Utility of Routine Spirometry Measures for Surveillance of Idiopathic Subglottic Stenosis

被引:39
作者
Carpenter, Delaney J. [1 ]
Ferrante, Sergio [2 ]
Bakos, Stephen R. [1 ]
Clary, Matthew S. [3 ]
Gelbard, Alexander H. [4 ]
Daniero, James J. [1 ]
机构
[1] Univ Virginia, Dept Otolaryngol Head & Neck Surg, POB 800713, Charlottesville, VA 22908 USA
[2] Univ Virginia, Sch Med, Charlottesville, VA 22908 USA
[3] Univ Colorado, Dept Otolaryngol Head & Neck Surg, Denver, CO 80202 USA
[4] Vanderbilt Univ, Dept Otolaryngol Head & Neck Surg, 221 Kirkland Hall, Nashville, TN 37235 USA
关键词
ENDOSCOPIC MANAGEMENT; PHYSIOLOGY;
D O I
10.1001/jamaoto.2018.2717
中图分类号
R76 [耳鼻咽喉科学];
学科分类号
100213 ;
摘要
IMPORTANCE Because of the recurrent nature of idiopathic subglottic stenosis, routine follow-up is necessary for monitoring progression of stenosis. However, no easily accessible, standardized objective measure exists to monitor disease progression. OBJECTIVE To determine whether peak expiratory flow (PEF) can be used as a reliable and easily accessible biometric indicator of disease progression relative to other validated spirometry measures in patients with idiopathic subglottic stenosis. DESIGN, SETTING, AND PARTICIPANTS Prospectively collected data on PEF, expiratory disproportion index (EDI), and total peak flow (TPF) from 42 women with idiopathic subglottic stenosis without comorbid lower airway or parenchymal lung disease who were treated at a single tertiary referral center between 2014 and 2018 were analyzed. The mean follow-up period was 182 months (range, 2-40 months). Ten patients initially screened were not included in the analysis owing to comorbid glottic or supraglottic stenosis or nonidiopathic etiology. MAIN OUTCOMES AND MEASURES Measurements of PEF, EDI, and TPF were taken at preoperative visits and at all other visits. RESULTS Forty-two women (mean age, 51.5 years; 98% white [n = 41]) met the inclusion criteria. The area under the curve for PEF was 0.855 (95% CI, 0.784-0.926). The optimal cutoff value was 4.4 liters per second (264 L/min), with a sensitivity and specificity of 84.4% and 82.0%, respectively. The area under the curve for EDI was 0.853 (95% CI. 0.782-0.925). For TPF, this was 0.836 (95% CI, 0.757-0.916). CONCLUSIONS AND RELEVANCE This study provides evidence supporting the use of PEF as a simple, efficient, and accessible way of monitoring progression of idiopathic subglottic stenosis and predicting receipt of surgical intervention. Sensitivity and specificity of PEF were comparable to those of the more complex measures of TPF arid EDI.
引用
收藏
页码:21 / 26
页数:6
相关论文
共 17 条
[1]   Evidence of Extraesophageal Reflux in Idiopathic Subglottic Stenosis [J].
Blumin, Joel H. ;
Johnston, Nikki .
LARYNGOSCOPE, 2011, 121 (06) :1266-1273
[2]   ASSESSMENT OF UPPER AIRWAYS OBSTRUCTION [J].
EMPEY, DW .
BRITISH MEDICAL JOURNAL, 1972, 3 (5825) :503-&
[3]   Disease Homogeneity and Treatment Heterogeneity in Idiopathic Subglottic Stenosis [J].
Gelbard, Alexander ;
Donovan, Donald T. ;
Ongkasuwan, Julina ;
Nouraei, S. A. R. ;
Sandhu, Guri ;
Benninger, Michael S. ;
Bryson, Paul C. ;
Lorenz, Robert R. ;
Tierney, William S. ;
Hillel, Alexander T. ;
Gadkaree, Shekhar K. ;
Lott, David G. ;
Edell, Eric S. ;
Ekbom, Dale C. ;
Kasperbauer, Jan L. ;
Maldonado, Fabien ;
Schindler, Joshua S. ;
Smith, Marshall E. ;
Daniero, James J. ;
Garrett, C. Gaelyn ;
Netterville, James L. ;
Rickman, Otis B. ;
Sinard, Robert J. ;
Wootten, Christopher T. ;
Francis, David O. .
LARYNGOSCOPE, 2016, 126 (06) :1390-1396
[4]   Causes and Consequences of Adult Laryngotracheal Stenosis [J].
Gelbard, Alexander ;
Francis, David O. ;
Sandulache, Vlad C. ;
Simmons, John C. ;
Donovan, Donald T. ;
Ongkasuwan, Julina .
LARYNGOSCOPE, 2015, 125 (05) :1137-1143
[5]   Idiopathic Subglottic and Tracheal Stenosis: A Survey of the Patient Experience [J].
Gnagi, Sharon H. ;
Howard, Brittany E. ;
Anderson, Catherine ;
Lott, David G. .
ANNALS OF OTOLOGY RHINOLOGY AND LARYNGOLOGY, 2015, 124 (09) :734-739
[6]   Spirometric reference values from a sample of the general US population [J].
Hankinson, JL ;
Odencrantz, JR ;
Fedan, KB .
AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 1999, 159 (01) :179-187
[7]   Using Pulmonary Function Data to Assess Outcomes in the Endoscopic Management of Subglottic Stenosis [J].
Kraft, Shannon M. ;
Sykes, Kevin ;
Palmer, Andrew ;
Schindler, Joshua .
ANNALS OF OTOLOGY RHINOLOGY AND LARYNGOLOGY, 2015, 124 (02) :137-142
[8]   CLASSIFICATION OF LARYNGOTRACHEAL STENOSIS [J].
MCCAFFREY, TV .
LARYNGOSCOPE, 1992, 102 (12) :1335-1340
[9]   PROPOSED GRADING SYSTEM FOR SUBGLOTTIC STENOSIS BASED ON ENDOTRACHEAL-TUBE SIZES [J].
MYER, CM ;
OCONNOR, DM ;
COTTON, RT .
ANNALS OF OTOLOGY RHINOLOGY AND LARYNGOLOGY, 1994, 103 (04) :319-323
[10]   Quantifying the physiology of laryngotracheal stenosis: Changes in pulmonary dynamics in response to graded extrathoracic resistive loading [J].
Nouraei, S. A. Reza ;
Winterborn, Claire ;
Nouraei, S. Mahmoud ;
Giussani, Dino A. ;
Murphy, Kevin ;
Howard, David J. ;
Sandhu, Guri S. .
LARYNGOSCOPE, 2007, 117 (04) :581-588