Learn more about lung and allergy treatments and procedures employed by the Department of Pulmonary, Allergy & Critical Care Medicine.
Airway Stents
Self-expandable metallic stents (SEMS) are the newest method of opening large airway obstructions. Cleveland Clinic pulmonologists have extensive experience placing SEMS using a flexible bronchoscope. The treatments are safe, can be performed in a procedure room without general anesthesia, and provide immediate relief of symptoms in 95 percent of patients. This procedure can also be performed in the intensive care unit on ventilator-dependent patients.
SEMS, which look like wire-mesh cages, are useful in holding open an airway compromised by a tumor, fistula or other type of tissue. SEMS are not curative, in that they do not change the disease process. These treatments do, however, make breathing easier.
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Arterial Blood Gas Analysis
Arterial blood gas analysis is a common test that measures the amount of oxygen and carbon dioxide in the blood. The results reveal whether or not adequate amounts of oxygen are reaching the blood and carbon dioxide is being expelled. The test is done on a blood sample taken from an artery in the arm.
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Brachytherapy Treatments
Brachytherapy is a type of radiation therapy that involves the temporary placement of small radioactive seeds in the airway near a tumor constricting the airway.
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Bronchoscopy
Bronchoscopy is the gold standard test for seeing inside the airway. The test can be performed to diagnose lung diseases or aid in allergy treatments, locating the source of a problem by visualizing the throat, larynx, trachea and lungs and collecting tissue samples for biopsy. For these purposes, a long, thin tube called a flexible bronchoscope is used. The test does not require general anesthesia, although a local anesthetic is used. It involves passing a tube called a bronchoscope through the nose or mouth, past the vocal chords and down the airway as far as necessary. A small camera conveys the images to a television monitor. Bronchoscopy can also be used to remove objects or mucus blocking the airway, or to destroy growths in the airway.
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Cardiopulmonary Exercise Testing
When shortness of breath on exertion is not easily explained, the doctor may order a cardiopulmonary exercise test. This test, which is similar to a cardiac exercise test, reveals how well the body does during exercise. However, the test measures the exchange of oxygen and carbon dioxide. This reveals how well the lungs are working. If they are not working properly, the test will reveal why.
To perform the test, the person pedals a type of stationary bicycle called a cycle ergometer. The test measures lung function, including the exchange of oxygen and carbon dioxide, and cardiac response to exercise. The results can help determine if a problem is due to lung or cardiovascular disease, informing the appropriate treatments.
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Cryotherapy
Cryotherapy uses an ultra-cold probe to freeze cancer cells and kill them. The treatments are sometimes an option for treating non-small-cell lung cancer classified as stage IIIB (spread to specific lymph nodes and probably not operable).
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Laser Therapy
In laser therapy, a thin beam of light is used to kill cancer cells or benign growths in the airway. The treatments are palliative, meaning that they relieve blockages and restore airflow to improve breathing. They are not curative, and are not one of the primary treatments for lung cancer.
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Lung Scan
Lung scans are outpatient nuclear radiology studies that produce images from the accumulation of radioactive tracer in the tissues. Lung scans are performed when a blood clot (pulmonary embolism) is suspected of obstructing blood flow to a lung, or when lung function must be evaluated before surgery to remove part of a lung.
To perform a ventilation scan, a gas containing xenon or krypton is inhaled into the lungs. To perform a perfusion scan, the radioactive tracer is injected into the bloodstream and travels into the lungs. After a lung scan is done, the body eliminates the radioactive compound as waste.
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Lung Transplantation
Lung transplantation is one of the possible treatments for patients with severe emphysema, pulmonary hypertension, cystic fibrosis, severe COPD or interstitial lung disease (idiopathic pulmonary fibrosis) that cannot be corrected with medication or other procedures.
Cleveland Clinic performed its first adult lung transplant in 1990 and first pediatric lung transplant in 1991. Since that time, the program has grown dramatically to include dozens of single lung, double lung and heart/lung transplants every year. Cleveland Clinic supports this program with special facilities and services for patients and their families throughout the transplant process.
The lung transplant team at Cleveland Clinic is specially trained to meet the needs of lung transplant patients. The primary members of the team are a transplant pulmonologist, who provides care before and after the operation, and a lung transplant surgeon, who performs the transplant and monitors the patient’s care in the hospital. The pulmonologist and surgeon work closely to adjust medications as needed and treat any complications that occur.
Other members of the transplant team include infectious disease specialists, who monitor patients taking immunosuppressant drugs; pharmacologists, who specialize in monitoring medications; nurses with special training in caring for lung transplant patients; a transplant coordinator, who coordinates all the step leading up to and following the transplant, finds a donor, arranges for pre-transplant testing, and educates the patient and family about post-transplant care; nursing assistants; dietitians; social workers; financial counselors; physical therapists; respiratory therapists; and many others. For children undergoing lung transplantation, the team includes many specialists who are trained to meet the needs of children and their families.
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Lung Volume Reduction Surgery
Lung volume reduction surgery is one of the exciting new treatments for patients whose lungs are damaged from advanced emphysema. In this surgery, a portion of the diseased lungs is removed to allow more room for the lungs to expand and contract and to relieve pressure on the diaphragm. As a result, the patient can take in more air with every breath.
Cleveland Clinic is one of only two centers in Ohio participating in the National Emphysema Treatment Trial. This trial, funded by the National Heart, Lung and Blood Institute, is comparing the effectiveness of lung volume reduction surgery to optimal medical management as emphysema treatments. Patients must have stopped smoking or agree to stop smoking. For more information about possible enrollment in the trial, please call 800-314-2597.
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Mechanical Ventilation
A mechanical ventilator is a machine that forces oxygen into the lungs through a plastic tube inserted in the mouth, nose or a hole made in the trachea (windpipe). Ventilators are used when the lungs are too diseased to exchange oxygen and carbon dioxide well enough to meet the body’s needs. Ventilation is also used when breathing naturally becomes impossible due to injuries to the lungs or chest, weakened chest muscles, airway obstruction, or alcohol or narcotic overdose. Ventilation is also used during general anesthesia.
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Photodynamic Therapy
Photodynamic therapy uses ultraviolet light and a special chemical to kill cancer cells growing inside the airway.
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Pulmonary Angiogram
A pulmonary angiogram is a test performed in the radiology department to look for blood clots in the lungs. Similar to an angiogram performed during a cardiac catheterization, the test uses moving x-rays and contrast media injected into the bloodstream to reveal areas of the lungs where blood flow is normal.
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Pulmonary Function Testing
Pulmonary function tests are commonly performed to measure the lungs’ ability to take in oxygen, exchange it for carbon dioxide, and exhale the carbon dioxide as waste. Pulmonary function tests are ordered to better understand how well the lungs are working and, therefore, the severity of lung disease.
The basic pulmonary function tests are spirometry, lung volume measurement and diffusing capacity. Spirometry measures how much air a patient can breathe in and out in a maximum breath and how fast this can be done. Lung volume measurement shows how much air remains in the lung after exhaling. Diffusing capacity reveals the amount of lung tissue damage in diseases such as emphysema.
Muscle strength assessment is another pulmonary function test. It measures the strength of the muscles supporting the breathing apparatus. The test is primarily used to ascertain whether patients are strong enough to breathe on their own if taken off a ventilator.
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Pulmonary Thromboendarterectomy
Pulmonary thromboendarterectomy is a special surgical procedure designed to remove blood clots blocking circulation to the lungs and causing chronic pulmonary hypertension. Whenever possible, pulmonary thromboendarterectomy is performed instead of lung transplantation for this disease.
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Pulse Oxymetry
Pulse oxymetry is a noninvasive test that uses a small cap placed on the earlobe or finger to measure blood oxygen levels.
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Surgery
Many different types of operation treatments are performed on patients with lung diseases. These include:
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Diagnostic biopsy for interstitial lung disease
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Surgical remove of a lung or lobe for lung cancer
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Lung volume reduction surgery for emphysema
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Lung transplantation for emphysema, pulmonary hypertension or cystic fibrosis
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Pulmonary thromboendarterectomy to remove blood clots
Whenever possible, minimally invasive surgery is performed. After minimally invasive treatments, patients recover more quickly and need less pain medication.
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Thoracentesis
The removal of plural fluid for diagnostic or treatment purposes.
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Transtracheal Oxygen Therapy
A method of delivering oxygen directly into the trachea through a small catheter inserted into the neck. This allows the inconspicuous delivery of oxygen on an ongoing basis.
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To schedule an appointment with a lung specialist or allergist in the Department of Pulmonary, Allergy and Critical Care Medicine, please call 216/444-5501 or 866/320-4573 (toll-free) or request an appointment online.
