Volume 11
Issue 01
January 2023
Inside This Issue
Editorial, 2-3
Technology Corner, 4-6
Tips from the Experts, 7-9
Humanitarian News, 10-13
Best Image Contest, 14
WABIP News, 15-16
Educaon, 17-22
Research, 23-24
Links, 25
Philippe ASTOUL, MD, PhD
WCBIP 2022 President
Hervé Dutau, MD
WBCE 2022 President
A Look Back at WCBIP/WCBE 2022 Marseille
WABIP Newsletter
J A N U A R Y 2 0 2 3 V O L U M E 1 1 , I S S U E 1
EXECUTIVE BOARD
Stefano Gasparini, MD
Italy, Chair
Pyng Lee, MD, PhD
Singapore, Vice-Chair
Hideo Saka, MD
Japan , Immediate Past-
Chair
David Fielding MD
Australia, Treasurer
Naofumi Shinagawa, MD
Japan,
Secretary General
Menaldi Rasmin, MD, PhD
Indonesia , President
WCBIP 2024
Rajesh Thomas, MD, PhD
Melbourne , President
WCBIP 2026
STAFF
Michael Mendoza
General Manager
Judy McConnell
Administrator
Kazuhiro Yasufuku
Newsleer Editor-in-chief
P A G E 2
Looking back at the program, events and parc-
ipants of WCBIP/WCBE 2022 in Marseille held
from October 6-9, we are very delighted and
proud to say that the congress was an out-
standing success. The magnicent Palais du
Pharo (built under Napoleon III XIXth century)
overlooking our 'Vieux Port' ('old Harbour') in
Marseille down town and its modern integrated
congress center was the seng for these two
and a half days of rich encounters and unfor-
geable exchanges.
Despite a dicult period marked by the COVID-
19 pandemic, a war next door, the economic
dicules of our daily lives and consequently
an uncertain future, less than 1% of the 766
acve parcipants (from 81 countries) used the
remote system (mainly by speakers). This
means two things: rst, a long desire to meet
up with colleagues aer a prolonged frustraon
of on-site meengs and second, the fact that
the intervenonal pulmonology community is a
true family with in mind the necessity of conn-
uous friendly collaboraons, ideally physical, for
sharing knowledge, for construcve cricisms,
i.e., a connuous medical educaon in this per-
petual fast-moving eld. The congress oered
high-caliber scienc sessions with emphasis on
new bronchoscopy and pleural techniques,
technologies and hands-on procedure work-
shops and it is hard to pick special moments
among the 44 sessions (including 10 plenary
sessions), 6 industry symposia and 6 workshops
allowing colleagues to have the opportunity to meet
experts in dedicated elds.
Parcipants could note a balance, a new fact, be-
tween bronchology and what we will call
pleurology(pleural techniques including medical tho-
racoscopy), the laer, undoubtedly too long in the
background, but which is an integral part of the inter-
venonal pulmonology and which broadens the im-
portance of pulmonologists in this eld. The sessions
in which our surgeon colleagues took part emphasized
this fact. In the same vein, the sessions dedicated to
the learning of the dierent techniques were parcu-
larly followed and the evoluon of a learning of the
techniques by companionship toward a teaching step
by stepwith rigorous evaluaon according to precise
criteria dened by groups of work for each stage of
acquision must become the standard in the near fu-
ture. For sure, collaboraons between the dierent
internaonal associaons are crucial to design a
unique educaonal program for young (but also more
skill) doctors involved in the intervenonal pulmonol-
ogy. The 'teachers' need also to be taught to design
and organize appropriate educaonal courses
throughout the world. In another word 'to teach the
teachers'.
The opening ceremony on Thursday night (Oct. 6) was
an early indicator of posivity and success. Aer the
president WCBIP 2022 welcome speech (your humble
servant), that of the president of the WCBE (my col-
laborator and friend HerDutau), of the presidents
of the WABIP (Hideo Saka) and IBES (Jan Kasperbau-
W A B I P N E W S L E T T E R
P A G E 3
During these two and half days of sharing many topics
and discussions were related to early diagnosis, preci-
sion staging, and intervenonal therapies in the eld
of thoracic cancers but also of chronic inammaon of
the airways (asthma, COPD) which will represent in the
future through the ELVR, the cryoablaon and other, a
complementary armamenterium for the management
of these diseases. The congress also covered other
technologies or elds in bronchology and pleurology
such as benign or malignant airway stenosis, cryobiop-
sy, thoracoscopy and other pleural procedures, trans
thoracic modalies and IP educaon. Briey to say that
WCBIP 2022 showed a full spectrum of intervenonal
pulmonology and we are very proud in Marseille to
have been the seng for this beauful specialty
through the WABIP, which we thank very warmly as
well as all colleagues for their trust, hoping to have
lived up to
it.
As presidents of the WCBIP/WBCE 2022, Philippe
Astoul and Hervé Dutau wish to our Indonesian Col-
leagues a great success for the next WCBIP 2024
which will be held in Bali (October 23rd – 25th, 2024).
Long live WABIP !
With our warmest regards,
Philippe ASTOUL, MD, PhD
WCBIP 2022 President
Hervé Dutau, MD
WBCE 2022 President
er), several colleagues were awarded tesfy-
ing to their commitment in the eld of inter-
venonal pulmonology but also to the vitality
of all parcipants of the WABIP recognizing
signicant contribuons to bronchology and
intervenonal pulmonology. This is how the
various prizes were awarded to Marn Philips,
Australia, (Gustav Killian Centenary Medal) for
career achievements and clinical pracces
which made a signicant impact on the art and
science of bronchology, Sepmiu Murgu, USA,
(WABIP Dumon Award) for contribuons to
enhancing othersskills in rigid bronchoscopy
and improving knowledge and understanding
of central airway obstrucon, Spasoje Popevic,
Serbia, (Disnguish WABIP Regent Award), for
signicant contribuons to the development
of WABIP acvies in Serbia and worldwide
during his term as Regent, and nally Teruomi
Miyazawa, Japan, (WABIP Lifeme Achieve-
ment Award), for outstanding achievements
and contribuons to the clinical pracce of
bronchology and intervenonal pulmonology
and who granted to the on-site audience a
very emoonal video message thanking all the
intervenonal pulmonology community for his
carrier. Young doctors were not forgoen with
the Heinrich Becker Young Invesgator
Awards for Research and Clinical Innovaon
given to Keisuke Kirita (Japan), Sandip Saha
(USA), Øyvind Ervik (Norway). A special men-
on to the team from Sarawak General Hospi-
tal (Malaysia) which won the WABIP Video
Fesval (best imaging, best innovaon, best
scienc) with a video entled Virtual Bron-
choscopy Navigaon (VBN) Guided Recanaliza-
on of Post Tuberculosis Right Main Bronchus
Chronic Total Occlusion (Author: Kho Sze-
Shyang – Watch video at
hps://youtu.be/95Fjk_weTIU)
W A B I P N E W S L E T T E R
P A G E 4
Technology Corner
Ulizaon of Illumisite
for Electromagnec Navigaon Bronchoscopy with
Digital Tomosynthesis and Connuous Tip Tracking
Introducon:
Electromagnec navigaon bronchoscopy (ENB) is a minimally invasive technology that guides bronchoscopes and biopsy tools to
pulmonary lesions. This technology has improved the ability to access peripheral lung lesions, but its historical diagnosc yield has
been subopmal. This limitaon was related to several factors, including the lack of integrated real-me imaging to account for CT-
to-body divergence and the lack of visualizaon of catheter posion during the biopsy phase of the procedure. The latest evoluon
of ENB combines digital uoroscopic tomosynthesis with connuous p tracking in the Illumisite
system (Medtronic, Plymouth,
Minnesota, USA) to overcome these barriers. Inial studies using this modality have been promising.
Background:
ENB uses a CT scan performed prior to the procedure to generate a virtual tracheobronchial tree so the proceduralist can create a
virtual pathway to the target lesion. CT-to-body divergence occurs when the virtual posion of the marked target on the CT scan,
which is performed at total lung capacity in an awake, spontaneously breathing person, and the actual posion of the lesion in the
paent under anesthesia dier, leading to a signicant challenge in obtaining a diagnosc specimen. Anesthesia protocols have been
developed to migate this phenomenon, but they cannot completely compensate for the CT-to-body divergence.
Digital uoroscopic tomosynthesis allows for correcon of CT-to-body divergence during the procedure. Aer automac registraon
is performed, navigaon to the target nodule occurs in standard fashion. Catheter manipulaon is performed manually allowing for
maximal precision, and speed is dependent upon the operator; it is not limited by a mechanical drive system as with other plaorms.
Once the catheter is within 2 cm of the target lesion, local registraon can be performed. This process ulizes a standard 12-inch 2-
dimensional C-arm uoroscope sweeping 50-degrees obliquely around the target lesion. With this newly acquired real-me data,
digital tomosynthesis is ulized to obtain a 3-dimensional reconstrucon of the area surrounding the target. The real-me locaon
of the lesion and catheter is idened, marked, and updated to allow for adjustments prior to radial ultrasound evaluaon and/or
biopsy (Figure 1).
An addional feature of the Illumisite
system is connuous real-me p tracking of the catheter. Prior ENB plaorms lose visuali-
Bryan S. Benn, MD, PhD
Pulmonary Department,
Respiratory Instute,
Cleveland Clinic, Cleveland, Ohio
Jonathan S. Kurman, MD, MBA
Division of Pulmonary and
Crical Care,
Medical College of Wisconsin,
Milwaukee, Wisconsin
W A B I P N E W S L E T T E R
P A G E 5
zaon of the target lesion and biopsy tool interacon when the locatable guide (LG) is removed from the extended working channel
(EWC). With the Illumisite
system, the cardinal direcons of movement are integrated into the EWC to allow for the ability to visu-
alize the interacon of the biopsy tool with the target lesion (Figure 2).
Clinical Applicaon:
How we do it
We perform our procedures under general anesthesia with neuromuscular blockade, fracon of inspired air (FiO
2
) between 40-60%,
dal volume of 6-8ml/kg ideal body weight and posive end expiratory pressure (PEEP) of at least 10cm H
2
O through an 8.5mm en-
dotracheal tube. PEEP of 15cm H
2
O is used for paents with severe obesity. Paents are also preoxygenated with 80% FiO
2
in order
to limit resorpon atelectasis. Aer navigang to within 2 cm of the target lesion, the bronchoscope is aached to a stabilizaon sys-
tem (Mediex, Islandia, NY, USA).
Once local registraon is launched, the adjustable pressure liming (APL) valve on the venlator is set to 15-20cm H
2
O (5cm greater
than the PEEP level) and the alveolar pressure is allowed to reach the same plateau value as seen by the venlator waveform. Manu-
al compression of the anesthesia machine bag is avoided. A 50-degree uoroscopic sweep is then performed during this breath hold
maneuver, with the acquired data then processed by the Illumisite
system. The sweep occurs over approximately 15 seconds.
Supporng Literature
Inial studies comparing the addion of digital tomosynthesis alone to tradional ENB (1) and the use of the Illumisite
system (2-4)
have shown promising results with minimal complicaon rates comparable to prior ENB studies. Introducon of uoroscopic digital
tomosynthesis to ENB improved diagnosc yield to 79% in 67 nodules compared to 54% in 101 nodules biopsied with ENB alone (1).
Diagnosc yield with the Illumisite
system ranges from 83-87% (2-4). Average reported corrected CT-to-body divergence was 12.2-
15.4mm when ulizing the Illumisite
system (1,3).
When assessing tradionally more challenging nodules that are smaller in size, dened as <2cm in diameter in all direcons, and radi-
ographic bronchus sign negave, results were also encouraging. In a prospecve, single center study, 75% (n=54/72) of lesions that
were <2cm in all dimensions were diagnosc, as were 79% (n=83/105) of bronchus sign negave lesions (4). A recent study compar-
ing the Illumisite
system with roboc bronchoscopy found comparable diagnosc yields of 80% and 77%, respecvely (5). The safe-
ty proles were also similar.
Conclusions:
Eorts to improve results of diagnosc bronchoscopy for peripheral lung lesions have led to signicant gains in the safety and accura-
cy of these procedures. Ulizing ENB with uoroscopic digital tomosynthesis to idenfy the locaon of the target lesion locaon in
real-me with connuous catheter p tracking through the Illumisite
system facilitates real-me biopsy tool-lesion interacon
feedback and overcomes CT-to-body divergence. Inial studies show improved diagnosc yields, including for smaller lung nodules
and those without a radiographic bronchus sign. Future studies evaluang the Illumisite
system in comparison to other diagnosc
bronchoscopy technologies and to TTNA will help inform which paents and which nodule characteriscs may benet from a specic
biopsy approach.
W A B I P N E W S L E T T E R
P A G E 6
References:
1. Aboudara M et al. Respirology. 2020;25(2):206-213
2. Avasarala SK et al. Respiraon. 2022;101(2):166-173
3. Dunn BK et al. J Bronchology Interv Pulmonol. [published online ahead of print, 2022 Mar 10]
4. Gmehlin CG et al. Respir Med. 2022;202:106941
5. Low SW et al. Chest. 2022;22:04032-6
Figure 1. A) Posion of the locatable guide (LG) aer navigang to the virtual target but before local registraon, which in-
volves real-me imaging using digital tomosynthesis. B) Posion of the LG aer local registraon. CT-to-body divergence re-
sulted in 1.4cm of discrepancy between the nodules preoperave and intraoperave locaon in this case. Catheter posion
can then be adjusted to account for this dierence. (Images courtesy of Medtronic.)
Figure 2. A) Preoperave CT chest demonstrang a sub-
cenmeter semisolid pleural-based nodule (white arrow)
directly behind a rib. B) The same nodule (white arrow)
is made uoroscopically visible by digital tomosynthesis
during the local registraon process, allowing the bron-
choscopist to account for CT-to-body divergence and
target the nodules real-me posion. C) Connuous p
tracking allows for visualizaon of the extended working
channels (EWC) exact posion even aer removing the
locatable guide (LG). D) Targeng mode allows for pre-
cise biopsy from dierent regions of the target lesion,
which can migate the impact of tumor heterogeneity.
The operator can also mark each biopsy posion virtual-
ly. (Images courtesy of Medtronic.)
Tips from the Experts
P A G E 7 V O L U M E 1 1 , I S S U E 1
Introducon:
The widespread availability and use of computed tomography (CT) have led to increased nodule detecon rate that prompted a need for
improved technology to aid in diagnosc procedures. In the modern era of diagnosc bronchoscopy, there has been an advent of innovave
plaorms, including electromagnec navigaon bronchoscopy (ENB) and roboc-assisted bronchoscopy (RAB). However, bronchoscopists
connue to have substanal challenges and have not achieved the diagnosc yield seen with a transthoracic approach [1]. One of the main
reasons for this shortcoming is the presence of CT-Body Divergence (CTBD). Combining arcial intelligence (AI) guided real-me imaging
such as C-arm Based tomosynthesis (CABT) with navigaon plaorms can potenally help improve diagnosc yield and accuracy.
Indicaons:
ENB and RAB have proprietary soware that uses a pre-procedure CT scan of the chest with a thin-slice protocol (1mm thickness) that is
obtained at full inspiraon (Total lung capacity - TLC) to build a virtual-navigaon pathway for intra-procedural guidance. CTBD results from
a physiological dierence in lung volume that shis airway anatomy and locaon of the lesion that may aect the intra-procedural accuracy.
During the procedure, paents are under posive pressure and not at TLC, whereas during the CT they were at TLC, with a breath hold, and
not under posive pressure. Furthermore, anatomical posional dierences with respect to the posioning of the arms (upright), chest wall,
which is expanded and lateralized at the me of imaging are dierent from the me of the procedure; the development of intra-procedural
atelectasis secondary to lower lung volumes, higher FiO2 during anesthesia, procedural me and bronchoscopic tool manipulaon of the
airway, may also contribute to the deviaon of the actual real-me pathway from the prior virtual pathway created. This variaon has been
studied with a pre-procedure CT performed at full inspiraon and expiraon in 46 paents (85 lesions) that detected an average moon of
17 mm in all lesions [2]. Similarly, another study that looked at planning CT and intra-procedure CBCT reported an average divergence of 14
mm [3]. This has been documented and noted across several peripheral navigaon plaorms (ENB and RAB) [4].
The role of real-me imaging (CABT) to conrm lesion locaon serves an essenal role in diagnosc procedures. For parenchymal lesions,
depending on the locaon of the lesion, CTBD can signicantly aect the relaonship in the posioning of the tool and lesion. CTBD is noted
to be highest in the lower lobes and although there are strategies that can be used to minimize CTBD and atelectasis (eg. adjusng venla-
tor sengs), knowing a real-me relaonship between tool and the target lesion adds signicant value intra-procedurally and may increase
the diagnosc yield when used in conjuncon with navigaon plaorms [3,4].
Planning:
For our procedures, we use the Monarch® system as the navigaon plaorm (Auris Health, CA) and Lung Vision (Body Vision Medical Ltd,
Israel) device for augmented uoroscopic imaging, which connects to our standard OEC Elite c-arm (GE).
Body Vision's proprietary technology, Lung Vision, ulizes CABT which allows for updated conrmaon of a lung nodule in real me based
on tomosynthesis registraon of the lesion. The system uses any standard C-arm to reconstruct a 3-dimensional intraprocedural image of
the target, thus overcoming CTBD. Addionally, the Body Vision plaorm provides uoroscopic visualizaon of pre-planned pathways and
visualizaon of tool to lesion relaonship, both of which can help ne-tune the bronchoscope's posion regardless of the navigaon
plaorm used. A pre-procedure CT scan is uploaded to the tablet, and the lesion pathway is marked. A CT scan is also uploaded to the Mon-
arch planning soware which performs the airway segmentaon and a virtual pathway is created to the lesion.
There are several ways to minimize CTBD. In our pracce, we employ a venlaon protocol of PEEP of 10, a dal volume of 6-8 ml /Kg pre-
C-Arm Based Tomosynthesis for real-me Augmented Fluoroscopy imaging during
Roboc Bronchoscopy
D. Kyle Hogarth, MD
Professor of Medicine
Co-Director, Lung Cancer Screening Program
Director, Bronchoscopy
Medical Director, Pulmonary Rehabilitaon
Program
University of Chicago
Nakul Ravikumar, MD
Fellow, Intervenonal Pulmonology
University of Chicago
Tips from the Experts
P A G E 8 V O L U M E 1 1 , I S S U E 1
dicted body weight, and a FiO2 of 0.4 or less as allowed by oxygen saturaon and hemodynamic stability. Once under general anesthesia, a 2-
step registraon is performed to integrate the pre-operave CT scan with the C-arm spin tomosynthesis. The rst step is registraon of the
main carina which is performed with a C-arm spin typically from -35 degrees to +35 degrees (LAO to RAO) aer which the C-arm is iso-
centered on the lesion and registraon of the lesion is performed with breath-hold with APL of 20cm. This process takes about 2-3 minutes.
Aer registering the lesion, the C-arm is pulled back, and an inspecon bronchoscopy is performed for airway surveillance to rule out central
airway lesions and to clear secreons. Aer the survey, the roboc bronchoscope is introduced to navigate to the lesion. The bronchoscope is
advanced ll about 2cm from the lesion (Figure 1A). The C-arm is then iso-centered back on the lesion and nal navigaon and posioning is
performed before sampling.
Sampling:
Aer the nal navigaon is performed to the updated target locaon, a radial EBUS is advanced to idenfy and conrm the lesion locaon,
proximity to the scope and to understand beer the relaonship with respect to the working channel to the best of the ability (Figure 1B). If
no radial EBUS imaging is obtained (Figure 1C), as is the case in a semisolid and ground glass nodule, sampling is performed based on the tar-
get locaon obtained by tomosynthesis (Figure 1D). A biopsy tool, either needle or forceps, is used for sampling. Once the bronchoscope and
tool are advanced to the lesion, another spin can be performed before the biopsy to visualize the tool-lesion relaonship to obtain real-me
feedback and conrm "tool in lesion". All biopsy specimens are then reviewed with the onsite pathologist to ensure adequate qualitave and
quantave sampling (Figure 1E). We terminate the procedure by slowly withdrawing the bronchoscope while ensuring that there is no
bleeding with 5-10 ml saline irrigaon.
Of note, we rounely use radial EBUS for our bronchoscopic procedures targeng lung nodules. Published data show increased yield in le-
sions that give a concentric view (84%) vs. eccentric view (48%) [5]. However, radial EBUS can give pseudo-assurance of posioning as it can
be aected by atelectasis or tool-related manipulaons that lead to microhemorrhages. At our instuon, we performed a retrospecve
study of 45 paents who had a diagnosc bronchoscopy that combined these technologies with an average lesion size of 16 mm. A radial
EBUS conrmaon was obtained in 73% of cases, and an immediate diagnosis was obtained in 38 of 45 cases (84%); 32 cases were malignant
and six were consistent with specic benign eology. The other 7 lesions demonstrated inammaon (n=4) or were non-diagnosc/atypical
(n=3). Of these 7, two had stable ndings at 1-year follow-up and one had a surgical wedge biopsy that was benign, leading to an overall diag-
nosc accuracy in 41/45 (91%) [6].
Quality control:
Real-me imaging is possible via radial EBUS and/or uoroscopy (Cone-beam CT and CABT) to provide addional insight at the me of the
procedure. While CABT represents a useful tool, the resoluon needs to improve further. With the added use of CABT, increased radiaon
exposure, uoroscopy me and procedure me is possible and studies evaluang these factors in CABT with RAB need to be performed. Cur-
rently, the radiaon dose from a Lung Vision procedure is 1/3
rd
that of Cone Beam CT. The diagnosc accuracy even with use of real me im-
aging is not a 100% and there is limitaon to the tool in lesionconcept and a bronchoscopist must use appropriate clinical judgement in
decision making in non-diagnosc cases.
Conclusion:
Given the current ability of newer plaorms to navigate further into the lung parenchyma, the use of augmented uoroscopy to obtain intra-
procedural imaging helps beer dene the tool-lesion relaonship and assist the bronchoscopist in maneuvering while increasing the yield
and accuracy in diagnosis of peripheral lung nodules, thus liming the need for addional procedures.
References:
1. Han et al. PLoS One. 2018 Jan; 22;13(1)
2. Chen et al. Chest. 2015 May; 147(5)
3. Pritche M. Journal of Thoracic oOncology. 2018 Oct; S403
4. Reisenauer J et al. Mayo Clin Proc Innov Qual Outcomes. 2022 Apr 23;6(3):177-185
5. Chen A et al. Ann Am Thorac Soc. 2014 May; 11(4):578-82
6. Hedstrom G et al. Chest. 2022 Vol 162 (4), A2082
Tips from the Experts
P A G E 9 V O L U M E 1 1 , I S S U E 1
Figure 1: A: Roboc bronchoscopy Navigaon, B: Radial EBUS advanced to the locaon of the nodule as determined on the CABT images
post registraon (Yellow spot marks the nodule), C: Radial EBUS advanced to the lesion but no ultrasonographic imaging of the nodule
obtained, D: Biopsy of the nodule with forceps, E: Rapid onsite evaluaon of the nodule biopsy showing non-small cell lung cancer with
nal path revealing poorly dierenated squamous cell lung cancer.
Humanitarian News
W A B I P N E W S L E T T E R P A G E 10
The Ethics of Migraon in the Times of Pandemic and War
Expressions like migraon crisis”, “migraon problemacor even migrants invasionhave lled the media in the last dec-
ade, brought the subject into our daily lives and made almost everyone coin a personal opinion based on dierent amounts
of data or informaon about it. But with no doubt, ethics scholars as well as general public had to rethink and mostly re-
frame their consideraons about this topic with the arrival of two unprecedented stormy events: the COVID-19 pandemic
and the massive refugee inux caused by the war in Ukraine.
We sadly have to admit that the internaonal state system aords freedom of movement and residency rights to individuals
in inverse proporon to the degree that they need them. Those with power and resources can in normalmes – easily
circulate between the worlds countries, while the impoverished and oppressed including those who count as refugees
under internaonal law – face severe, life-threatening obstacles to nding liveable condions. This situaon arises from a
system that gives states a rather discreonary power over who to admit onto their territory.
One deeply regreable feature of the polical world we inhabit is that, while everyone supposedly has a human right to seek
and to enjoy in other countries asylum from persecuon, in pracce many people seek asylum and do not nd it.
The discussion about rights and dues surrounding migraon and freedom to travel is not new. But the mobility restricons
deployed against COVID-19 forced many people otherwise unaected by border controls to confront the irritang queson
of who gets to move and why. The pandemic has call aenon to the many reasons, from care to subsistence and the intrin-
sic value of feeling unrestricted.
Many people that would have never imagined having any restricon of their freedom of moving had faced for their rst me
the weird disrupons and reconguraons that have occurred in our daily life since the emergence of COVID-19. Beyond the
medical consequences that implied wearing PPE, over demands to healthcare workers, social distancing, lockdowns, some
other social phenomena became central. Sgmasaon; data control, inaccurate informaon, exacerbaon of racism, vac-
cines distribuon, and polical use of this uncanny outbreak, took shape in responses and reconguraons in this new world
conguraon. In the specic realm of migraon, pandemic mes worsened the already dramac experience of migraon
adding considerable anxiety and fears about the future. The closure of borders, restricon of travel and suspension of most
internaonal ights has completely altered the environment through which migraon occurs and migrant lives can be estab-
lished and sustained. While most governments have permied the return of cizens and those with long-term residence
rights, the fate of irregular migrants, asylum seekers, refugees, and guest workers made the condions of survivability much
more dicult and unstable by new restricons. Addionally asylum seekers face another pause in the staggered and delayed
process of gaining legal recognion; refugees are considered bioethical risks and were subject to enhanced restraint proce-
dures; and guest workers lost their precarious informal jobs and any source of revenue but neither permied to travel to
countries where they lived.
At the same me, the public health crisis dramacally worsened pre-exisng trends towards more restricve and repressive
modes of enforcement, including a mass shutdown of borders ; a remarkable expansion in state surveillance and a spike in
xenophobia and racism; all at a me when the economic and polical circumstances are pushing millions across the globe
into poverty and uer vulnerability.
In facing the news about the dramac situaon of migrants, general public comfort themselves with the idea that this situa-
on is limited to those trying to enter illegally to some countries and that people in real danger of current persecuon get
their refugee status and may achieve a lawful freedom. With that perspecve, there is nothing unfairin restricng the in-
ux of the so-called illegal migrantswho cannot formally qualify as refugees. But during the last years, the global refugee
crisis has caused many relavely wealthy Western states to see a dramac upck in the number of people arriving on their
territory to claim asylum. While there is a general agreement that these states have some obligaon to refugees and asylum
seekers, which precise obligaons the states have is far from being established. It is not uncommon to hear that this obliga-
on is considered a duty to rescue refugees from the harms created by their home countries. But what the duty to rescue
refugees requires from relavely wealthy Western democracies for them to be able to say that has done its fair share is an
unanswered queson.
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W A B I P N E W S L E T T E R P A G E 11
Far from the ethical and legal discussion in internaonal fora or academic environments, in the real world the gures show
that , as relavely wealthy countries are very unlikely to accept all the refugees that claim for asylee, the best of the oered
soluons is to be rescuedin a refugee camp and wait for a legal permission to be relocated in other country, a permission
which may be conceded or not. When we talk about a refugee camp, we mean the temporary selements that are set up by
the UNHCR to receive those who have le their countries, eeing from persecuon, war, or other forms of conict. Their
goal is to aend to the immediate needs of refugees who are seeking help by providing security, food, water, and medical
care.
But the problem with refugee camps occurs when temporarycamps intended to help with immediate needs become long-
term selements. Refugees are given raons and a place to live but are usually not permied to work or move around with-
in the country. Refugee camps are oen places of insecurity and abuse, imposed idleness and reduced autonomy, and hold
very lile hope of seeing something beer in the next future. As pointed out for McDonald-Gibson, a refugee camp is emo-
onally too close to be in jail, pung your life on pause, receiving just enough food and water to survive, but with no chance
at all to provide for a family or plan for a future.
In the 21st century, only about 1% of refugees will be reseled in a given year, 2% will be able to return home, and the vast
majority will spend on average 17 years as a refugee either in a camp or informally in a city with lile access to internaonal
aid. The 10% of refugees who seek asylum directly in the West must risk their lives, overcome brutal restricon policies and
spend their whole life savings just to survive those perilous trips.
Given the condions in a refugee camp, it is understandable that many refugees reject them and increasingly choose to go
to cies, where they live informally (that is, without being formally registered with the UNHCR or the local government).
That behavior has some advantages as they maintain their freedom of movement, can live where they want and can come
and go freely. But they pay it with the huge disadvantage of not receiving assistance from the internaonal community in
terms of housing, food, health care or educaon when they are outside of refugee camps. As an example, fewer than 1 in 10
Syrian refugees in Turkey, Lebanon and Jordan receive any material support from the UN or its partners. Though help with
food, health care and educaon may not be adequate in camps, the virtual absence in urban centres can be devastang.
Even when many refugees are able to nd some work, it is oen well below what is needed to survive, forcing refugees to
ask for some help from their children adding some small income. This in turn results in insurmountable barriers to going to
school. According to Amnesty Internaonal most of Syrian refugee children in Turkey remain without access to primary edu-
caon.
Some authors argue that thinking about moral obligaons purely in terms of dues of rescue obscures the role that rescuing
states have played in creang and sustaining the condions of violence, insecurity and poverty in their countries of origin
and (directly or indirectly) have contributed to many of the harms that refugees experience as they seek refuge. The role of
the Western states (that are so proud of being the strongest democracies in the world) is not solely one of rescue, but of
creators and supporters of a system that helps few, harms some and makes it nearly impossible for most of them to access
the minimum condions for human dignity
If we accept the reality that many states are unlikely to accept as many refugees as they ought, though some refugees will be
admied, many with rm claims will be wrongfully rejected. Are some ways of wrongfully rejecng refugees less objecona-
ble than others? Is then morally jusable to give priority to refugees who ee from worse forms of discriminaon or perse-
cuon or any other kind of priorizaon”? If guided by the internaonal law rules, we should not be primarily concerned
about refugees arriving in recipient states that formally apply for asylum. If those cases the queson about priories should
become a queson about clearly dening the principles that determine who is granted the legal status of a refugee and who
should receive asylum and consequently all those lling the requirements, should be accepted. Which also means that if a
state grants someone the legal status of a refugee under internaonal convenons, then it would be illegal to deny the per-
son asylum based on any extra consideraons of priorizaon.
However, we have to face the uncomfortable queson about which real and varied factors impinge on the recepon of refu-
gees Or even more dramacally told: are some refugees more worthy than others?
Since 2011, more than six and a half million people—from Syria, Afghanistan, Venezuela, Eritrea, and other countries—have
sought asylum in Europe. Naonalists across the Connent have made anpathy toward such migrants a cornerstone of
their agendas. Refugees have even been called Muslim invaders.In Poland, in 2021 migrants and asylum seekers (most of
Humanitarian News
W A B I P N E W S L E T T E R P A G E 12
them from Iraq and Afghanistan, trapped on Belarus's borders with Poland and Lithuania) tried to cross its border with Bela-
rus and were brutally pushed back by security forces with water cannons and tear gas. However, we can see that aer the
conict in Ukraine most of the European Union polical leaders have said publicly that refugees from Ukraine are welcome
and countries have been preparing to receive refugees on their borders with teams of volunteers handing out food, water,
clothing, and medicines. Slovakia[and Poland have said that refugees eeing the war in Ukraine will be allowed to enter their
countries even without passports, or other valid travel documents; other EU countries, such as Ireland, have announced the
immediate liing of visa requirements for people coming from Ukraine. Even free public transport and phone communica-
on is being provided for Ukrainian refugees. Legal reforms are being prompted that may allow refugees from Ukraine be
oered up to three years temporary protecon in EU countries, without having to apply for asylum, conceding rights to a
residence, permit and access to educaon, housing, and the labour market
Of course, facing such a huge crisis as this war is, that generous collaboraon is welcome and perfectly understandable. The
horric situaons created by the Russian invasion to Ukraine turned thousands and thousands of people into refugees from
one week to the other, triggering one of the largest and fastest refugee movements that Europe has witnessed since the end
of World War and the one of the largest humanitarian crisis that Europe has seen. But we should remember that it was not
so long ago that the connent faced another crical humanitarian challenge, the 2015 refugee "crisis" spurred by the conict
in Syria.
The current refugees eeing from Ukraine made their way to the borders of Poland, Slovakia, Romania, and Hungary. But
unlike many others who, over the past decade, have sought to escape conict and oppression by eeing to European coun-
tries, they were welcomed inside. We have heard (and found it natural?) some reporters covering the war saying These are
not refugees from Syria. . . . These are Chrisans, they are white, theyre very similar to the people that live in Poland.Or
referring to Kyiv, With all due respect, these people do not come from Iraq or Afghanistan or Syria, they come from a rela-
vely civilized, relavely European city.We have also witnessed that the non-European refugees from Ukraine (thousands
of Africans living in Ukraine, mainly students), struggled to enter Poland and other countries as refugees being violently
stopped by the Ukraine authories at the border or unwelcome in any of the receiving countries.
This current scenario obliges all of us as mankind to reect on the uerly dierent responses the Western world has had at
these two situaons of humanitarian crisis”. It should provide a cauonary lesson for those hoping for a more humane, gen-
erous Western democracies. This is indeed how the internaonal refugee protecon regime should work, especially in mes
of crisis: countries keep their borders open to those escaping wars and conict; temporary eliminaon of unnecessary iden-
ty and security checks; permission to arrive without valid identy and travel documents; and of course, no detenon
measures or impediment to freely join family members in other countries. Communies and their leaders should always
welcome refugees with generosity and solidarity.
Bes and Collier argue that providing refuge is about fullling our duty of rescue’. According to them, the duty of rescuing
refugees is born out of a common humanity that we share with other human beings. It creates moral obligaon to assist
strangers who are in desperate need when we can do so at no signicant cost to ourselves, so, the well-known principle of
the Good Samaritan. An the parable of the Good Samaritan points out that there is no connecon between the rescuer, the
Samaritan, and the person in need of help; the Good Samaritan simply helps out of human decency, not because they were
responsible for harming the person lying by the side of the road.
On the one hand, we are urged to confront the uncomfortable electoral reality of widespread public hoslity towards great-
er immigraon, and the increasing acceptance of the immense suering caused by real-world border enforcement pracces
and the undisputable racism that lays under those public opinions”. It implies that how ambious the migraon and asylum
law reforms should be in order to fulll the moral call will be a maer of vigorous dispute at a me when fundamental as-
sumpons about movement and membership are in queson.
However, it should be considered that the world today is parcelled up between sovereign states whose legimacy derives
from their role in protecng the human rights of those individuals within their territory. Owen argues that the mere exist-
ence of refugees is always evidence that some states are failing in their role, requiring internaonal society to oer subs-
tute protecon. In his words, the instuon of refugeehood acts as a legimacy repair mechanismthat rearms the mini-
mal condions of the imagined reconciliaon of an internaonal order of sovereign states and a cosmopolitan order of hu-
man rights’. It means that the protecon of refugees not only answers to the morally urgent need of the worlds most vul-
Humanitarian News
W A B I P N E W S L E T T E R P A G E 13
nerable groups; it funcons as a global public goodfrom which all states benet in terms of their legimacy.
The Ukraine refugee crisis presents the Western countries with not only an important opportunity to demonstrate their gen-
erosity, humanitarian values, and commitment to the global refugee protecon regime; it is also a crical moment of reec-
on: it is the moment to analyse if the peoples all over the world may be able to overcome their widespread racism and ani-
mosity and make the universalist spirit of the 1951 Refugee Convenon something more that worthless pages. In fact, the
Arcle 3 of the Convenon is quite explicit when saying that all member states "shall apply the provisions of this Convenon
to refugees without discriminaon as to race, religion or country of origin." We have to face the atmosphere of the moment
and respond ourselves truthfully if all the internaonal organisaons, internaonal convenons and laws, really rule our
global connivance or are just decorave disrespected documents to be ridiculed or manipulated by the social actors holding
the real power.
Many humanitarians doubt that the current change in mood toward refugees escaping Ukraine will aect the migrants risk-
ing their lives on the Mediterranean. It may be too late to undo the damage of strong xenophobic polics. But the triumph of
exclusionary naonalism is by no means inevitable. The COVID-19 has provided undeniable evidence of humanitys shared
vulnerability and interdependence. We should have learnt that the enre world is our neighbourhood and that nobody can
get security and salvaon by his or her own. The hope is that seeing so clearly the double standards applied to migrant and
asylum seekers and having understood our interdependence just as members of the human race, we will be able to
acknowledge that the current status quo is deeply unfair and revisit some fundamental principles regarding border controls.
References:
1. Beitz C. 2011. The Idea of Human Rights. New York: Oxford University Press.
2. Bes A et al. 2017. Refuge: Rethinking Refugee Policy in a Changing World. Oxford: Oxford UP
3. Aitchison G. Ethics & Global Polics. 2021: 14:1
4. Cherem MG . Ethics & Global Polics, 2020:13:1, 33-49, DOI: 10.1080/16544951.2020.1735018
5. May L. 2011. Global Jusce and Due Process. Cambridge: Cambridge University Press.
6. Owen D. Moral Philosophy and Polics 3. 2016: (2): 141164
7. Parekh P. Ethics & Global Polics. 2020: 13:1, 21-32
*The views expressed in this arcle are those of the author (Silvia Quadrelli) and do not necessarily reect the ocial posi-
ons of the Execuve Board or Internaonal Board of Regents of the WABIP.
Best Image Contest 2023 (1 of 3)
Descripon:
Endobronchial Rhinosporidiosis
A. Tracheal mucosal inltraon with strawberry like growth
B. Complete occlusion of right main bronchus due to endobronchial growth
C. Endoluminal growths in bilateral main bronchi
D. Histopathological image Mature spoprangia with thick chinous wall containing mulple endospores
Submiers:
Pree Vidyasagar, Harikishan Gonuguntla
Best Image Contest
P A G E 14
This image is 1 of 3 selected among 100+ submissions to our Best Image Contest held in late 2022. Our next
Image Contest will open later this year. We look forward to receiving your image submissions.
P A G E 15
WABIP News
Intervenonal Pulmonology Instute of the WABIP in Turkey is Coming Soon
The rst Intervenonal Pulmonology Instute (IPI) of the
World Associaon for Bronchology and Intervenonal Pul-
monology (WABIP) will inaugurate in May 2023 at the LIV
hospital, Istanbul. The innovave idea of teaching and
training in Intervenonal Pulmonology to doctors from
around the globe was created and movated by Prof. Ali I.
Musani. His novel concept is poised to gather internaonal
fellows and the WABIP faculty to the rst IPI at the Liv
Hospital.
We look forward to launching the Instute on February
25th, 2023, with an Advanced Bronchoscopy Confer-
ence.The Inaugural meeng will oer a comprehensive program on advanced diagnosc and therapeuc bron-
choscopy. The president of the WABIP, Stefano Gasparini; head of Instutes Ali Musani; and other disnguished
internaonal and local faculty will visit the Liv Hospital and discuss nal plans with the leadership of the Liv hospi-
tal. Aer this meeng, WABIP and Liv Hospital will ocially sign the contract that will connect the worlds largest
internaonal organizaon of intervenonal pulmonologists and a private hospital system to democraze
knowledge, healthcare, and science for all the worlds.
The fellowship program of instute will accept its rst fellow in the summer of 2023. The curriculum and fellowship
selecon commiee chairs, Lorenzo Corbea (Italy) and Javier Flandes (Spain) are working hard at nalizing the
tasks assigned to their commiees. Fellowship applicants can send their inquiries to Dr. Dalar at Levent-
dalar@gmail.com and Dr. Flandes at jandes@quironsalud.es
We look forward to a new beginning in Intervenonal Pulmonology on the Global Horizon.
Levent Dalar MD.
Site Director IPI, LIV Hospital, Istanbul.
WABIP Vising Scholar Travel Grant Connues
I am very proud and happy to be a recipient of the WABIP
Vising Scholar Travel Grant, being awarded this honor
back in 2019. Prof. Venerino Pole from Italy had caught
my aenon as I was reading his papers and book on
Transbronchial Cryobiopsy, Intersal Lung Diseases and
other intervenonal procedures. I was very gracious to
have the professor and his colleagues accept me as a train-
ee, but then the pandemic hit, and it forced me to delay
my training.
Finally in 2022 when the severity of the pandemic had
greatly decreased, it was nally my opportunity to revisit
the WABIP travel grant awarded to me years earlier. I con-
tacted Professor Pole again, and started to make ar-
rangements for my training.
Dr. Sangit Kasaju (trainee), Prof. Venerino Pole, Prof. Claudia
Revaglia
P A G E 16
WABIP News
I have arrived GB Morgagni Hospital, Forli, Italy in rst week of December 2022. I was amazed by their bronchoscopy
suits ( Endoscopia toracica). I have able to meet other faculty members, residents, nurses and whole team. I have found
out that Professor Venerino Pole is very famous clinician here and this hospital is referral center in Bologna region.
They have been so kind and extremely helpful. I am also amazed to see volumes and variees of cases they handle. On
my rst day I have able to seen and have assisted Cryobiopsy, EBUS, Transesophageal bronchial biopsy; Bronchial lavage,
Rigid and Flexible bronchoscopy. I have seen total le side lung lavage for pulmonary alveolar proteinosis, which is rare
lung diseases and this procedure is only done in this hospital in this region according to doctors here. I have been im-
pressed also with their ecient and dynamic team here and they have been making complex procedures so simple.
This did inspire me a lot. I able to do even exible bronchoscopy and bronchial lavage on my own on my second day,
guided by them. I have also aended mul disciplinary grand rounds together with whole facules, pathologists , radiol-
ogists. They presented cases even in english just for me although they used to do in Italian language usually. I am seeing
very interesng cases scheduled for coming weeks for procedures. These cases excite me a lot. and even Im wishing if i
can extend for longer duraon so I can learn at depth.
I would like to thank WABIP for granng me this grant, Prof Henri Colt past Chair of WABIP for vising NCCP, interna-
onal congress in Nepal and encouraging me to establish NABIP aliated with WABIP and Professor Venerino Pole,
Professor Claudia Revaglia and whole team for making my stay wonderful learning experience. I hope I can reciprocate
knowledge I gained here to my colleagues in Nepal and I do believe my fellow countrymen will surely benet from this.
Thank you!
Sangit Kasaju, M.D. (Nepal)
WABIP Vising Scholar Awardee
P A G E 17
Education
First WABIP/Chile Intervenonal Bronchoscopy Workshop
On December 5th and 6th, the very rst WABIP acvity in Chile was held. This was the 3rd aempt to organize a WABIP/Chile
event that was repeatedly delayed because of the epidemiological condions. Happily, nally pandemia has given us a break
to gather our colleagues who were eagerly expecng this educaonal event at the Centro Cultural El Tranque, one of the most
selected facules in Lan America and Europe. That Centre is a modern, fully equipped and with a permanente sta trained to
support and provide the best logisng for surgical and endoscopical procedures simulaon.
With the great support of Clínica Meds and the new Chilean IB center, we did a theorecal / hands-on course focused in ad-
vanced techniques, that included: EBUS, rigid bronchoscopy, laser ablaon, metallic and silicone stenng and cryobiopsy. In
this last technique, we had the honor to receiving the invaluable presence of one of the most important gures in this eld,
Dr. Sara Tomasse from Florence, Italy. An outstanding teacher who shared her experse with paence, sophiscated educa-
onal skills and incredible kindness.
Sara Tomasse sharing her experse
As an organizer Im very thankful of the kind and uncondional parcipaon of our internaonal professors:
Dr. Artemio García (Argenna)
Dr. Fernando Monge (Perú)
And the none less important support of our great local Chilean faculty:
Dra. Macarena Rodríguez
Dr. Arturo Morales
Dr. Felipe Undurraga
Dr. Alfredo Jalilie
P A G E 18
Education
Some of the regional instructors of the WABIP workshop in Chile
Artemio García, a regular reless instructors in so many WABIP hands-on sessions.
The event was very successful and all our aendees (mainly bronchoscopists with an intermediate level of previous train-
ing) found the experience not only very useful but also incredibly inspiring to increase their own interest in bronchoscopy
and in training other colleagues themselves. I hope that this was the rst of many future events of cooperaon between the
Chillean bronchoscopists and our worldwide Associaon . We pledge to acvely work to help WABIP to grow and get
stronger to be able to give this same opportunity to many of our colleagues all around the world.
P A G E 19
Education
Several staons fully working in the hands-on pracce of dierent techniques.
We nally render thanks to WABIP and its Execuve Board for the unlimited support they permanently show for the bron-
choscopy educaon. The reless work of the WABIP leadership made this possible in spite of the incredible obstacles
posted by the pandemic.
Dr. David Lazo P.
Director First WABIP/Chile Intervenonal Bronchoscopy Workshop.
Chile Regent
P A G E 20
Education
WORKSHOP WABIP IN ECUADOR
Celebrang the return of the onsite acvies, WABIP has re-started its tradional training programs.
Dr. Rocío de Janon, Regent of the Ecuadorian Society of Tisiology and Thorax Diseases, organized and chaired a
wonderful workshop with very acve hands-on sessions. The event occurred on November 17-18, 2020 in one of
the largest hospitals in the country, Hospital de Especialidades Teodoro Maldonado Carbo in Guayaquil city,
where Dr. De Janon (as a Chair of Respiratory Medicine) and her group have developed a compelling bronchosco-
py unit.
The organizing team with the instructors
This II Bronchoscopy course-workshop, sponsored by WABIP and the Ecuadorian Society of Tisiology and Thorax
Diseases had the parcipaon of 30 specialists in respiratory medicine who are already working in bronchosco-
py and who have a basic or intermediate level of previous bronchology training.
WABIP gathered for this very meaningful educaonal event some of its most experienced instructors: Dr. Fabien
Maldonado (USA), Artemio García (Argenna), Marco Solís (Bolivia) and Silvia Quadrelli (Argenna).
Aer the didacc lectures in the morning, aendants worked at dierent staons, including exible bronchosco-
py, cryobiopsy, rigid bronchoscopy, EBUS and convenonal TBNA .
Every single parcipant had the opportunity to pracce each technique in the dierent inanimate models under
the meculous guidance of the instructors.
A great experience, beaufully organized by Dr. De Janon's team and highly valued by all parcipants, which al-
lowed everyone to get in contact with the WABIP experts during 2 full days, in a warm ambiance of comradeship,
curiosity and enthusiasm.
WABIP thanks the enormous eort made by the organizing team and the invaluable contribuons of its instruc-
tors, who selessly help the Associaon to disseminate bronchoscopy training throughout the world in order to
create safer, more reliable and fully comfortable procedures for every paent in every country.
P A G E 21
Education
Dr. Fabien Maldonado teaching rigid bronchoscopy
Dr Artemio García working at the EBUS staon
Marco Solís Dr training in cryobiopsy
P A G E 22
Education
Workshop of Advanced Diagnosc and Therapeuc Bronchoscopy in High Fidelity
Cadaveric Models in Uruguay
On November 29th WABIP co-sponsored, with the Uruguayan Society of Pneumology, the rst bronchoscopy workshop
with high delity cadaveric models in Uruguay.
The acvity occurred in Maciel Hospital, one of the oldest naonal statal school hospitals in Montevideo, with the par-
cipaon of presgious internaonal professors: Dr. Juergen Hetzel from Germany and Dr. Artemio Garcia from Argen-
na.
Almost 30 pulmonologists and thoracic surgeons with basic bronchoscopy skills parcipated in enhancing their training
to create safer, more reliable, and fully comfortable bronchoscopic procedures.
Special thanks to the enormous eort made by the organizing team and the invaluable contribuons of its local instruc-
tors (Dr. Nicolas Arechavaleta, Dr. Eduardo Quintana, Dra. Ana Gruss from The Pneumology Department at the Faculty
of Medicine and Dr. Wiliam Bapsta, Dr. Manuel Da Fonte and Dr. Florencia Picaroni from The Clinical Simulaon Unit
of the Uruguayan Society of Anesthesiology), who selessly helped to disseminate bronchoscopy training.
The List of Bronchoscopic Therapies Goes On!
Bronchoscopic Treatment of Chronic Bronchis - Bronchial Rheoplasty!
Chronic Bronchis is a chronic, progressive disease with debilitang symptoms. Medical management of this disease is oen unsuccessful. Several
innovave bronchoscopic treatments focused on the ablaon and destrucon of hypertrophied submucosal glands and hyperplasc goblet cells
are being tested in animal and human models. Some therapeuc modalies include liquid nitrogen metered cryospray and Bronchial Rheoplasty
(BR). Another modality with a slightly dierent mode of acon being tested is targeted lung denervaon (TLD), which aims to decrease the release
of acetylcholine, which regulates smooth muscle tone and mucus producon by ablang the parasympathec nerves along the main bronchi.
These modalies are at dierent stages of clinical trials and promise decreased exacerbaon frequency, reduced chronic bronchis symptoms, and
improved quality of life.
Bronchial Rheoplasty uses an endobronchial catheter deployed through the working channel of a exible bronchoscope to apply nonthermal
pulsed electrical elds to the airways. Each lung is treated at a dierent me, approximately one month apart.
Recently, a study published in the American Journal of Respiratory and Crical Care Medicine (1) established the safety and ecacy of Rheoplasty
in paents with severe chronic bronchis. In this study, two prospecve, mulcenter, single-arm clinical studies under two nearly idencal proto-
cols recruited paents at ve terary academic centers in Austria, Australia, and Chile.
Bronchial Rheoplasty was performed in all 30 paents, with a mean age of 67; mean postbronchodilator FEV of 65%; mean COPD Assessment Test
score of 25.6; mean SGRQ score of 59.6. There were no device-related and four procedure-related serious adverse events through 6 months, and
none aer that through 12 months. The most frequent nonserious, device- and/or procedure-related event through 6 months was mild hemoptysis
in 47% (14 of 30) paents.
Histologically, the mean goblet cell hyperplasia score was reduced by a stascally signicant amount (P < 0.001). Signicant changes from baseline
to 6 months in COPD Assessment Test (mean, −7.9; median, −8.0; P = 0.0002) and SGRQ (mean, −14.6; median, −7.2; P = 0.0002) scores were ob-
served, with similar observaons through 12 months. The histological ndings, as shown in g 1 (1), show a signicant reducon in the number of
epithelial goblet cells, parcularly in those paents with pretreatment evidence of moderate-to-severe goblet cell hyperplasia.
Editor-in-Chief: Dr. Kazuhiro Yasufuku
Research
Primary Business Address:
Kazuhiro Yasufuku, Editor-in-Chief WABIP
Newsleer
c/o Judy McConnell
200 Elizabeth St, 9N-957
Toronto, ON M5G 2C4 Canada
E-mail: newsleer@wabip.com
P A G E 23
Associate editor:
Dr. Ali Musani
Associate editor:
Dr. Sepmiu Murgu
Ali I. Musani MD, FCCP
University of Colorado School of Medicine,
Denver
This study provides proof of concept and the rst clinical evidence of the feasibility, safety, and inial outcomes of BR in symptomac pa-
ents with chronic bronchis. This study has limitaons, including a small sample size and a lack of a control group. Therefore, large, ran-
domized, and prospecve studies are required despite clinical and histologic evidence supporng improvements.
Reference:
1. Valipour A et al.; J. Am J Respir Crit Care Med. 2020 Sep 1;202(5):681-689. doi: 10.1164/rccm.201908-1546OC. PMID: 32407638; PMCID: PMC7462406.
Research
P A G E 24
Figure 1. Histological ndings from the right bronchus intermedius of a study paent.
The goblet cells, with magenta-colored cytoplasmic mucin highlighted by periodic
acid–Schi staining, are seen in the supercial bronchial epithelium. (A) On
Day 0, immediately before therapy, signicant goblet cell hyperplasia can be
seen (score of 2). (B) Right bronchus intermedius 120 days aer the
inial treatment, demonstrang complete regeneraon of the pseudostraed
columnar epithelium with a reducon of goblet cell numbers (semiquantave
assessment score of 1).
*This gure was used with permission from the American Thoracic Society .
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25
WABIP ACADEMY- WEBCASTS
The WABIP has started a new educaon project recently: THE WABIP ACADEMY. The WABIP Academy will pro-
vide free online webcasts with new and hot topics that will interest pulmonologists and intervenonalists.
Current webcast topic: Tissue acquision for biomarker directed therapy of NSCLC
You can reach these webcasts by using this link: hp://www.wabipacademy.com/webcast/
www.bronchology.com Home of the Journal of Bronchology
www.bronchoscopy.org Internaonal educaonal website for
bronchoscopy training with u-tube and
facebook interfaces, numerous teachiing
videos, and step by step tesng and assess
ment tools
www.aabronchology.org American Associaon for Bronchology and I
ntervenonal Pulmonology (AABIP)
www.eabip.org European Associaon for Bronchology and
Intervenonal Pulmonology
W A B I P N E W S L E T T E R
Links
www.chestnet.org Intervenonal Chest/Diagnosc Procedures (IC/DP)
NetWork
www.thoracic.org American Thoracic Society
www.ctsnet.org The leading online resource of educaonal and
scienc research informaon for cardiothoracic
surgeons.
www.jrs.or.jp The Japanese Respirology Society
sites.google.com/site/asendoscopiarespiratoria/
Asociación Sudamericana de Endoscopía Respiratoria
P A G E 25