SESSION TYPE: Therapeutic Bronchoscopy
PRESENTED ON: Sunday, October 21, 2012 at 01:15 PM - 02:45 PM
PURPOSE: Central airway obstruction is seen in about 25% patients with primary or metastatic lung malignancy and 20% of patients with lung transplantation. It can cause significant impairment in pulmonary physiology and patient’s quality of life. Therapeutic bronchoscopy can provide immediate relief of airway obstruction. There are several retrospective studies showing its advantages. However, it has been rarely studied in a prospective fashion.
METHODS: We prospectively studied patients who underwent therapeutic bronchoscopy for central airway obstruction. Spirometry, San Diego Shortness of Breath questionnaire (SOBQ), and SF-36 questionnaire responses were obtained before therapeutic bronchoscopy, and at follow up 6-8 weeks after the procedure.
RESULTS: 35 patients were enrolled. Mean age was 57.8 ± 13.4 years. There were 19 males and 16 females. There were 18 patients with malignant airway obstruction, and 17 patients with non-malignant airway obstruction (14 patients with lung transplantation related stenosis, 2 patients with idiopathic subglottic stenosis and 1 patient with bronchomalacia). Rigid and flexible bronchoscopy was performed for all the patients. 27 stents were placed, including 6 silicone, 7 hybrid and 14 metal stents. Mechanical debridement was performed in 13, electrocautery was used in 10, argon plasma coagulation (APC) in 5 and potassium-titinyl-phosphate (KTP) Laser in 4 patients. Pre-procedure forced vital capacity (FVC) was 1.92 ±0.73 L while post procedure FVC was 2.47 ± 0.78 L, p-value for difference 0.003. Pre-procedure FEV-1 was 1.38 ± 0.61 L and post-procedure FEV1 was 1.77 ± 0.68 L, p value for difference 0.02. Pre-procedure SOBQ score improved from 57.9 ± 31.6 to post-procedure score of 42.2 ± 29.2, p value for difference 0.03. In the SF-36, there was improvement in almost all the domains, with statistically significant improvement (p-value of 0.05) seen in Role Limitations due to Physical Health Domain. There were no significant immediate complications.
CONCLUSIONS: Therapeutic bronchoscopy provides improvement in spirometry, shortness of breath, and quality of life in patients with central airway obstruction.
CLINICAL IMPLICATIONS: Therapeutic bronchoscopy helps with the central airway obstruction associated with malignant and non-malignant pulmonary disorders.
DISCLOSURE: The following authors have nothing to disclose: Kamran Mahmood, Scott Shofer, Neil Ninan, Matthew Beyea, Momen Wahidi
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