Effect of inhaled fluticasone propionate on laryngotracheal stenosis after balloon dilation: a randomized controlled trial

Abstract

Purpose Laryngotracheal stenosis describes various airflow compromising conditions leading to laryngeal and tracheal narrowing, including subglottic and tracheal stenosis. Direct laryngobronchoscopy is the diagnostic gold standard for laryngotracheal stenosis. This study aimed to explore the effect of inhaled fluticasone propionate as adjuvant medical therapy in patients with laryngotracheal stenosis after balloon dilation. Methods This prospective randomized controlled trial was conducted from April 2019 to April 2020. Fourteen adults (≥ 18 years) with laryngotracheal stenosis consented to participate. All patients underwent endoscopic balloon dilation. Seven patients were treated with inhaled fluticasone propionate, and seven acted as controls. Detailed documentation of operative findings and pre-and post-balloon dilation spirometry measurements were recorded. Basic demographic data and operative details, including information about the percentage of laryngotracheal stenosis, distance of laryngotracheal stenosis from the vocal cords, the stenotic segment vertical length, and the largest endotracheal tube used before and after dilation were noted. Results Spirometry measurements were obtained on 34 occasions (17 before and 17 after balloon dilation). The two groups were similar in spirometry values after treatment. Both groups had significantly improved on most spirometry values after balloon dilation. Conclusion We found that using inhaled steroids after balloon dilatation in patients with laryngotracheal stenosis had no benefit over non-user patients in spirometry parameters during the short postoperative follow-up. To confirm this outcome, we recommend a large-scale double-blind study with a longer follow-up period.

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

“…Some case reports and retrospective series argue for the efficacy of ICS in treating airway stenosis, but there is a paucity of prospective data on the therapy [92,93]. In a small prospective randomized controlled trial (n = 14), the use of ICS in LTS after balloon dilation showed no short-term benefits of treatment [94]. These findings may be explained by a computational analysis using 3-dimensional larynx models that suggests in ideal conditions, only 2.48% of inhaled drug particles may deposit at the site of stenosis [95].…”

Recurrence Following Endoscopic Laser Wedge Excision and Triple Medical Therapy for Idiopathic Subglottic Stenosis

“…051). More recent studies also found no strong evidence for triple therapy as a whole or for any individual component 6,13,15 . However, these studies were unable to account for therapy compliance.…”

“…While there is wide agreement in the theoretical benefit of treating iSGS with ICS and PPI, [12][13][14] the use of TMP-SMX remains the most controversial aspect. 6,15 Since 2005, our institution has regularly prescribed TMP-SMX for iSGS.…”

Nonmalignant Central Airway Obstruction: Options for Challenging Cases

“…The delivery modality has varied throughout the years and has been described as systemic, nebulized, delivered through a meter dose inhaler, and submucosal injection. 23 Submucosal injection has been proposed as a delivery modality with minimal side effects due to its limited systemic absorption. 22 The most common agent utilized has been triamcinolone acetonide (40 mg/mL).…”