Stabilization of the central airways provides relief of symptoms in some patients with tracheobronchomalacia (TBM). There are no specific tests to ascertain the actual improvement in airflow limitation in central airways. The purpose of this study is to correlate improvement in symptoms, as perceived by the patients, to the changes in objective measures.
All patients that had stent placement for TBM were prospectively evaluated. Prior to the procedure, all patients underwent subjective testing with St. George Respiratory Questionnaire (SGRQ) and Karnofski Index (KI) and objective testing with spirometry, and a 6-minute walk test. Within two weeks after the procedure, patients answered a simple ‘yes’ or ‘no’ question for improvement in symptoms and the same subjective and objective measures were repeated. The measures were compared between the groups that answered ‘yes’ and ‘no’ following stent placement.
Ninety one patients with confirmed moderate to severe TBM underwent silicone stent placement to stabilize the central airways. Seventy-two (79%) patients answered ‘yes’ to improvement in symptoms following airway stabilization with stents. Patients with improvement in symptoms had an average improvement or decrease by 21.7 on SGRQ score from before to after procedure (compared to a 1.7 increase in patients without improvement in symptoms; p = 0.003), an increase of 10.9 on KI (compared to a decrease by 0.9 in patients without improvement; p = 0.01) and an increase by 120 feet on 6 MWT (compared to a decrease by 208 feet; p-0.02). No significant change was noted in FEV1 from pre- to post-stent placement in both groups.
Subjective improvement in symptoms translates to an improved score on SGRQ and KI and correlates well with an improvement in 6 MWT, following central airway stabilization in patients with TBM. FEV1 does not correlate with subjective improvement.
Subjective perception of improvement in symptoms by the patients is adequate to assess success of airway stabilization in TBM as it correlates well with an improvement in 6 MWT. FEV1 is not a reliable measure for the same.
Chakravarthy Reddy, No Financial Disclosure Information; No Product/Research Disclosure Information