Abstract
BackgroundIn patients with bronchial obstruction, pulmonary function tests may not change significantly after intervention. The airflow asynchrony in both lungs due to unilateral bronchial obstruction may be applicable as a physiological indicator. The airflow asynchrony is reflected by the difference in the left and right lung sound development at tidal breathing.ObjectivesTo investigate the usefulness of left and right lung asynchrony due to unilateral bronchial obstruction as a physiological indicator for interventional bronchoscopy.MethodsFifty cases with central airway obstruction were classified into three groups: tracheal, bronchial and extensive obstruction. The gap index was defined as the absolute value of the average of gaps between the left and right lung sound intensity peaks for a 12-second duration.ResultsBefore interventional bronchoscopy, the gap index was significantly higher in the bronchial (p<0.05) and extensive obstruction groups (p<0.05) than in the tracheal group. The gap index in cases with unilateral bronchial obstruction of at least 80% (0.18±0.04 seconds) was significantly higher than in cases with less than 80% obstruction (0.02±0.01 seconds, p<0.05). After intervention for bronchial obstruction, the dyspnea scale (p<0.001) and gap index significantly improved (p<0.05), although no significant improvements were found in spirometric assessments. The responder rates for dyspnea were 79.3% for gap indexes over 0.06 seconds and 55.6% for gap indexes of 0.06 seconds or under.ConclusionsAssessment of left and right lung asynchrony in central airway obstruction with bronchial involvement may provide useful physiological information for interventional bronchoscopy.
Highlights
Patients suffering from central airway obstruction (CAO) can receive significant relief from life-threatening symptoms through interventional bronchoscopy
Before interventional bronchoscopy, the gap index was significantly higher in the bronchial (p,0.05) and extensive obstruction groups (p,0.05) than in the tracheal group
The gap index in cases with unilateral bronchial obstruction of at least 80% (0.1860.04 seconds) was significantly higher than in cases with less than 80% obstruction (0.0260.01 seconds, p, 0.05)
Summary
Patients suffering from central airway obstruction (CAO) can receive significant relief from life-threatening symptoms through interventional bronchoscopy. Performing interventional procedures at the exact location of the obstruction can provide the greatest functional benefit to patients [1,2,3,4,5,6,7,8,9,10]. To evaluate the effects of intervention during the procedure, we have recently introduced airway pressure assessment. The lateral airway pressure is measured during intervention to physiologically evaluate tracheal obstruction, and we have found that lateral airway pressure measurement can estimate the need for additional procedures [15]. In patients with bronchial obstruction, pulmonary function tests may not change significantly after intervention. The airflow asynchrony in both lungs due to unilateral bronchial obstruction may be applicable as a physiological indicator. The airflow asynchrony is reflected by the difference in the left and right lung sound development at tidal breathing
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