Abstract

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.