The Value of Dyspnea and Spirometry in Detecting Relapse of Benign Tracheal Stenosis

Abstract

<b><i>Background:</i></b> Benign tracheal stenosis may relapse after management. <b><i>Objectives:</i></b> This study aimed to assess the value of dyspnea and spirometry in detecting relapse of benign tracheal stenosis. <b><i>Methods:</i></b> 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. <b><i>Results:</i></b> 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. <b><i>Conclusions:</i></b> 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.

COVID-19 Patients Presenting with Post-Intubation Upper Airway Complications: A Parallel Epidemic?

“…Our facility is a large referral center for Interventional Pulmonology and central airway strictures management, receiving every year six to seven cases of post-intubation tracheal stenosis from different ICUs around the country. During the 5-year-period 2015–2019, we admitted and described 35 such patients [ 21 ], while since the COVID-19 pandemic outbreak, we have admitted an unprecedented high number of patients (23 in 18 months), who soon after discharge from the ICU developed stridor and exertional dyspnea due to post-intubation/post-tracheostomy airway stenosis and/or tracheoesophageal fistulae. The true incidence of PITS might be even higher as a number of post-COVID patients may not be referred for dyspnea/tracheal stenosis due to more debilitating COVID-related post-ICU sequelae.…”

Influence of Achalasia on the Spirometry Flow–Volume Curve and Peak Expiratory Flow

“…Patients in our study who had a flattened expiratory curve had a reduction in PEF (less than 80% predicted values). A study by Kossoyvaki and colleagues defined the possibility of monitoring patients with relapsed benign tracheal stenosis with PEF [27,28]. They showed great results.…”