Journal article
Modeling Recurrence in Idiopathic Subglottic Stenosis With Mobile Peak Expiratory Flow
The Laryngoscope, Vol.131(12), pp.E2841-E2848
12/01/2021
DOI: 10.1002/lary.29760
PMCID: PMC8595545
PMID: 34309022
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(1000) cohort recorded PEF data on a mobile smartphone app. Cox regression tested the associations between the magnitude of postoperative PEF improvement and longitudinal 90-day PEF decline with the risk of disease recurrence.
Results: Within the NoAAC iSGS(1000) 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 one operation during study follow-up. The mean PEF preceding operative intervention was 241 L/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 (hazard ratio [HR] for 100 L/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.
Details
- Title: Subtitle
- Modeling Recurrence in Idiopathic Subglottic Stenosis With Mobile Peak Expiratory Flow
- Creators
- Kyle Kimura - Vanderbilt University Medical CenterLiping Du - Vanderbilt UniversityLynn D. Berry - Vanderbilt UniversityLi-Ching Huang - Vanderbilt UniversitySheau-Chiann Chen - Vanderbilt UniversityDavid O. Francis - University of Wisconsin–MadisonAlexander Gelbard - Vanderbilt University Medical CenterNorth American Airway Collaborative
- Contributors
- Henry T Hoffman (Contributor) - University of Iowa, OtolaryngologyDouglas J Van Daele (Contributor) - University of Iowa, Otolaryngology
- Resource Type
- Journal article
- Publication Details
- The Laryngoscope, Vol.131(12), pp.E2841-E2848
- DOI
- 10.1002/lary.29760
- PMID
- 34309022
- PMCID
- PMC8595545
- NLM abbreviation
- Laryngoscope
- ISSN
- 0023-852X
- eISSN
- 1531-4995
- Publisher
- Wiley
- Number of pages
- 8
- Grant note
- 1409-22214 / Patient Centered Outcomes Research Institute; Patient-Centered Outcomes Research Institute - PCORI R01HL146401-01 / National Heart, Lung, and Blood Institute, NIH; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Heart Lung & Blood Institute (NHLBI)
- Language
- English
- Date published
- 12/01/2021
- Academic Unit
- Radiation Oncology; Otolaryngology
- Record Identifier
- 9984312244902771
Metrics
5 Record Views