Physiology-based minimum clinically important difference thresholds in adult laryngotracheal stenosis.

OBJECTIVES/HYPOTHESIS: Delivering evidence-based patient care is predicated on the availability of objective and validated outcome measures. We aimed to calculate physiology-based minimum clinically important difference (MCID) values for adult laryngotracheal stenosis (LTS). STUDY DESIGN: Prospective observational study. METHODS: Patient demographics, morbidities, and stenosis severity were assessed preoperatively. Flow-volume loops and Medical Research Council (MRC) dyspnea grades were measured in 21 males and 44 females before and 6 to 8 weeks after airway surgery, and before treating recurrent disease in 10 patients. Anchor and distribution-based methodologies were used to calculate MCIDs for treatment efficacy and disease recurrence respectively. RESULTS: The mean age at treatment was 46 ± 16 years. The most common etiology was idiopathic subglottic stenosis (38%). Most lesions (66%) obstructed >70% of the lumen. There were strong correlations between treatment-related changes in total peak flow (TPF) (ΔTPF) (peak expiratory flow + |peak inspiratory flow|) and the ratio of area under the flow-volume loop (AUC) to forced vital capacity (FVC) (ΔAUCTotal /FVC), and treatment-related changes in the MRC grade (ΔMRC) (r = -0.76 and r = -0.82, respectively). Both TPF and AUCTotal /FVC discriminated between effective (ΔMRC <0) and ineffective (ΔMRC ≥0) interventions, yielding MCID values of 4.2 L/s for TPF and 2.1 L(2) /s for AUCTotal /FVC, respectively. Ten patients required airway treatment for recurrent disease, and TPF and AUCTotal /FVC levels had distribution-based MCID values of 0.9 and 0.6, respectively. CONCLUSIONS: Flow-volume loops provide a quantitative method of objectively assessing outcomes in LTS. TPF is the most convenient index for this purpose, but AUCTotal /FVC provides marginally greater sensitivity and specificity.

Outcome of treating airway compromise due to bronchial stenosis with intralesional corticosteroids and cutting-balloon bronchoplasty.

OBJECTIVES: To determine the feasibility, safety, and efficacy of treating benign bronchial stenosis with laryngoscopy, jet ventilation, intralesional corticosteroids, and cutting-balloon bronchoplasty. STUDY DESIGN: Case series with planned data collection. SETTING: National airway unit. SUBJECTS AND METHODS: Ten adult patients with bronchial stenosis caused by Wegener's granulomatosis (n = 6), tuberculosis (n = 2), intubation (n = 1), and photodynamic therapy (n = 1) who underwent bronchoplasty using cutting-balloon dilation via suspension laryngoscopy in 2009. Information about patient demography, etiology, lesion characteristics, and details of the interventions were recorded. Patients underwent spirometry before surgery and at last follow-up. Chest infection rate in the 6 months before bronchoplasty and from bronchoplasty to the last follow-up was ascertained. RESULTS: There were 3 men and 7 women. Mean age at bronchoplasty was 46 ± 20 years. Length of stay was 1 day in all cases, and no treatment-related complications occurred. One patient required a second bronchoplasty at 55 days. Mean follow-up was 7 ± 2.3 months. Forced expiratory volume in 1 second increased from a prebronchoplasty mean of 1.6 ± 0.6 to 2.2 ± 0.5 at last follow-up (P < .0001; paired Student t test). Forced vital capacity rose from 2.7 ± 0.6 to 3.1 ± 0.6 (P = .02), and peak expiratory flow rate increased from 3.7 ± 0.8 to 5.0 ± 0.8 (P < .0001). Chest infection rate fell from an average of 0.7 ± 0.3 infections per month to 0.2 ± 0.2 (P < .003; paired Student t test). CONCLUSION: Cutting-balloon bronchoplasty via suspension laryngoscopy is an effective treatment for benign bronchial stenosis. It is safer than airway stenting and is less invasive than thoracotomy. The authors propose its use as first-line treatment for this condition.