Abstract
Background: Benign tracheal stenosis may relapse after management. Objectives: This study aimed to assess the value of dyspnea and spirometry in detecting relapse of benign tracheal stenosis. Methods: Patients with benign tracheal stenosis were evaluated post-management, at regular follow-up and emergency visits, with the Medical Research Council (MRC) dyspnea scale, spirometry, and flexible bronchoscopy. Patient visits were categorized and compared, in terms of change in clinical and functional parameters, in 2 groups: visits with relapse (case group) and visits with no relapse (control group). The ability of the MRC dyspnea scale and spirometry to predict relapse was evaluated. Results: Thirty-five patients with benign tracheal stenosis were included. Mean follow-up duration was 3.2 years (standard deviation = 3.3). Spirometry data were analyzed from 43 relapse visits (23 patients) versus 90 nonrelapse visits. The MRC dyspnea score and most spirometric indices were associated with relapse. In the receiver operating characteristic analysis, forced expiratory volume in 1 s, forced expiratory flow when 25% of forced vital capacity has been expired, peak expiratory flow (PEF), and total peak flow were superior to the MRC dyspnea score in predicting relapse. Among spirometric indices, >10.8% of PEF reduction has been very sensitive and specific. Conclusions: This study supports the role of dyspnea and spirometry in monitoring benign tracheal stenosis, with spirometry predicting relapse even in clinically stable patients. PEF being a very sensitive index has the additional advantage of being assessed by peak flow meter and could potentially be used for remote monitoring.
References
1.
Lorenz
RR
. Adult laryngotracheal stenosis: etiology and surgical management
. Curr Opin Otolaryngol Head Neck Surg
. 2003
;11
(6
):467
–72
. .2.
Melkane
AE
, Matar
NE
, Haddad
AC
, Nassar
MN
, Almoutran
HG
, Rohayem
Z
, Management of postintubation tracheal stenosis: appropriate indications make outcome differences
. Respiration
. 2010
;79
(5
):395
–401
. .3.
Wain
JC
Jr. Postintubation tracheal stenosis
. Semin Thorac Cardiovasc Surg
. 2009
;21
(3
):284
–9
. .4.
Bisson
A
, Bonnette
P
, El Kadi
NB
, Leroy
M
, Colchen
A
, Personne
C
, Tracheal sleeve resection for iatrogenic stenoses (subglottic laryngeal and tracheal)
. J Thorac Cardiovasc Surg
. 1992
;104
(4
):882
–7
. .5.
Brichet
A
, Verkindre
C
, Dupont
J
, Carlier
ML
, Darras
J
, Wurtz
A
, Multidisciplinary approach to management of postintubation tracheal stenoses
. Eur Respir J
. 1999
;13
(4
):888
–93
. .6.
Noppen
M
. Chapter 16 ‒ airway injury and sequelae: a conservative view
. Eur Respir Monogr
. 2004
;29
:234
–45
.7.
Spittle
N
, McCluskey
A
. Lesson of the week: tracheal stenosis after intubation
. BMJ
. 2000
;321
(7267
):1000
–2
. .8.
Nouraei
SA
, Nouraei
SM
, Patel
A
, Murphy
K
, Giussani
DA
, Koury
EF
, Diagnosis of laryngotracheal stenosis from routine pulmonary physiology using the expiratory disproportion index
. Laryngoscope
. 2013
;123
(12
):3099
–104
. .9.
Galluccio
G
, Lucantoni
G
, Battistoni
P
, Paone
G
, Batzella
S
, Lucifora
V
, Interventional endoscopy in the management of benign tracheal stenoses: definitive treatment at long-term follow-up
. Eur J Cardiothorac Surg
. 2009
;35
(3
):429
–33
. .10.
Bo
L
, Li
C
, Chen
M
, Mu
D
, Jin
F
. Application of electrocautery needle knife combined with balloon dilatation versus balloon dilatation in the treatment of tracheal fibrotic scar stenosis
. Respiration
. 2018
;95
(3
):182
–7
. .11.
Miller
RD
, Hyatt
RE
. Obstructing lesions of the larynx and trachea: clinical and physiologic characteristics
. Mayo Clin Proc
. 1969
;44
(3
):145
–61
.12.
Yernault
JC
, Englert
M
, Sergysels
R
, De Coster
A
. Upper airway stenosis: a physiologic study
. Am Rev Respir Dis
. 1973
;108
(4
):996
–1000
. .13.
Rotman
HH
, Liss
HP
, Weg
JG
. Diagnosis of upper airway obstruction by pulmonary function testing
. Chest
. 1975
;68
(6
):796
–9
. .14.
Empey
DW
. Assessment of upper airways obstruction
. Br Med J
. 1972
;3
(5825
):503
–5
. .15.
Nouraei
SM
, Franco
RA
, Dowdall
JR
, Nouraei
SA
, Mills
H
, Virk
JS
, Physiology-based minimum clinically important difference thresholds in adult laryngotracheal stenosis
. Laryngoscope
. 2014
;124
(10
):2313
–20
. .16.
Kraft
SM
, Sykes
K
, Palmer
A
, Schindler
J
. Using pulmonary function data to assess outcomes in the endoscopic management of subglottic stenosis
. Ann Otol Rhinol Laryngol
. 2015
;124
(2
):137
–42
. .17.
Naunheim
MR
, Paddle
PM
, Husain
I
, Wangchalabovorn
P
, Rosario
D
, Franco
RA
Jr. Quality-of-life metrics correlate with disease severity in idiopathic subglottic stenosis
. Laryngoscope
. 2018
;128
(6
):1398
–402
. .18.
Carpenter
DJ
, Ferrante
S
, Bakos
SR
, Clary
MS
, Gelbard
AH
, Daniero
JJ
. Utility of routine spirometry measures for surveillance of idiopathic subglottic stenosis
. JAMA Otolaryngol Head Neck Surg
. 2019
;145
(1
):21
–6
. .19.
Fletcher
CM
, Elmes
PC
, Fairbairn
AS
, Wood
CH
. The significance of respiratory symptoms and the diagnosis of chronic bronchitis in a working population
. Br Med J
. 1959
;2
(5147
):257
–66
. .20.
Miller
MR
, Hankinson
J
, Brusasco
V
, Burgos
F
, Casaburi
R
, Coates
A
, Standardisation of spirometry
. Eur Respir J
. 2005
;26
(2
):319
–38
. .21.
Murgu
S
, Colt
HG
. Morphometric bronchoscopy in adults with central airway obstruction: case illustrations and review of the literature
. Laryngoscope
. 2009
;119
(7
):1318
–24
. .22.
Youden
WJ
. Index for rating diagnostic tests
. Cancer
. 1950
;3
(1
):32
–5
. .23.
DeLong
ER
, DeLong
DM
, Clarke-Pearson
DL
. Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach
. Biometrics
. 1988
;44
(3
):837
–45
. .24.
Meyer
M
. Latrogenic tracheobronchial lesions: a report on 13 cases
. Thorac Cardiovasc Surg
. 2001
;49
(2
):115
–9
. .25.
Linhas
R
, Lima
F
, Coutinho
D
, Almeida
J
, Neves
S
, Oliveira
A
, Role of the impulse oscillometry in the evaluation of tracheal stenosis
. Pulmonology
. 2018
;24
(4
):224
–30
. .26.
Nouraei
SA
, Nouraei
SM
, Randhawa
PS
, Butler
CR
, Magill
JC
, Howard
DJ
, Sensitivity and responsiveness of the medical research council dyspnoea scale to the presence and treatment of adult laryngotracheal stenosis
. Clin Otolaryngol
. 2008
;33
(6
):575
–80
. .27.
Nouraei
SM
, Patel
A
, Virk
JS
, Butler
CR
, Sandhu
GS
, Nouraei
SA
. Use of pressure-volume loops for physiological assessment of adult laryngotracheal stenosis
. Laryngoscope
. 2013
;123
(11
):2735
–41
. .28.
Abdullah
A
, Alrabiah
A
, Habib
SS
, Aljathlany
Y
, Aljasser
A
, Bukhari
M
, The value of spirometry in subglottic stenosis
. Ear Nose Throat J
. 2019
;98
(2
):98
–101
. .29.
van Noord
JA
, Wellens
W
, Clarysse
I
, Cauberghs
M
, Van de Woestijne
KP
, Demedts
M
. Total respiratory resistance and reactance in patients with upper airway obstruction
. Chest
. 1987
;92
(3
):475
–80
. .30.
Bogaard
JM
, Pauw
KH
, Stam
H
, Versprille
A
. Interpretation of changes in spirographic and flow-volume variables after operative treatment in bilateral vocal cord paralysis
. Bull Eur Physiopathol Respir
. 1985
;21
(2
):131
–5
.© 2021 S. Karger AG, Basel
2021
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.
