Faculty Collaboration Database

Modeling Recurrence in Idiopathic Subglottic Stenosis With Mobile Peak Expiratory Flow. Laryngoscope 2021 Dec;131(12):E2841-E2848

Date

07/27/2021

Pubmed ID

34309022

Pubmed Central ID

PMC8595545

DOI

10.1002/lary.29760

Scopus ID

2-s2.0-85121957720 (requires institutional sign-in at Scopus site)   6 Citations

Abstract

OBJECTIVES/HYPOTHESIS: We sought to establish normative peak expiratory flow (PEF) data for patients with idiopathic subglottic stenosis (iSGS), evaluate whether immediate changes in PEF after a procedure predict long-term treatment response, and test if a decline in longitudinal PEF is associated with disease recurrence.

STUDY DESIGN: International, prospective, 3-year multicenter cohort study of 810 patients with untreated, newly diagnosed, or previously treated iSGS.

METHODS: iSGS patients consented and enrolled in the North American Airway Collaborative (NoAAC) iSGS¹⁰⁰⁰ cohort recorded PEF data on a mobile smartphone app. Cox regression tested the associations between the magnitude of postoperative PEF improvement and longitudinal 90-day PEF decline with the risk of disease recurrence.

RESULTS: Within the NoAAC iSGS¹⁰⁰⁰ cohort, 810 patients participated in a 3-year prospective study comparing surgical treatment efficacy and 385 had appropriate PEF measurements and follow-up data. Of those patients, 42% (161/385) required at least one operation during study follow-up. The mean PEF preceding operative intervention was 241 L/min (95% confidence interval [CI]: 120-380) corresponding to a predicted PEF of 52%. The mean increase in PEF following a procedure was 111 L/min (95% CI: 96-125 L/min). Interestingly, the magnitude of immediate PEF improvement was not predictive of disease recurrence (hazard ratio [HR] for 100 L/min increase = 0.90, 95% CI: 0.60-1.00). However, recurrence was associated with the magnitude of PEF decline over 90 days (30% vs. 10% decline, HR = 2.2, 95% CI: 1.5-3.0).

CONCLUSIONS: We provide normative PEF data on a large iSGS patient cohort. The degree of PEF improvement immediately after surgery was not associated with a longer procedure-free interval. However, a 30% decline in PEF over 90 days was associated with elevated risk of disease recurrence.

LEVEL OF EVIDENCE: 2 Laryngoscope, 131:E2841-E2848, 2021.

Author List

Kimura K, Du L, Berry LD, Huang LC, Chen SC, Francis DO, Gelbard A, North American Airway Collaborative (NoAAC)

Authors

Joel H. Blumin MD Chief, Professor in the Otolaryngology department at Medical College of Wisconsin
Jonathan Bock MD Professor in the Otolaryngology department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Female
Humans
Laryngoscopy
Laryngostenosis
Longitudinal Studies
Male
Middle Aged
Peak Expiratory Flow Rate
Prognosis
Prospective Studies
Recurrence
Reoperation
Risk Assessment
Surveys and Questionnaires
Treatment Outcome