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How can we identify subglottic stenosis in patients with suspected obstructive disease?
Department of Ear Nose and Throat, Faculty of Medicine and Health, Örebro University Hospital, Örebro, Sweden.ORCID iD: 0000-0001-6065-9016
Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Respiratory Medicine.ORCID iD: 0000-0003-1926-8464
Department of Clinical Physiology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
Department of Ear Nose and Throat, Faculty of Medicine and Health, Örebro University Hospital, Södra Grev Rosengatan, 701 85, Örebro, Sweden; Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.ORCID iD: 0000-0002-2610-6992
2023 (English)In: European Archives of Oto-Rhino-Laryngology, ISSN 0937-4477, E-ISSN 1434-4726, Vol. 280, no 11, p. 4995-5001Article in journal (Refereed) Published
Abstract [en]

PURPOSE: Subglottic stenosis, a rare condition of the upper airway, is frequently misdiagnosed as obstructive lung disease. The aim of this study was to investigate whether subglottic stenosis could be identified and distinguished from asthma and chronic obstructive pulmonary disease (COPD) using spirometry or the dyspnea index (DI).

METHODS: The study population included 43 patients with asthma, 31 patients with COPD and 50 patients with subglottic stenosis planned to undergo endoscopic intervention. All patients completed the DI and underwent dynamic spirometry registering both inspiratory and expiratory volumes and flows, including the expiratory disproportion index (EDI), the ratio of forced expiratory volume in 1 s to peak expiratory flow. One-way analysis of variance assessed the discrepancy of the variables among the study groups, and receiver operating curve (ROC) analysis determined the measurement with the best discriminatory power providing a cutoff value, maximizing both sensitivity and specificity.

RESULTS: The only statistically significant variables differing between all three groups were the EDI and the DI. The EDI showed an excellent area under the ROC curve (0.99, p < 0.001) with a cutoff value of 0.39 (98% sensitivity, 96% specificity), followed by DI (0.87, p < 0.001) with a cutoff score of > 25 (83% sensitivity and 78% specificity).

CONCLUSION: In patients with dyspnea of unknown cause, an increase in EDI should arouse a suspicion of extrathoracic airway obstruction, advocating for further evaluation with laryngotracheoscopy.

Place, publisher, year, edition, pages
Springer, 2023. Vol. 280, no 11, p. 4995-5001
Keywords [en]
Asthma, COPD, Dyspnea Index, Expiratory Disproportion Index, Functional assessment, Subglottic stenosis
National Category
Respiratory Medicine and Allergy
Identifiers
URN: urn:nbn:se:oru:diva-107486DOI: 10.1007/s00405-023-08141-3ISI: 001042445400003PubMedID: 37540269Scopus ID: 2-s2.0-85166980660OAI: oai:DiVA.org:oru-107486DiVA, id: diva2:1786803
Funder
Örebro UniversityRegion Örebro CountyAvailable from: 2023-08-10 Created: 2023-08-10 Last updated: 2024-01-02Bibliographically approved

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Ntouniadakis, EleftheriosSundh, Josefin

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