Author(s)
James J. Daniero, MD
Delaney Carpenter, BS
Stephen Bakos, MD
Matthew S. Clary, MD
Alexander Gelbard, MD
Affiliation(s)
University of Virginia
Abstract:
Patients with the same disease experience their illness differently. Despite the unique and homogeneous population in ISGS, in practice it seems as though some patients tolerate a great deal of stenosis prior to significant functional compromise, while others are quite sensitive to even a small change in the degree of stenosis. There is currently no measure that is used to follow a patient’s sensitivity to their disease over time. The Clinical COPD Questionnaire (CCQ), a simple survey that has been validated for assessing the psychophysical well-being and symptom severity in patients with LTS, may prove useful in determining a patient’s disease sensitivity when used in conjunction with pulmonary function values. Records of 28 adult patients evaluated for management of idiopathic subglottic stenosis between June of 2014 and June of 2016 were entered into a database and retrospectively analyzed. The utility of the total peak flow rate (TPF) and expiratory disproportion index (EDI) in the determination of stenosis grade were analyzed. We also calculated two different disease severity indices, incorporating spirometry and Clinical COPD Questionnaire (CCQ) scores into a single value to quantify a patient’s subjective experience with the disease over time. TPF was superior to EDI in distinguishing grade I stenosis from grade II and III stenosis. Using a threshold value of 7.5 L/s or below, we were able to differentiate the groups with a sensitivity of 91.7% and specificity of 72.5%. For each of these visits, both disease sensitivity indices were calculated as above and the resultant values were plotted as a function of time, where time zero is the first visit in which this data was collected. Furthermore, no significant relationship was discovered between the disease sensitivity index and time. This suggests that a patient's experience of iSGS is a relatively constant factor that varies along with disease severity over time.