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Original Research: Pulmonary Procedures |

Therapeutic Bronchoscopy for Malignant Central Airway ObstructionTherapeutic Bronchoscopy for Malignant Obstruction: Success Rates and Impact on Dyspnea and Quality of Life

David E. Ost, MD, MPH, FCCP; Armin Ernst, MD, MHCM, FCCP; Horiana B. Grosu, MD; Xiudong Lei, PhD; Javier Diaz-Mendoza, MD; Mark Slade, MBBS, FCCP; Thomas R. Gildea, MD, FCCP; Michael S. Machuzak, MD, FCCP; Carlos A. Jimenez, MD, FCCP; Jennifer Toth, MD; Kevin L. Kovitz, MD, FCCP; Cynthia Ray, MD, FCCP; Sara Greenhill, MD, FCCP; Roberto F. Casal, MD; Francisco A. Almeida, MD, FCCP; Momen M. Wahidi, MD, FCCP; George A. Eapen, MD, FCCP; David Feller-Kopman, MD, FCCP; Rodolfo C. Morice, MD, FCCP; Sadia Benzaquen, MD; Alain Tremblay, MDCM, FCCP; Michael Simoff, MD, FCCP; on behalf of the AQuIRE Bronchoscopy Registry
Author and Funding Information

From the Department of Pulmonary Medicine (Drs Ost, Grosu, Jimenez, Eapen, and Morice) and the Department of Biostatistics (Dr Lei), The University of Texas MD Anderson Cancer Center, Houston, TX; the Reliant Medical Group (Dr Ernst), Worcester, MA; the Department of Pulmonary and Critical Care Medicine (Drs Diaz-Mendoza, Ray, and Simoff), Henry Ford Hospital, Detroit, MI; the Department of Thoracic Oncology (Dr Slade), Papworth Hospital, Cambridge, England; The Respiratory Institute (Drs Gildea, Machuzak, and Almeida), Cleveland Clinic Foundation, Cleveland, OH; the Penn State Cancer Institute (Dr Toth), Hershey, PA; the University of Illinois Hospital and Health Sciences Center (Dr Kovitz), Chicago, IL; the Department of Pulmonary and Critical Care Medicine (Dr Greenhill), Boston University, Boston, MA; the Department of Interventional Pulmonology (Dr Greenhill), Chicago Chest Center, Chicago, IL; the Department of Pulmonary and Critical Care (Dr Casal), Baylor College of Medicine, Houston, TX; the Department of Internal Medicine (Dr Wahidi), Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University Medical Center, Durham, NC; the Department of Pulmonary and Critical Care Medicine (Dr Feller-Kopman), Johns Hopkins Hospital, Baltimore, MD; the Department of Pulmonary, Critical Care, and Sleep Medicine (Dr Benzaquen), University of Cincinnati, Cincinnati, OH; and the Department of Pulmonary and Critical Care Medicine (Dr Tremblay), University of Calgary, Calgary, AB, Canada.

CORRESPONDENCE TO: David E. Ost, MD, MPH, FCCP, The University of Texas MD Anderson Cancer Center, Pulmonary Department, 1515 Holcombe Blvd, Unit 1462, Houston, TX 77030; e-mail: dost@mdanderson.org


FUNDING/SUPPORT: The American College of Chest Physicians funded the database construction for the AQuIRE program. This research was supported in part by the National Institutes of Health through a Cancer Center Support Grant [Grant P30CA016672], biostatistics core, at the University of Texas, MD Anderson Cancer Center.

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


Chest. 2015;147(5):1282-1298. doi:10.1378/chest.14-1526
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BACKGROUND:  There is significant variation between physicians in terms of how they perform therapeutic bronchoscopy, but there are few data on whether these differences impact effectiveness.

METHODS:  This was a multicenter registry study of patients undergoing therapeutic bronchoscopy for malignant central airway obstruction. The primary outcome was technical success, defined as reopening the airway lumen to > 50% of normal. Secondary outcomes were dyspnea as measured by the Borg score and health-related quality of life (HRQOL) as measured by the SF-6D.

RESULTS:  Fifteen centers performed 1,115 procedures on 947 patients. Technical success was achieved in 93% of procedures. Center success rates ranged from 90% to 98% (P = .02). Endobronchial obstruction and stent placement were associated with success, whereas American Society of Anesthesiology (ASA) score > 3, renal failure, primary lung cancer, left mainstem disease, and tracheoesophageal fistula were associated with failure. Clinically significant improvements in dyspnea occurred in 90 of 187 patients measured (48%). Greater baseline dyspnea was associated with greater improvements in dyspnea, whereas smoking, having multiple cancers, and lobar obstruction were associated with smaller improvements. Clinically significant improvements in HRQOL occurred in 76 of 183 patients measured (42%). Greater baseline dyspnea was associated with greater improvements in HRQOL, and lobar obstruction was associated with smaller improvements.

CONCLUSIONS:  Technical success rates were high overall, with the highest success rates associated with stent placement and endobronchial obstruction. Therapeutic bronchoscopy should not be withheld from patients based solely on an assessment of risk, since patients with the most dyspnea and lowest functional status benefitted the most.


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