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Therapeutic bronchoscopy for malignant central airway obstruction: success rates and impact on dyspnea and quality of life.

Publication ,  Journal Article
Ost, DE; Ernst, A; Grosu, HB; Lei, X; Diaz-Mendoza, J; Slade, M; Gildea, TR; Machuzak, MS; Jimenez, CA; Toth, J; Kovitz, KL; Ray, C ...
Published in: Chest
May 2015

BACKGROUND: There is significant variation between physicians in terms of how they perform therapeutic bronchoscopy, but there are few data on whether these differences impact effectiveness. METHODS: This was a multicenter registry study of patients undergoing therapeutic bronchoscopy for malignant central airway obstruction. The primary outcome was technical success, defined as reopening the airway lumen to > 50% of normal. Secondary outcomes were dyspnea as measured by the Borg score and health-related quality of life (HRQOL) as measured by the SF-6D. RESULTS: Fifteen centers performed 1,115 procedures on 947 patients. Technical success was achieved in 93% of procedures. Center success rates ranged from 90% to 98% (P = .02). Endobronchial obstruction and stent placement were associated with success, whereas American Society of Anesthesiology (ASA) score > 3, renal failure, primary lung cancer, left mainstem disease, and tracheoesophageal fistula were associated with failure. Clinically significant improvements in dyspnea occurred in 90 of 187 patients measured (48%). Greater baseline dyspnea was associated with greater improvements in dyspnea, whereas smoking, having multiple cancers, and lobar obstruction were associated with smaller improvements. Clinically significant improvements in HRQOL occurred in 76 of 183 patients measured (42%). Greater baseline dyspnea was associated with greater improvements in HRQOL, and lobar obstruction was associated with smaller improvements. CONCLUSIONS: Technical success rates were high overall, with the highest success rates associated with stent placement and endobronchial obstruction. Therapeutic bronchoscopy should not be withheld from patients based solely on an assessment of risk, since patients with the most dyspnea and lowest functional status benefitted the most.

Duke Scholars

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Published In

Chest

DOI

EISSN

1931-3543

Publication Date

May 2015

Volume

147

Issue

5

Start / End Page

1282 / 1298

Location

United States

Related Subject Headings

  • Respiratory System
  • Remission Induction
  • Quality of Life
  • Middle Aged
  • Male
  • Lung Neoplasms
  • Humans
  • Female
  • Dyspnea
  • Bronchoscopy
 

Citation

APA
Chicago
ICMJE
MLA
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Ost, D. E., Ernst, A., Grosu, H. B., Lei, X., Diaz-Mendoza, J., Slade, M., … AQuIRE Bronchoscopy Registry, . (2015). Therapeutic bronchoscopy for malignant central airway obstruction: success rates and impact on dyspnea and quality of life. Chest, 147(5), 1282–1298. https://doi.org/10.1378/chest.14-1526
Ost, David E., Armin Ernst, Horiana B. Grosu, Xiudong Lei, Javier Diaz-Mendoza, Mark Slade, Thomas R. Gildea, et al. “Therapeutic bronchoscopy for malignant central airway obstruction: success rates and impact on dyspnea and quality of life.Chest 147, no. 5 (May 2015): 1282–98. https://doi.org/10.1378/chest.14-1526.
Ost DE, Ernst A, Grosu HB, Lei X, Diaz-Mendoza J, Slade M, et al. Therapeutic bronchoscopy for malignant central airway obstruction: success rates and impact on dyspnea and quality of life. Chest. 2015 May;147(5):1282–98.
Ost, David E., et al. “Therapeutic bronchoscopy for malignant central airway obstruction: success rates and impact on dyspnea and quality of life.Chest, vol. 147, no. 5, May 2015, pp. 1282–98. Pubmed, doi:10.1378/chest.14-1526.
Ost DE, Ernst A, Grosu HB, Lei X, Diaz-Mendoza J, Slade M, Gildea TR, Machuzak MS, Jimenez CA, Toth J, Kovitz KL, Ray C, Greenhill S, Casal RF, Almeida FA, Wahidi MM, Eapen GA, Feller-Kopman D, Morice RC, Benzaquen S, Tremblay A, Simoff M, AQuIRE Bronchoscopy Registry. Therapeutic bronchoscopy for malignant central airway obstruction: success rates and impact on dyspnea and quality of life. Chest. 2015 May;147(5):1282–1298.

Published In

Chest

DOI

EISSN

1931-3543

Publication Date

May 2015

Volume

147

Issue

5

Start / End Page

1282 / 1298

Location

United States

Related Subject Headings

  • Respiratory System
  • Remission Induction
  • Quality of Life
  • Middle Aged
  • Male
  • Lung Neoplasms
  • Humans
  • Female
  • Dyspnea
  • Bronchoscopy