Does the <scp>Expiratory Disproportion Index</scp> Remain Predictive of Airway Stenosis in Obese Patients?

Calamari, Kevin; Politano, Stephen; Matrka, Laura

doi:10.1002/lary.28850

Cited by 3 publications

(7 citation statements)

References 20 publications

(30 reference statements)

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“…Pulmonary function tests (PFTs) have proven reliable for diagnosis and differentiation of LTS from other pulmonary diseases through the use of the expiratory disproportion index (EDI), which is based on the ratio of forced expiratory volume in 1 s to peak expiratory flow rate [64]. The diagnostic utility of EDI in obese patients is reliable, albeit with a lower sensitivity than nonobese patients, making it less useful to rule out airway stenosis in this cohort [65]. This diagnostic test could potentially prevent delays in diagnosis.…”

Section: Diagnosis and Preoperative Evaluationmentioning

confidence: 99%

An Updated Review of Subglottic Stenosis: Etiology, Evaluation, and Management

2022

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Purpose of ReviewTo assimilate the newly published literature regarding subglottic stenosis (SGS), including basic science and translational research on mechanisms of etiology, clinical diagnostics, and therapeutic treatments. Recent FindingsThe role of inflammation in development of iatrogenic and idiopathic SGS (iSGS) is continuing to be studied. The IL-23/IL-17A inflammatory axis appears to be a potential mechanism for development of iSGS. Additionally, as anticipated in an inflammatory milieu, PD-1/PD-L1 expression is upregulated. If the PD-1/PD-L1 axis is important in SGS pathogenesis, then it may represent a potential target for immunotherapeutic inhibition, given its success in cancer treatment. In terms of surgical management, prospective studies show that endoscopic approaches have more frequent recurrence compared to open techniques. Summary SGS arises from various etiologies, and further understanding of its pathogenesis can aid in the development of novel therapies. It is imperative to obtain a thorough history for each patient presenting with respiratory complaints, as misdiagnosis can delay proper treatment. Endoscopic and open surgical techniques continue to be investigated in a growing number of prospective clinical trials to determine optimal treatment protocols. In-office injections are gaining popularity and show promise in the treatment of SGS.

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Section: Diagnosis and Preoperative Evaluationmentioning

confidence: 99%

An Updated Review of Subglottic Stenosis: Etiology, Evaluation, and Management

2022

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“…Today, there’s a lack of evidence on the validity of the EDI as screening parameter for upper airway stenosis. To our knowledge, there are only two recent studies who reported on the diagnostic accuracy of the EDI for upper airway stenosis patients: Nouraei et al in 2013 and Calamari et al in 2020 [ 13 , 14 ].…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…The second report on the EDI, of Calamari et al in 2020, focused on the influence of obesity on the diagnostic accuracy of the EDI as screening tool for upper airway stenosis [ 14 ]. They defined obesity as a BMI > 30 [ 14 ]. They found a sensitivity of 50.0% (95% CI 32.7%-67.3%) and specificity of 71.9% (95% CI 68.2%‐75.6%) using a cut-off EDI value of > 50 for obese stenotic versus obese non-stenotic patients [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

“…They found a sensitivity of 50.0% (95% CI 32.7%-67.3%) and specificity of 71.9% (95% CI 68.2%‐75.6%) using a cut-off EDI value of > 50 for obese stenotic versus obese non-stenotic patients [ 14 ]. They concluded that although the mean EDI values were significantly different in stenotic and nonstenotic patients in both BMI cohorts, the EDI was not as sensitive at identifying stenotic cases in obese patients as in nonobese patients [ 14 ]. Our study cohort didn’t include just a few obese patientsso it was not possible to confirm this.…”

Section: Discussionmentioning

confidence: 99%

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The diagnostic accuracy of spirometry as screening tool for adult patients with a benign subglottic stenosis

Schuering,

Halperin,

Ninaber

et al. 2023

BMC Pulm Med

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Background There is a considerable diagnostic delay in the diagnosis ‘benign acquired subglottic stenosis in adults’ (SGS, diagnosed by the reference standard, i.e. laryngo- or bronchoscopy). Patients are frequently misdiagnosed since symptoms of this rare disease may mimic symptoms of ‘asthma.’ The ‘Expiratory Disproportion Index’ (EDI) obtained by spirometry, may be a simple instrument to detect an SGS-patient. The aim of this study was to evaluate the diagnostic accuracy of the EDI in differentiating SGS patients from asthma patients. Methods We calculated the EDI from spirometry results of all SGS-patients in the Leiden University Medical Center (LUMC), who had not received treatment 2 years before their spirometry examination. We compared these EDI results with the EDI results of all true asthma patients between 2011 and 2019, who underwent a bronchoscopy (exclusion of SGS by laryngo- or bronchoscopy). Results Fifty patients with SGS and 32 true asthma patients were included. Median and IQR ranges of the EDI for SGS and asthma patients were 67.10 (54.33–79.18) and 37.94 (32.41–44.63), respectively. Area under the curve (ROC) of the accuracy of the EDI at discriminating SGS and asthma patients was 0.92 (95% CI = 0.86–0.98). The best cut-off point for the EDI was > 48 (i.e. possible upper airway obstruction), with a sensitivity of 88.0%% (95%CI = 77.2-95.0%%) and specificity of 84.4% (95%CI = 69.4-94.1%). Conclusions The EDI has a good diagnostic accuracy discriminating subglottic stenosis patients from asthma patients, when compared to the reference standard. This measurement from spirometry may potentially shorten the diagnostic delay of SGS patients. Further studies are needed to evaluate clinical reproducibility.

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Incidence of Tracheal Stenosis in ICU Hospitalized COVID-19 Patients: Results from a Prospective, Observational, Multicenter Study

Perroni,

Radovanovic,

Mondoni

et al. 2023

JPM

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Background: Tracheal stenosis represents a fearsome complication that substantially impairs quality of life. The recent SARS-CoV-2 pandemic increased the number of patients requiring invasive ventilation through prolonged intubation or tracheostomy, increasing the risk of tracheal stenosis. Study design and methods: In this prospective, observational, multicenter study performed in Lombardy (Italy), we have exanimated 281 patients who underwent prolonged intubation (more than 7 days) or tracheostomy for severe COVID-19. Patients underwent CT scan and spirometry 2 months after hospital discharge and a subsequent clinical follow-up after an additional 6 months (overall 8 months of follow-up duration) to detect any tracheal lumen reduction above 1%. The last follow-up evaluation was completed on 31 August 2022. Results: In the study period, 24 patients (8.5%, CI 5.6–12.4) developed tracheal stenosis in a median time of 112 days and within a period of 200 days from intubation. Compared to patients without tracheal stenosis, tracheostomy was performed more frequently in patients that developed stenosis (75% vs 54%, p = 0.034). Tracheostomy and alcohol consumption (1 unit of alcohol per day) increased risk of developing tracheal stenosis of 2.6-fold (p = 0.047; IC 0.99–6.8) and 5.4-fold (p = 0.002; CI 1.9–16), respectively. Conclusions: In a large cohort of patients, the incidence of tracheal stenosis increased during pandemic, probably related to the increased use of prolonged intubation. Patients with histories of prolonged intubation should be monitored for at least 200 days from invasive ventilation in order to detect tracheal stenosis at early stage. Alcohol use and tracheostomy are risk factors for developing tracheal stenosis.

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Does the Expiratory Disproportion Index Remain Predictive of Airway Stenosis in Obese Patients?

Cited by 3 publications

References 20 publications

An Updated Review of Subglottic Stenosis: Etiology, Evaluation, and Management

An Updated Review of Subglottic Stenosis: Etiology, Evaluation, and Management

The diagnostic accuracy of spirometry as screening tool for adult patients with a benign subglottic stenosis

Incidence of Tracheal Stenosis in ICU Hospitalized COVID-19 Patients: Results from a Prospective, Observational, Multicenter Study

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