Modeling Recurrence in Idiopathic Subglottic Stenosis With Mobile Peak Expiratory Flow

Authors

Kyle Kimura
Liping Du
Lynn D Berry
Li-Ching Huang
Sheau-Chiann Chen
David O Francis
Alexander Gelbard

Publication Date

12-1-2021

Journal

Laryngoscope

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) iSGS

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 1 operation during study follow-up. The mean PEF preceding operative intervention was 241L/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 (HR for 100L/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.

Keywords

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, iSGS, PEF, Expiratory Flow, Disease-free interval

Comments

PMID: 34309022