Pulmonary Procedures |

Idiopathic Subglottic Stenosis: An Evolving Therapeutic Algorithm FREE TO VIEW

Andrea Loiselle, MD; Zachary DePew, MD; Eric Edell, MD; Jan Kasperbauer, MD; Fabien Maldonado, MD
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Mayo Clinic, Rochester, MN

Chest. 2013;144(4_MeetingAbstracts):804A. doi:10.1378/chest.1703191
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SESSION TITLE: Bronchoscopy and Interventional Procedures Posters I

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM

PURPOSE: Idiopathic subglottic stenosis (ISS) is a rare type of airway narrowing of unidentified etiology. Cricotracheal resection is often considered, but requires expertise and a hospital stay. Endoscopic management affords patients less convalescence and is an effective option but its recurrence rate is high. We report our experience consisting of a standardized endoscopic approach combined with an empiric medical treatment based on the presumed pathophysiology of the disease.

METHODS: We identified all patients diagnosed with ISS at our institution between 1987 and 2012 who were managed with standardized endoscopic treatment. We retrospectively reviewed their electronic records and abstracted patient characteristics, presenting symptoms and medical treatments prescribed. We categorized subjects into the following 4 groups: group 0: no associated medical treatment, group 1: anti-gastroesophageal reflux disease (GERD) agents, group 2: anti-GERD agents and inhaled corticosteroids (ICS) and group 3: anti-GERD agents, ICS and trimethoprim-sulfamethoxazole. The influence of medical management on annual recurrence rate was analyzed using negative binomial logistic regression.

RESULTS: One hundred and ten patients treated with standardized endoscopic management were included in our analysis. There were 17 patients in group 0, 19 patients in group 1, 25 patients in group 2 and 49 patients in group 3. When controlling for the presence of GERD symptoms at presentation, triple drug therapy (group 3) was associated with a reduction in the rate of recurrence/person/year (relative risk= 0.52, P=0.051).

CONCLUSIONS: Medical management with triple drug therapy in addition to standardized endoscopic management of ISS may be associated with a reduction in recurrence rate when controlling for the presence of GERD symptoms.

CLINICAL IMPLICATIONS: This is the largest retrospective study on ISS. We confirmed that this rare condition affects mostly non-smoking females who suffer a high recurrence rate when treated endoscopically. The association of triple drug therapy with a reduction in recurrence rate needs to be confirmed through prospective studies.

DISCLOSURE: The following authors have nothing to disclose: Andrea Loiselle, Zachary DePew, Eric Edell, Jan Kasperbauer, Fabien Maldonado

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