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Original Research: Asthma |

An Index to Objectively Score Supraglottic Abnormalities in Refractory AsthmaSupraglottic Index: Learning, Validation, and Significance

James T. Good, Jr, MD, FCCP; Donald R. Rollins, MD, FCCP; Douglas Curran-Everett, PhD; Steven E. Lommatzsch, MD; Brendan J. Carolan, MD; Peter C. Stubenrauch, MD; Richard J. Martin, MD, FCCP
Author and Funding Information

From the Department of Medicine (Drs Good, Rollins, Lommatzsch, Carolan, Stubenrauch, and Martin), Division of Pulmonary, Critical Care, and Sleep Medicine, and the Department of Biostatistics and Bioinformatics (Dr Curran-Everett), National Jewish Health, Denver, CO.

Correspondence to: Richard J. Martin, MD, FCCP, National Jewish Health, 1400 Jackson St, Denver, CO 80206; e-mail: martinr@njhealth.org


Funding/Support: The authors have reported to CHEST that no funding was received for this study.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;145(3):486-491. doi:10.1378/chest.13-1455
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Background:  Patients with refractory asthma frequently have elements of laryngopharyngeal reflux (LPR) with potential aspiration contributing to their poor control. We previously reported on a supraglottic index (SGI) scoring system that helps in the evaluation of LPR with potential aspiration. However, to further the usefulness of this SGI scoring system for bronchoscopists, a teaching system was developed that included both interobserver and intraobserver reproducibility.

Methods:  Five pulmonologists with expertise in fiber-optic bronchoscopy but novice to the SGI participated. A training system was developed that could be used via Internet interaction to make this learning technique widely available.

Results:  By the final testing, there was excellent interreader agreement (κ of at least 0.81), thus documenting reproducibility in scoring the SGI. For the measure of intrareader consistency, one reader was arbitrarily selected to rescore the final test 4 weeks later and had a κ value of 0.93, with a 95% CI of 0.79 to 1.00.

Conclusions:  In this study, we demonstrate that with an organized educational approach, bronchoscopists can develop skills to have highly reproducible assessment and scoring of supraglottic abnormalities. The SGI can be used to determine which patients need additional intervention to determine causes of LPR and gastroesophageal reflux. Identification of this problem in patients with refractory asthma allows for personal, individual directed therapy to improve asthma control.

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