Section of Interventional Pulmonology and Pulmonary Oncology

Faculty

Jason Akulian, MD MPH

Associate Professor of Medicine
Section Chief, Interventional Pulmonology and Pulmonary Oncology

Academic Office: 919-966-2531

Admin Assistant: 919-966-0440

Email: jason_akulian@med.unc.edu
Allen Cole Burks, MD

Assistant Professor of Medicine

Appointments: 984-974-8641

Office: 919-966-2531

Email: acoleburks@med.unc.edu

Fellow 2022 – 2023

Maxwell Diddams, MD

Interventional Pulmonary Fellow

Email: maxwell.diddams@unchealth.unc.edu

UNC Multidisciplinary Thoracic Oncology Program (MTOP) Clinic

MTOP Clinic location: 2nd Floor, North Carolina Cancer Hospital, 101 Manning Drive, Chapel Hill, NC 27514
For New Patient Appointments, call Vickie Dowdy, Intake Coordinator at 984-974-8641; fax 984-974-8616
For Return Clinic Appointments and Radiology Test Scheduling, call 984-974-8780

Patient Questions and Instructions

For Medical or Device (PleurX) related questions, call Tammy Allred, Nurse Coordinator (984-974-8470) during business hours.
For Clinic or Procedure instructions/questions, call Ashley Ray, Administrative Assistant (919-966-0440) during business hours.
After Hours Call hospital operator (984-974-4100) ask for the interventional pulmonology fellow on call.

Referring physicians: Please e-mail Dr. Akulian, Dr. MacRosty, and/or Dr. Burks and we will expedite your patients’ appointment

Our goal is to provide expeditious care to patients with malignant and benign diseases of the airways, lung tissue, and pleura in a multidisciplinary fashion with outstanding communication to both the patient and the referring physicians.

Patients with lung nodules/masses and hilar/mediastinal lymphadenopathy are evaluated and treated in a multidisciplinary approach with members from Interventional Pulmonology (IP), Medical Oncology, Thoracic Surgery, and Radiation Oncology in the weekly UNC Multidisciplinary Thoracic Oncology Program (MTOP) clinics and conference.

We are part of a larger complex airway team that involves Interventional Pulmonology (IP), Otolaryngology (ENT/Head and Neck surgery), Thoracic Surgery, and Anesthesiology. This team serves patients with complex upper and lower airway obstructions and patients requiring tracheostomy for respiratory failure or cancer.

Services Provided

Therapeutic Bronchoscopy

We provide relief of dyspnea (difficulty breathing) from cancerous and non-cancerous causes using rigid and flexible bronchoscopy techniques and state of the art equipment including:

Ablation Techniques:
Argon Plasma Coagulation (APC)
Laser Ablation
Microdebrider
Mechanical Debulking
Electrocautery
Cryotherapy
Photodynamic Therapy (PDT)
Endobronchial Brachytherapy
Stenting – Silicone, Metallic, and Hybrid/Covered Metallic
Montgomery T-tube Placement
Balloon Bronchoplasty
Percutaneous Tracheostomy
Bronchoscopic Lung Volume Reduction (BLVR) – Valves for COPD Treatment

Advanced Diagnostic Bronchoscopy

We diagnose, stage, and provide samples for therapeutic and prognostic testing, and place fiducial markers for Stereotactic Body Radiation Therapy (SBRT/Cyberknife) all within the same procedure and anesthesia session. We accomplish this with the most up to date and state of the art equipment.

Electromagnetic Navigation Bronchoscopy (EMB)
Linear and Radial Endobronchial Ultrasound (EBUS)
Autofluorescence and Narrow-Band Imaging
Robotic Bronchoscopy

Carolina Center for Pleural Disease Treatment and Research

We also provide consultation and treatment of benign and malignant pleural disease such as mesothelioma, metastatic cancer, connective tissue diseases, bronchopleural fistula/persistent air leak and both acute and chronic infection in concert with Medical Oncology, Thoracic Surgery and Interventional Radiology. We perform all pleural procedures under image guidance (ultrasound or CT) including:

Ultrasound-Guided Thoracentesis
Ultrasound-Guided Pleural and Lymph Node Biopsy
Ultrasound-guided Small Bore Chest Tube/Pigtail Catheter Placement
Pleural Manometry
Tunneled Pleural Catheter (PleurRx®) Placement
Chemical Pleurodesis/Pleural Sealing
Medical Thoracoscopy

Diseases Evaluated and Treated

Lung Nodules and Masses
Lung Cancer
Central Airway Obstruction
- Malignant/Cancerous
- Non-Malignant/Non-Cancerous
  - Sarcoidosis
  - ANCA associated Vasculitides
  - Post-Intubation Tracheal Stenosis
  - Subglottic Stenosis
  - Foreign Bodies
  - Tracheobronchomalacia
  - Relapsing Polychondritis
  - Respiratory Papillomatosis
  - Pulmonary Alveoloar Proteinosis
  - Post-Transplant Stenosis
  - Post-Infectious Stenosis
Pleural Effusions
- Transudative
  - Heart Failure
  - Hepatic Hydrothorax/Cirrhosis
  - Renal Failure
- Exudative
  - Malignant
  - Mesothelioma
  - Infectious/Empyema
  - Tuberculous
  - Connective Tissue Disorders
  - Others
Pneumothorax
- Traumatic
- Broncho-Pleural fistula
- Alveolar-Pleural fistula
- Primary
- Secondary to Lung Disease
End Stage Severe COPD/Emphysema

Areas of Research

We are constantly striving to improve our ability to provide the most accurate diagnostic and therapeutic information in the least invasive way possible. Through an active clinical research endeavor, we are developing, evaluating, and defining minimally invasive devices, techniques, and therapies for the diagnosis and treatment of malignant and benign airway, lung, and pleural diseases.

Device Development and Evaluation
Lung Nodule Localization, Diagnosis, and Marking
Therapeutics
- Intrapleural Cancer Therapies
- Endobronchial Medication Delivery and Ablation
- Peripheral Medication Delivery and Nodule Ablation
- Pathophysiology and Treatment of Immune-Therapy Related Lung Toxicities
Mechanisms of Pleural Disease, Metastasis, and Therapeutics

Active Studies

RETROLYSIS — A retrospective multicenter registry of the use of intrapleural lytic therapy.
Steerable peripheral needle platform – NIH R01 Funded
Stationary Digital Chest Tomosynthesis as an intraprocedural guidance and localization confirmation platform – NIH R01 Funded
LCCC 1626 – Phase 1 trial of intrapleural oncolytic viral therapy in combination with PD-L1 therapy for maligant pleural effusions
Intratumoral/lymph node injection of radiosensiting microspheres prior to SBRT
SWIFT Trial – Trial of silver coated indwelling pleural catheters to decrease time to pleurodesis (no longer enrolling).
Precepta – Testing airway scrapings for genetic alterations that may predict lung cancer in patients with small nodules and low to intermediate risk factors. (no longer enrolling)
All-in-One – Trial of an Electromagnetic Navigation system for patients at intermediate to high risk of lung cancer who have small nodule (less than 3mm) to provide a diagnosis and staging within one minimally invasive procedure, utilizing both endobronchial and transthoracic approaches. (no longer enrolling)
Refining and defining the optimal process for obtaining adequate samples for Next generation genetic sequencing of lung tumors to direct tailored oncology care.
Characterizing and describing the mechanism of development and developing potential definitive treatments of pleural effusions (benign and malignant) using translational research methods on fluid obtained from humans and in mouse models.

Interventional Pulmonology Study Coordinator:

Ashley Delgado
Phone: 919-445-0367

Interventional Pulmonary (IP) Fellowship

We offer a comprehensive, one year, interventional pulmonology fellowship. To learn more, please visit the Interventional Pulmonary (IP) Fellowship website.