Therapeutic Bronchoscopy Improves Spirometry, Quality of Life, and Survival in Central Airway Obstruction

Abstract

Background: Central airway obstruction (CAO) occurs in patients with primary or metastatic lung malignancy and nonmalignant pulmonary disorders and results in significant adverse effects on respiratory function and quality of life. Objectives: The objective of this study was to assess the effect of therapeutic bronchoscopic interventions on spirometry, dyspnea, quality of life, and survival in patients with CAO. Methods: We prospectively studied patients who underwent therapeutic rigid bronchoscopy for CAO. Spirometry, San Diego Shortness of Breath questionnaire (SOBQ), and SF-36 questionnaire responses were obtained before the procedure and at follow-up 6-8 weeks after the procedure. Results: Fifty-three patients (24 malignant and 29 nonmalignant CAO), who underwent successful rigid bronchoscopic intervention, were enrolled. Airway stent placement and various debulking techniques including mechanical debridement and heat therapy were used. After bronchoscopy, there was a significant increase in forced vital capacity (2.2 ± 0.91 l before, 2.7 ± 0.80 l after, p = 0.009) and forced expiratory volume at 1 s (1.4 ± 0.60 l before, 1.8 ± 0.67 l after, p = 0.002). The SOBQ score improved from 55.8 ± 30.1 before the procedure to 37.9 ± 27.25 after the procedure (p = 0.002). In the SF-36, there was an improvement in almost all domains, with statistically significant improvement seen in several domains. Benefits were seen independent of the etiology of CAO, site of intervention or stent placement. The patients with malignant CAO, in whom airway patency could not be achieved, had a poor survival. Conclusions: Alleviation of CAO with therapeutic rigid bronchoscopy results in improvement in spirometry, shortness of breath, quality of life, and survival.

Effect of Verbal Empathy and Touch on Anxiety Relief in Patients Undergoing Flexible Bronchoscopy: Can Empathy Reduce Patients' Anxiety?

“…Flexible bronchoscopy (FB) is an essential tool for the diagnosis and treatment of various pulmonary conditions [4] and is one of the most common procedures performed by pulmonologists. With the induction of sedatives and local anesthetics, FB is generally tolerable for patients under conscious sedation [3,5,6].…”

Novel Magnetic Resonance Imaging for Assessment of Bronchial Stenosis in Lung Transplant Recipients

“…Minimal clinically significant difference of 8 (Range 5–11) and 3 (Range 2–4), in SOBQ and SF-36 respectively, have been described in patients with central airway obstruction. 6 …”

“…An increase of forced expiratory volume at 1 second (FEV1) or forced vital capacity (FVC) of 200 ml was considered clinically significant. 6 …”

“…2,3 It leads to respiratory failure, prolonged hospitalization and adversely impacts quality of life, allograft function and survival. 4–6 The diagnosis is usually established by pulmonary function tests (PFT) and CT scan, followed by bronchoscopy. Although pulmonary function testing is commonly utilized for the assessment of bronchial stenosis, it is effort-dependent, cannot localize the site of obstruction and is fundamentally hampered by low specificity, as multiple etiologies like rejection and infection can lead to abnormal results.…”

Silicone Y-Stent Placement on the Secondary Left Carina

“…Airway stent placement has been known as a useful palliation in patients suffering from airway stenosis [1,2,3,4]. The stents should be inserted so as to cover the whole stenotic region, with a shape selected to fit the anatomical structure of the airway.…”