ASTHMAOriginal Research ways of patients with refractory asthma, which allows for better phenotyping of these individuals and, thus, specifi c patient-oriented therapy. 6 This approach has led to improved outcomes. 6 Laryngopharyngeal refl ux (LPR) can occur in association with gastroesophageal refl ux (GER) or independent from GER. LPR can be injurious to the supraglottic area and lower airway, with potential aspiration. To better evaluate potential supraglottic injury resulting from LPR, a supraglottic index (SGI) was developed and used to give objective, applicable, and reproducible data for use in patients with asthma. 6 To R efractory 1 or severe asthma has a high associated morbidity and economic cost. 2,3 Even with asthma guideline therapy, 4 up to 50% of patients have asthma that is not well controlled or is refractory to treatment. 5 Fiber-optic bronchoscopy has been shown to be useful in evaluating both the upper and lower airBackground: Patients with refractory asthma frequently have elements of laryngopharyngeal refl ux (LPR) with potential aspiration contributing to their poor control. We previously reported on a supraglottic index (SGI) scoring system that helps in the evaluation of LPR with potential aspiration. However, to further the usefulness of this SGI scoring system for bronchoscopists, a teaching system was developed that included both interobserver and intraobserver reproducibility. Methods: Five pulmonologists with expertise in fi ber-optic bronchoscopy but novice to the SGI participated. A training system was developed that could be used via Internet interaction to make this learning technique widely available. Results: By the fi nal testing, there was excellent interreader agreement ( k of at least 0.81), thus documenting reproducibility in scoring the SGI. For the measure of intrareader consistency, one reader was arbitrarily selected to rescore the fi nal test 4 weeks later and had a k value of 0.93, with a 95% CI of 0.79 to 1.00. Conclusions: In this study, we demonstrate that with an organized educational approach, bronchoscopists can develop skills to have highly reproducible assessment and scoring of supraglottic abnormalities. The SGI can be used to determine which patients need additional intervention to determine causes of LPR and gastroesophageal refl ux. Identifi cation of this problem in patients with refractory asthma allows for personal, individual directed therapy to improve asthma control. CHEST 2014; 145(3):486-491Abbreviations: GER 5 gastroesophageal refl ux; LPR 5 laryngopharyngeal refl ux; RFS 5 refl ux fi nding score; SGI 5 supraglottic index

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