Multidisciplinary team a unique resource for patients with obstructed airways

Larry Cochran, a 59-year-old resident of Oxford, Iowa, is one of hundreds of people living a more comfortable life because of a unique group of physician specialists at University of Iowa Hospitals and Clinics.

Cochran has significant tracheal stenosis as a result of trauma and needed over 100 surgical procedures under general anesthesia between 1985 and 1998 to remain alive. His condition forced him to retire from farming and truck driving.

After beginning treatment (and having a stent inserted to aid breathing) with a group of specialists called the Airway Team, Cochran has needed no additional surgical procedures under general anesthesia.

"The Airway Team still manages me actively," Cochran said. "At the beginning, I didn't care if I lived or died. I couldn't breathe. Now, after three years, I feel so much better ..."

Geoffrey McLennan, M.D., Ph.D., conceived the idea of a multidisciplinary Airway Team several years back--and airway treatment has never been the same.

Seeking to combine the knowledge of experts throughout UI Hospitals and Clinics, McLennan, a pulmonary specialist, organized an otherwise disconnected group of specialists. These specialists were linked by their remarkable ability to help people overcome problems associated with significant obstruction in the main airways.

"The Airway Team is unique and our patients are better for it," said McLennan.

Alan Ross, M.D., an anesthesiologist and a specialist in lung surgery, is a crucial part of McLennan's team. "These patients cannot delay treatment; they're borderline emergencies," he said. "The team comes together, often late at night; we put our heads and talents together, and go to work. Every patient we have treated has had a successful outcome. Over the past decade, we have treated several hundred patients with life-threatening airway tumors, calcified obstructions, and other severe blockages."

Procedures available to patients include balloon bronchoplasty, stent insertion, laser procedures, argon plasma coagulation (an electrical current is used to create a plasma beam that burns away airway obstructions), and cryotherapy (blood vessels and bits of tumors are frozen to stop bleeding).

Along with McLennan and Ross, the usual members of the Airway Team include:

• William Barnhart, a "gadget inventor" from the radiology department. Barnhart has 10 patents in various stages with the U.S. patent office, and developed a new kind of stent (a model used, in this case, to push the airway open) that can be customized on a patient-by-patient basis, to McLennan's specifications.
• J. Scott Ferguson, M.D., internal medicine specialist. Ferguson functions as one of the team's pulmonologists/proceduralists and is trained for rigid bronchoscopy, laser bronchoscopy, and stent placement.
• Scott Graham, M.D., otolaryngologist. Because the upper airway, voice box, and trachea are Graham's specialty, he shares areas of complimentary interest with McLennan.
• Eric Hoffman, Ph.D., a physiologist in the radiology department and biomedical engineering department. Hoffman uses advanced quantitative, volumetric imaging methods to study the lungs and airways.

Other team members include Kemp Kernstine, M.D., Ph.D., a thoracic surgeon; Jennifer Pohlman, Pat Rodgers, Lou Ann Vogel, and Kurt Wolf from respiratory care; and Janice Cook-Granroth from the Division of Physiologic Imaging.

From one procedure performed several years ago, the Airway Team has expanded its services to about 140 patients annually, McLennan said.

For more information, patients and families should call the UI Health Access number listed below and ask for McLennan. For consultation or referral, physicians should call UI Consult.

A complementary service for pediatric patients, the Pediatric Airway Team has been working with children for the past six years. The team is made up of pediatric otolaryngologists, pediatric pulmonologists, pediatric surgeons, and pediatric radiologists. Parents of children with airway problems can contact University of Iowa Children's Hospital at 1-888-573-5437 and ask for an appointment with either Richard Smith, M.D. (pediatric otolaryngology) or Miles Weinberger, M.D. (pediatric pulmonology). For consultation or referral, physicians should call UI Consult.

Larry Cochran is extremely grateful tot he Airway Team for helping him overcome obstructions in his windpipe.