Contribution of flow-volume curves to the detection of central airway obstruction

Raposo, Liliana; Bugalho, António; Gomes, Maria João Marques

doi:10.1590/s1806-37132013000400008

Cited by 12 publications

(14 citation statements)

References 17 publications

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“…In 10 cases without recurrence, we observed aspecific alterations of loop. Sterner et al Second, in line with previous studies [3,8,[14][15][16][17][18], MEF50%/MIF50% ratio was the most sensitive quantitative parameter, and correctly identified 21 out of 27 (78%) patients with recurrence. In the most of fixed stenosis (16 of 21; 76%), the value of MEF50%/MIF50% ratio was between 1 and 1.5, since the fixed scar similarly reduced MIF50% and MEF50%.…”

Section: Comparison Among Each Individual Criterionsupporting

confidence: 81%

Flow-Volume Curve Analysis for Predicting Recurrence After Endoscopic Dilation of Airway Stenosis

Fiorelli

Poggi

Ardò

et al. 2019

The Annals of Thoracic Surgery

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BACKGROUND: The flow-volume curve is a simple test for diagnosing upper airway obstruction. We evaluated its use to predict recurrence in patients undergoing endoscopic dilation for treatment of benign upper airway stenosis. METHODS: The data of 89 consecutive patients undergoing endoscopic dilation of simple upper airway stenosis were retrospectively reviewed. Morphological distortion of flow-volume loop (visual analysis) and quantitative criteria including MEF 50% /MIF 50% <0.3 or > 1.0; FEV 1 /MEF>10; and FEV 1 /FEV 0.5 >1.5 were considered as predictive of recurrence. In all cases, the recurrence was confirmed by radiological and/or bronchoscopic findings. The sensitivity, specificity, PPV, NPV, and accuracy of visual, quantitative and aggregate criteria for detecting recurrence were computed and compared. RESULTS: Of89 patients treated, 27 (30%) had a recurrence. Visual analysis presented a sensitivity, specificity, PPV, NPV, and accuracy of 63%; 83.9%; 63%; and 83.9%, and 77.5% respectively. Among the quantitative criterion, the MEF50%/MIF50% was the most accurate having a sensitivity, specificity, PPV, NPV, and accuracy of 77.8%; 79%; 61.8%; and 89.1%, and 78.7% respectively. Aggregate criterion presented the best yield compared to other criteria in terms of sensitivity (81.5%), specificity (91.9%), PPV (81.5%), NPV (91.9%), and accuracy (88.8%). CONCLUSIONS: The flow-volume curve is a simple and non-invasive method to follow patients undergoing endoscopic dilation of upper airway stenosis. Morphological changes in the flowvolume loop and in the MEF50%/MIF50% ratio are suggestive of recurrence and guide the physician to implement the follow-up with further diagnostic (non)invasive exams.

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Section: Comparison Among Each Individual Criterionsupporting

confidence: 81%

Flow-Volume Curve Analysis for Predicting Recurrence After Endoscopic Dilation of Airway Stenosis

Fiorelli

Poggi

Ardò

et al. 2019

The Annals of Thoracic Surgery

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“…Although beyond the scope of this review, multiple quantitative spirometric criteria have been proposed to detect the disproportionate reduction in maximal flow rates responsible for the classic truncation of the inspiratory and expiratory limbs seen on visual assessment of flow volume curves (24,25). Additionally, effort independent technologies such as vibration response imaging (VRI) and impulse oscillometry (IOS) have shown promise as alternative methods to detect and quantify CAO but the role of these technologies remains unclear (26)(27)(28)(29).…”

Section: Pulmonary Function Testingmentioning

confidence: 99%

Malignant central airway obstruction

Mudambi¹,

Miller²,

Eapen³

2017

J. Thorac. Dis.

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This review comprehensively describes recent advances in the management of malignant central airway obstruction (CAO). Malignant CAO can be a dramatic and devastating manifestation of primary lung cancer or metastatic disease. A variety of diagnostic modalities are available to provide valuable information to plan a therapeutic intervention. Clinical heterogeneity in the presentation of malignant CAO provides opportunities to adapt and utilize endoscopic technology and tools in many ways. Mechanical debulking, thermal tools, cryotherapy and airway stents are methods and instruments used to rapidly restore airway patency. Delayed bronchoscopic methods, such as photodynamic therapy (PDT) and brachytherapy can also be utilized in specific non-emergent situations to establish airway patency. Although data regarding the success and complications of therapeutic interventions are retrospective and characterized by clinical and outcome measure variability, the symptoms of malignant CAO can often be successfully palliated. Assessment of risks and benefits of interventions in each individual patient during the decision-making process forms the critical foundation of the management of malignant CAO.

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“…In fact, in addition to the positive correlation detected between the FEF 50% /FIF 50% ratio and Rm, the present investigation revealed associations between FEF 50% /FIF 50% and cervical tracheal diameter and Δ tracheal diameters. The negative correlation between the FEF 50% /FIF 50% ratio and the cervical tracheal diameter reflected the limitation of the inspiratory flow in this tracheal region and has been previously reported in patients with LAO who underwent fibrobronchoscopy [ 23 ].…”

Section: Discussionmentioning

confidence: 64%

“…However, we did not find any statistically significant correlation of this scale with the parameters studied, which was in contrast to the results reported by de Andrade and Raposo et al . [ 23 ], who found a statistically significant correlation between the MMRC scale and an obstruction in the upper third of the trachea in patients without acromegaly. For that reason, we believe that the mechanisms responsible for dyspnea in acromegalic patients are multiple and involve more than the obstruction of the trachea.…”

Section: Discussionmentioning

confidence: 99%

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Functional changes are associated with tracheal structural abnormalities in patients with acromegaly

Camilo

Guimarães

Mogami

et al. 2016

aoms

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IntroductionAlthough impaired pulmonary function and respiratory sleep disorders are described as responsible for increased mortality in acromegalic patients, little is known about the tracheal abnormalities in this group of patients. Thus, the objectives of this study were to describe the tracheal structural abnormalities and correlate these changes with the respiratory function and clinical data of acromegalic patients.Material and methodsThis is a cross-sectional study that was carried out at two university hospitals. Twenty acromegalic patients underwent spirometry, forced oscillation technique, and computed tomography (CT) assessments. Dyspnea and daytime sleepiness were assessed using the Modified Medical Research Council (MMRC) scale and the Epworth Sleepiness Scale (ESS), respectively. Forty matched subjects served as controls.ResultsThe acromegalic patients exhibited larger median ratios between forced expiratory flow and forced inspiratory flow at 50% of the forced vital capacity (FEF50%/FIF50%) (2.05 vs. 1.06, p = 0.0001) compared with healthy volunteers. In the CT analysis, acromegalic patients exhibited larger median differences between their cervical and thoracic tracheal diameters (Δ tracheal diameters) (3 vs. 1 mm; p = 0.003). An association was found between FEF50%/FIF50% and the following variables: mean resistance (Rm), cervical tracheal diameter, and Δ tracheal diameters. Rm also exhibited a negative correlation with cervical tracheal diameter. Neither the MMRC scale nor the ESS exhibited any significant correlation with large airway obstruction (LAO) indices or with the measured tracheal diameters.ConclusionsAcromegalic patients have tracheal structural abnormalities which are associated with functional indicators of LAO but not with clinical data.

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Contribution of flow-volume curves to the detection of central airway obstruction

Cited by 12 publications

References 17 publications

Flow-Volume Curve Analysis for Predicting Recurrence After Endoscopic Dilation of Airway Stenosis

Flow-Volume Curve Analysis for Predicting Recurrence After Endoscopic Dilation of Airway Stenosis

Malignant central airway obstruction

Functional changes are associated with tracheal structural abnormalities in patients with acromegaly

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