To demonstrate subjective and objective improvement in patients undergoing central airway stabilization with moderate to severe tracheobronchomalacia (TBM).
Single center prospective observational study from July / 2004 to June /2006 of patients referred for evaluation of TBM. Patients were evaluated at baseline (1st visit)and the following information was obtained: demographic data (age, race, gender); co-morbid conditions; spirometry (FEV1); dynamic airway CT and bronchoscopy. If patients were considered for a stent trial based on their symptoms as well as on the bronchoscopic and CT findings then a 6 Minute Walk Test (6MWT) and standardized questionnaires were done: St George’s Respiratory Questionnaire (SGRQ), Baseline Dyspnea Index (BDI), ATS dyspnea score and Karnosfsky Performance Status (KPS). Silicone stents were placed in the trachea, main bronchus or both. Patients were scheduled for post-stent follow up after 4-6weeks. On that visit a 6MWT and standardized questionnaires were performed. If symptoms improved (less cough,less dyspnea, better clearing of secretions,less O2 or Off MV) and the patient had a low/intermediate surgical risk, stents were removed and they were scheduled for tracheobronchoplasty in 2 weeks.Patients were scheduled for post-surgical follow up (3rd Visit) at 3 months. At that time patient underwent spirometry (FEV1),dynamic airway CT, bronchoscopy, 6 MWT and standardized questionnaires.
Number of patients:18; patients stented:13; patients with tracheoplasty:10; SGRQ: Mean Score (Baseline N=7): 79, (Post-stent N=7):68, (Post-surgery N=1):54; BDI: Mean score (Baseline N=5): 1.8, (TDI post-stent N=5): +3.6, (TDI post-surgical N=2): +8.5; ATS dyspnea score: Mean Score (Baseline N=6):3.3, (Post-stent N=6): 1.5, (Post-surgical N=2): 0.5; KPS: Mean score (Baseline N=6): 63, (Post-stent N=6):81, (Post-surgical N=2): 80; 6MWT: (Baseline N=1): 1200ft, (post-surgical N=1):1500 ft.
These results suggest that in carefully selected patients central airway stabilization improves: respiratory symptoms, health related quality of life, functional status and 6 minute walk distance.
A carefully selected group of patients with symptomatic, moderate to severe TBM should be considered for central airway stabilization.
Adnan Majid, None.