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Lung India Official publication of Indian Chest Society  
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ORIGINAL ARTICLE
Year : 2020  |  Volume : 37  |  Issue : 2  |  Page : 114-119

Rigid bronchoscopic interventions for central airway obstruction – An observational study


1 Department of Pulmonary Medicine, SGPGIMS, Lucknow, Uttar Pradesh, India
2 Department of Radiodiagnosis, SGPGIMS, Lucknow, Uttar Pradesh, India
3 Department of Anesthesiology, SGPGIMS, Lucknow, Uttar Pradesh, India

Correspondence Address:
Dr. Alok Nath
Department of Pulmonary Medicine, SGPGIMS, Lucknow, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/lungindia.lungindia_454_19

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Background: Central airway obstruction (CAO) is a significant cause of morbidity and mortality in patients with thoracic malignancies. In this prospective study, we describe the role of rigid bronchoscopy (RB) in the multimodality management of CAO. Methods: Prospective description of different rigid bronchoscopic techniques used for CAO between July 2016 and July 2019. Results: A total of 152 procedures (124 therapeutic/palliative and 28 diagnostics) in 111 adults and 10 pediatric patients were performed. The mean age in 111 adults (66 males) and 10 pediatric (5 males) patients were 45.4 ± 15.8 (range 16–80) and 5.4 ± 3.6 (range 1–10) years, respectively. Palliation of the airway obstruction (48.8%) and establishment of diagnosis (23.2%) were the main indications of RB in our study. Mechanical debulking in 53 (57%) and airway dilatation in 40 (43%) patients were the most utilized interventions during the palliative or therapeutic RB. There was a significant decrease in mean (modified Medical Research Council) dyspnea scale from 3.9 ± 1.0 to 1.42 ± 0.63 and increase in mean Visual Analogue Scale from 2.06 ± 0.74 to 8.7 ± 0.54 after the procedure (P < 0.0001). Additional therapy was undertaken in 38 (31.4%) of 121 patients, and surgical excision was the primary form of definitive treatment in 17 patients Moderate bleeding was encountered in 13.3% of the procedures mainly in the diagnostic RB. The mean procedure duration was 28.4 (range, 11–49) min and 13.2 (7–22) min in the adults and pediatric patients, respectively. A total of 31 patients succumbed to the illness due to the progressive nature of their disease. Conclusions: An individualized approach to interventional procedures is safe and effective way to achieve and maintain palliation of CAO. RB with multimodality treatment achieves the goal in majority of the patients.


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