Modeling Recurrence in Idiopathic Subglottic Stenosis With Mobile Peak Expiratory Flow. (26th July 2021)

• Record Type: Journal Article
• Authors: Kimura, Kyle; Du, Liping; Berry, Lynn D.; Huang, Li‐Ching; Chen, Sheau‐Chiann; Francis, David O.; Gelbard, Alexander
• Other Names: Anderson Catherine investigator.; Amin Milan R. investigator.; Benninger Michael S. investigator.; Blumin Joel H. investigator.; Bock Jonathan M. investigator.; Bryson Paul C. investigator.; Castellanos Paul F. investigator.; Chen Sheau‐Chiann investigator.; Clary Matthew S. investigator.; Cohen Seth M. investigator.; Crawley Brianna K. investigator.; Dailey Seth H. investigator.; Daniero James J. investigator.; de Alarcon Alessandro investigator.; Donovan Donald T. investigator.; Edell Eric S. investigator.; Ekbom Dale C. investigator.; Fink Daniel S. investigator.; Franco Ramon A. investigator.; Garrett C. Gaelyn investigator.; Guardiani Elizabeth A. investigator.; Hillel Alexander T. investigator.; Hoffman Henry T. investigator.; Hogikyan Norman D. investigator.; Howell Rebecca J. investigator.; Hussain Lena K. investigator.; Johns Michael M. investigator.; Kasperbauer Jan L. investigator.; Khosla Sid M. investigator.; Kinnard Cheryl investigator.; Kupfer Robbi A. investigator.; Langerman Alexander J. investigator.; Lee Jaclyn investigator.; Lentz Robert J. investigator.; Lorenz Robert R. investigator.; Lott David G. investigator.; Makani Samir S. investigator.; Maldonado Fabien investigator.; Mannion Kyle investigator.; Matrka Laura investigator.; McWhorter Andrew J. investigator.; Merati Albert L. investigator.; Mori Matthew investigator.; Netterville James L. investigator.; O'Dell Karla investigator.; Ongkasuwan Julina investigator.; Patel Siddharth A. investigator.; Postma Gregory N. investigator.; Reder Lindsay S. investigator.; Rohde Sarah L. investigator.; Richardson Brent E. investigator.; Rickman Otis B. investigator.; Rosen Clark A. investigator.; Rutter Michael J. investigator.; Sandhu Guri S. investigator.; Schindler Joshua S. investigator.; Schneider G. Todd investigator.; Shah Rupali N. investigator.; Sikora Andrew G. investigator.; Sinard Robert J. investigator.; Smith Marshall E. investigator.; Smith Libby J. investigator.; Soliman Ahmed MS. investigator.; Sveinsdóttir Sigríður investigator.; Van Daele Douglas J. investigator.; Veivers David investigator.; Verma Sunil P. investigator.; Weinberger Paul M. investigator.; Weissbrod Philip A. investigator.; Wootten Christopher T. investigator.; Shyr Yu investigator.;
• Is Part Of: Laryngoscope. Volume 131:Number 12(2021)
• Page Start: E2841
• Page End: E2848
• Publication Date: 2021-07-26
• Subjects: Idiopathic subglottic stenosis -- peak expiratory flow -- expiratory flow -- disease‐free interval; Otolaryngology -- Periodicals; 617.51005
• DOI: 10.1002/lary.29760
• Languages: English
• ISSNs: 0023-852X

Abstract

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. Level of Evidence: 2 Laryngoscope, 131:E2841–E2848, 2021