbiology of Postobstructive Pneumonia in Lung Cancer Patients

“…These studies were largely performed in COPD patients or perioperative patients undergoing pulmonary resection for cancer and additional studies are needed to see whether these results correlate with that found in postobstructive pneumonias. 27,28 In patients who cannot tolerate bronchoscopy alternate imaging is required. 26 The ability to sample a pulmonary lesion directly could be a significant advantage when sputum cultures are negative and the addition of endobronchial ultrasound has greatly enhanced the diagnostic utility of bronchoscopies.…”

“…28 Bronchoplasty and airway stenting are also commonly used to restore airway patency with good results but also carry inherent risks. Interventional bronchoscopy techniques, such as tumor debulking with Nd:YAG laser have shown promise for the treatment of proximal airway lesions while argon plasma anticoagulation and electrocautery have also been used safely and effectively for removal of airway lesions while providing good hemostasis.…”