The healthcare industry has significantly evolved with the integration of technology and advancements in patient care. Despite this progress, cardiovascular diseases such as heart disease and stroke remain the leading causes of natural death worldwide, followed by cancer and chronic respiratory diseases. A report from the World Health Organization (WHO) highlights that death due to lung diseases in India have notably increased, accounting for a significant percentage of total deaths. Respiratory diseases affecting lung health include asthma, chronic obstructive pulmonary disease (COPD), interstitial lung disease (ILD), pneumonia, and tuberculosis (TB). While the risk factors for chronic respiratory diseases include tobacco smoking (including second-hand smoke), air pollution, allergens and occupational risks, specialists in lung health, particularly pulmonologists, play a crucial role in helping patients combat and manage the challenges posed by these lung diseases. Dr Visweswaran Balasubramanian, an Interventional Pulmonologist is also recognized as one of the leading experts in this field.

Unfolding the Trajectory into Pulmonology Care
Dr Viswesvaran has completed his MBBS at Coimbatore Medical College, followed by an MD from the Patel Chest Institute, the leading institution for pulmonology in the country. He then pursued a DM, a super-specialization degree in pulmonary and critical care medicine, at Safdarjung Hospital in New Delhi, where he was a gold medalist. After that, he continued his education with a fellowship in advanced interventional pulmonology in Malaysia, as well as a fellowship in sleep medicine. In addition, he has acquired European Diploma in Adult respiratory medicine (Switzerland). He maintained a continuous educational trajectory without any breaks from his post-secondary schooling until the completion of his fellowships. For the past five and a half years, he has been working with the Yashoda Group of Hospitals in Hyderabad.

Currently, he serves as a Senior Consultant specializing in interventional pulmonology, ECMO and Lung transplantation team and sleep medicine at the Yashoda Hospitals in Somajiguda, Hyderabad. Additionally, he is the Clinical Director for the advanced interventional pulmonology fellowship at the hospital, where he trains pulmonologists from across the country and international fellows in the complexities of advanced intervention¬al pulmonology. In his practice, Dr Viswesvaran also manages critically ill patients and advanced life support systems, such as ECMO (Extracorporeal Membrane Oxygenation). He is actively involved in lung transplantation services as well.

Dr Viswesvaran’s journey into the medical field was sparked by a personal event. When he was around 10 or 12 years old, his grandmother suffered from severe asthma. At that time, there were not enough medications or specialists available to effectively manage her respiratory issues, and ultimately, she passed away. This experience motivated him to pursue a career as a pulmonologist, as he recognized a significant need for skilled specialists in lung-related problems, even in major Tier-I cities where such expertise was in short supply.

Additionally, from a young age only, he was also fascinated by the research being conducted in the field of cancer, particularly lung cancer, which is one of the most prevalent forms of cancer globally. He believed that his work and knowledge in this area could make a meaningful contribution to society, and thus with this in mind, committed himself to the field of pulmonary medicine. This same passion led him to specialize in advanced interventional pulmonology, as many aspects of lung cancer require these specialized services, which were not widely available in India a decade ago.

He became one of the few trained experts in advanced interventional pulmonology in the country, offering critical services that were previously lacking.

The Approach to Challenges through Advancements
Lung issues have never been widely addressed by the demography as much it is today since the COVID-19 pandemic instance. Oncologists specializing in cancer treatment too have made significant contributions to managing lung cancers. Many people were unaware of the seriousness of lung issues and the role of pulmonologists earlier. There’s a critical need to increase public and general practitioner awareness about pulmonary medicine, especially regarding interstitial lung disease (ILD) in India. ILD, characterized by breathing difficulties and cough, can lead to severe lung fibrosis if not diagnosed and treated promptly, often requiring oxygen support or lung transplantation. In some regions of India, exposure to pigeon dust and feathers significantly contributes to ILD. Inhalation of proteins in this dust can harm the lungs, but many patients and general practitioners lack awareness, leading to late-stage referrals.

Additionally, the value of interventional pulmonology is often misunderstood. While people readily seek specialists for attacks, the importance of interventional pulmonology is not as widely recognized. Dr Viswesvaran says, “I’m proud to say our institution has become a leader in this field over the past five years, training candidates from India and abroad, including participants from African nations, the Philippines, Nepal, and Middle Eastern countries, who come to learn advanced techniques from us”.

Recent advancements in interventional pulmonology have facilitated procedures such as bronchoscopy, which allows for the internal examination of the lungs and the collection of biopsies for diagnosis. Endobronchial ultrasound (EBUS) provides a means to assess lymph nodes without requiring major surgery, enabling biopsies to be performed as an outpatient procedure. Additionally, thoracoscopies can now be used to diagnose cause of pleural fluid without invasive techniques. As a result, many patients with advanced cancer, who were previously overlooked in their care, now have access to effective treatments that were once unavailable.

Focused Intent to Provide Comprehensive Care
Lung transplantation is a vital option for patients with advanced lung disease, similar to kidney and liver transplants. Many young patients with interstitial lung disease (ILD) regain normal lives after transplantation, so highlighting the importance of raising awareness about lung health, including ILD and lung cancer is essential today. To be noted, lung problems do not exist in isolation, hence when assessing a patient, it is important to recognize that they may have underlying issues related to pulmonary disorders, heart disorders, or other health concerns. Ultimately, as a physician, reviewing the patient holistically remains crucial. It's essential to be open to the opinions of other specialties to provide comprehensive care.

Dr Viswesvaran is dedicated to improving the services in this field and thus, striving to make a significant impact in the lung healthcare space. Working at one of the best institutions in the country, he effectively collaborates with leading experts from various specialties to treat patients, valuing their insights. He says, “Being part of an environment that encourages learning from the best minds is a privilege”.

Achievements, Milestones & Future Envision
This decade is crucial for pulmonologists following the COVID-19 pandemic, raising awareness of pulmonology specialty, and improving pulmonologists abilities to manage complex cases and enhance patient care. Now, even the world is looking up to India for advancements in interventional pulmonology due to the developments taking place here.

Dr Viswesvaran's journey in lung healthcare has been rewarding. He has treated many patients, including a 50-year-old man from West Bengal with endobronchial tuberculosis (TB) that collapsed one of his lungs, leaving him dependent on oxygen for six months. After consulting multiple doctors, he was resigned to needing oxygen for life. Upon arriving at Dr Viswesvaran's clinic, the team was initially skeptical but inspired by the patient’s determination to recover, they performed an advanced bronchoscopic procedure, which successfully reopened the collapsed lung. The patient regained good lung function and was able to return to daily activities without oxygen. Similarly witnessing outcomes of successful lung transplantation of critically ill patients are highly rewarding as it it highlights the impact of ECMO and lung transplantation in giving patients a second chance at life.

Dr Viswesvaran has also received several awards for Best Overall Performance, Best Innovation, and Best Presentation at the World Congress of Bronchology and Interventional Pulmonology (WCBIP), which honors the top professionals in this field. He has numerous international research publications and has also authored chapters in various books involving respiratory medicine. Additionally, he has recognized for his works by Yashoda Somajiguda. endeavoring to drive evolution in this space, he is even engaged in mentoring others. He avers, “Teaching is not only beneficial for my juniors in gaining knowledge, but it also serves to help me perfect my own techniques, boosting critical thinking and patient outcomes”.

Looking further, he states, “I believe that a doctor never truly retires, it really isn’t an option for us. The moment one feels they can no longer update their knowledge is the moment a doctor effectively retires. For us, retirement isn't really an option. What drives our growth is the constant learning and relearning that we do every day. So, even I strive to keep moving forward with the hope of providing the best care for our patients and supporting our medical community”. He quotes, “With emerging technologies and growing interest in interventional pulmonology and lung transplantation, we look forward to transformative advancements in the field. Also, if we can make this knowledge more accessible and affordable for patients from all backgrounds, that will be the milestone we aim to achieve”.