Elizabeth Malsin

Alveolar–pleural or broncho-pleural fistulas, leading to persistent air leaks (PALs), are associated with prolonged hospitalization and substantial morbidity. While guidelines advocate surgical repair as the primary treatment, its efficacy is limited. For patients recently subjected to thoracic surgery or those for whom surgery is contraindicated due to severe illness, viable treatment alternatives have been lacking. This article reviews the newer and less invasive treatment options for PALs. Further research is crucial, including randomized controlled trials comparing these options, and long-term monitoring of intervention outcomes is warranted.

Bronchoscopic lung volume reduction (BLVR) is an established treatment modality for the management of advanced chronic obstructive pulmonary disease complicated by severe emphysema and hyperinflation refractory to other therapies. BLVR aims to reduce hyperinflation and residual volume, thereby improving pulmonary function, symptom control, and quality of life. Multiple distinct devices and technologies, including endobronchial coils, thermal vapor ablation, bio-lung volume reduction, and airway bypass stenting, have been developed to achieve lung volume reduction with varying degrees of accessibility and evidence. The most promising BLVR treatment modality to date has been the placement of one-way endobronchial valves (EBVs), with more than 25,000 cases performed worldwide. Identifying symptomatic patients who would benefit from BLVR is challenging and can be time and resource intensive, and candidacy may be limited by physiologic parameters. Additional new technologies may be able to improve the identification and evaluation of candidates as well as increase the portion of evaluated patients who ultimately qualify for BLVR. In this review, we aim to provide historical context to BLVR, summarize the available evidence regarding its use, discuss potential complications, and provide readers with a clear guide to patient selection and referral for BLVR, with a focus on EBV placement. In addition, we will highlight potential future directions for the field.

Benign airway obstruction occurs in a group of heterogeneous diseases with the potential for both high symptom burden and a challenging clinical course. The diverse pathophysiology causing benign obstruction includes not just a multitude of spontaneous diseases such as infections, autoimmune diseases, and benign tumors, but also the iatrogenic causes of intubation and tracheostomy, as well as the complications from lung transplantation. Despite the pathology, there is a tendency of both under diagnosis and delay in diagnosis, as well as variability in the predicted clinical course. Management of patients with benign airway obstruction requires an understanding of both the underlying process and the data supporting disease-specific interventions. New technology and studies in the fields of otolaryngology, pulmonology, and thoracic surgery have improved and diversified available treatments and treating providers can consider endoscopic intervention, surgical options, and systemic medical therapies. The objectives of this review include describing the commonalities and differences in the presentation and treatment of common causes of benign airway obstruction, as well as an up-to-date literature review of the current management strategies. We aim to highlight recent updates to diagnosis and management, as well as the need for a multidisciplinary approach for both management and further study of this diverse and challenging group of diseases.