Pulmonary Procedures |

Measuring Central Airway Obstruction: What Do Bronchoscopists Do? FREE TO VIEW

Abbie Begnaud; John Connett; Eileen Harwood; Hiren Mehta
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Pulmonary, Allergy, Critical Care, and Sleep Medicine, University of Minnesota, Minneapolis, MN

Chest. 2014;146(4_MeetingAbstracts):747A. doi:10.1378/chest.1993686
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SESSION TITLE: Bronchoscopy and Interventional Procedures

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Monday, October 27, 2014 at 01:30 PM - 02:30 PM

PURPOSE: Axial imaging is the gold standard for measuring CAO but anecdotal evidence suggests that many bronchoscopists use visual estimation. The prevalence and reliability of this method has never been reported. This study aims to determine bronchoscopists’ opinions about and practical methods of assessing central airway obstruction (CAO).

METHODS: Members of the American Association of Bronchology and Interventional Pulmonology were invited to participate in an online survey. In addition to reporting opinions and practice in measuring CAO, participants were shown ten bronchoscopic photos of abnormal central airway lesions and asked to estimate degree of obstruction with a sliding scale tool of 0 to 100%.

RESULTS: One-hundred and eighteen responses were obtained from individuals with varied interventional bronchoscopy experience. Nearly all were pulmonologists (97%) but had been trained to perform airway interventions in a variety of ways. Most participants reported using visual numeric estimation of CAO (91%) and largely those are numeric estimates (87%). Fifty-five participants volunteered other methods they used in addition and their comments reflected discontent with the reliability of those. When shown the same ten bronchoscopic photos, estimates varied considerably, with very large ranges of responses in all cases and standard deviations in excess of 20% in some cases. When asked if they agreed that measurement of airway narrowing should be standardized, nearly half (46%) strongly agreed and another 40% somewhat agreed.

CONCLUSIONS: Although limited by sample size and static photos of abnormal airways, this survey supports the assertion that most bronchoscopists use a method of estimating CAO that is subjective and unreliable but ubiquitous in the absence of a clinically practical alternative.

CLINICAL IMPLICATIONS: A standardized and reliable method of measuring CAO, preferably one that is practical to perform frequently and at the point of care (bronchoscopy) is needed. All bronchoscopists will encounter at some point CAO and will be faced with the problem of documenting degree of CAO, whether as a basis for referral to an interventionalist or for their own prognostication, procedural planning and post-therapeutic comparison.

DISCLOSURE: The following authors have nothing to disclose: Abbie Begnaud, John Connett, Eileen Harwood, Hiren Mehta

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