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Editorial

All Facts Considered...

Mehta, Atul C. MB, BS

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I vividly recall, it was 11 years ago in Rochester, Minnesota, Udaya Prakash and a few others sat down to lay the foundation for the American Association for Bronchology (AAB). Most of the evening was spent writing the mission statement, which finally read: “Association dedicated to promoting excellence in clinical care, education and research in the fields of bronchology and interventional pulmonology. The corner stone of the mission is to enhance multidisciplinary and international collaboration in quest to develop, evaluate and disseminate techniques and procedures that will benefit patients with lung cancer, tracheobronchial diseases, pleural processes and other thoracic disorders.” Obviously, this was similar to the mission of the World Association for Bronchology; in other words, based on the dreams of Dr. Shigeto Ikeda, “spreading the art and science of flexible bronchoscopy throughout the world.” It is the accomplishments of our organization since then that encourages me to accept the editorship of Journal of Bronchology.

Over the years, AAB has remained the role model for international bronchology organizations—European Association for Bronchology and Interventional Pulmonology, South American Bronchology Association (Asociacion Sudamericana De Bronchologia-ASB), Indian Association for Bronchology, Spanish Association of Respiratory Endoscopy (Asociacion Espanola De Endoscopia Respiratoria-AEER)—just to name a few. “Bronchoscopy” has become a common word throughout the globe. Collectively, several highly successful academic conferences and the hands-on courses have been carried out fulfilling the desires of the chest clinicians worldwide. With great efforts, the presence of our subspecialty has been established at the annual meetings of the American College of Chest Physicians, American Thoracic Society, as well as the European Respiratory Society. The number of abstracts related to the pulmonary interventions presented at these meetings is increasing steadily along with the peer-reviewed publications. In addition, consensus statements and guidelines in our subject have started emerging at the request of major national organizations. 1,2 A recent state-of-the art article in the New England Journal of Medicine by Seijo et al. stands as a testimonial to the fact that our work is drawing attention. 3

The past few years have also seen increasing indications for diagnostic as well as therapeutic bronchoscopy, keeping pace with highly desirable minimally invasive procedures. Most of our procedures have been brought out of the operating room improving the cost, comfort, and patient welfare. The need for mediastinoscopy and other surgical procedures for staging of lung cancer has also been reduced. 4 We have created better understanding among pulmonologists, thoracic surgeons, otolaryngologists, anesthesiologists, radiologists, oncologists, and others. Needless to say, our patients are the biggest beneficiaries of our collaborations.

Twenty-five years ago, when I began my pulmonary training, flexible bronchoscopy was merely a curiosity. Able hands of the first-generation bronchoscopists transformed the procedure into an art. Today it is a highly popular research tool for the scientists involved in the field of asthma pulmonary hypertension and pulmonary fibrosis. 5,6 Is it not true that early detection of lung cancer can come only through the hands of a bronchoscopist? 7 I have also rustled with the following question: What is responsible for slowly improving mortality among the patients with lung cancer? To my knowledge, there are no specific surgical, chemotherapy, or radiation programs claiming the credit. Is it not possible that the prompt diagnosis aided by bronchoscopy along with the life-saving interventions such as laser photoresection or an endobronchial stent placement are slowly making their impact? 8

Lung transplantation is yet another issue. Success of lung transplantation, as much as it relies on the immunosuppressive regimen, equally requires support from the bronchoscopy services. Diagnosis of rejection is impossible without the transbronchial biopsy, whereas the management of serious airway complications requires involvement of an experienced bronchoscopist. 9,10

Since the inception of the organization, our interest has grown beyond the field of bronchoscopy. Pleuroscopy, as well as percutaneous dilatational tracheostomy, is gaining popularity among the pulmonologists, and they constantly rely on us for further guidance.

In the era of cost containment, pulmonary interventions are relatively expensive, affordable mainly in the developed countries. Unfortunately, lung conditions are most prevalent in developing countries where resources are limited. Our group is sensitive to this issue as well. We have risen to the occasion by creating a philanthropic arm, the World Bronchology Foundation, to assist needy institutions throughout the world. Very recently, a bronchoscopy clinic was established in a remote village in Kenya with help from Indiana University and under the directorship of the current President of AAB, Dr. Praveen Mathur.

All facts considered . . . not too bad! In fact, we have accomplished a lot. I think we have kept up with our mission statement and we are on the right track.

Now, there is a question of recognition. Most of us, some more than others, seek “recognition” as the only hallmark to claim our success. Maybe it is my religious belief that encourages me to battle the issue in an optimistic manner—it is said in Bhagavat Gita, “Karmanay evadhi kars te, ma phalesu kadachan.”— you have a right to perform your prescribed duty, but you are not entitled to the fruits of action.11 I agree, such views might not be acceptable in their entirety to the modern-day academician yet, but I also believe that if we continue on our path, we are bound to be recognized.

Lastly, I would like to remind you that if we are following the dream of Dr. Ikeda, we should never forget his teaching: “Never give up.”12

REFERENCES

1. Bolliger CT, Mathur PN, Beamis JF, et al. ERS/ATS statement on interventional pulmonology. Eur Respir J. 2002; 19:356–373.
2. Ernst A, Silvestri G, Johnston D. Interventional pulmonary procedures: guidelines from the American College of Chest Physicians. Chest. 2003; 123:1693–1717.
3. Seijo LM, Sterman DH. Interventional pulmonology. N Engl J Med. 2001; 344:740–749.
4. Jain P, Arroliga A, Mehta AC. Cost-effectiveness of transbronchial needle aspiration in the staging of lung cancer. Chest. 1996; 110:24S.
5. Kavuru MS, Dweik RA, Thomassen MJ. Role of bronchoscopy in asthma research. Clin Chest Med. 1999; 1:153–190.
6. Tony-Eissa N, Erzurum SC. Flexible bronchoscopy in molecular biology. Clin Chest Med. 2001; 2:343–354.
7. Lam S, Kennedy T, Unger M, et al. Localization of bronchial intraepithelial neoplastic lesions by fluorescence bronchoscopy. Chest. 1998; 113:696–702.
8. Desai SJ, Mehta AC, VanderBrug Medendrop S, et al. Survival experience following Nd:YAG laser photoresection for primary bronchogenic carcinoma. Chest. 1988; 94:939–944.
9. Trulock EP. Flexible bronchoscopy in lung transplantation. Clin Chest Med. 1999; 1:77–88.
10. Chhajed PN, Malouf MA, Tamm M. Interventional bronchoscopy for the management of airway complications following lung transplantation. Chest. 2001; 120:1894–1895.
11. Bhagavad Gita, As It Is [translation by A. C. Bhaktivedanta Swami Prabhupada]. London: Collier Macmillan Publishers; 1974:47, 132.
12. Ikeda S. Never Give Up. Shinki Miyazaki, Japan: Dai Nippone Printing Co Ltd; 2000.
© 2004 Lippincott Williams & Wilkins, Inc.