Therapeutic Bronchoscopy for Malignant Central Airway Obstruction: Success Rates and Impact on Dyspnea and Quality of Life

David E. Ost, MD, MPH, FCCP; Armin Ernst, MD, MHCM, FCCP; Horiana B. Grosu, MD; Xiudong Lei, PhD; Javier Diaz-Mendoza, MD; Mark Slade, MBBS, FCCP; Thomas R. Gildea, MD, FCCP; Michael S. Machuzak, MD, FCCP; Carlos A. Jimenez, MD, FCCP; Jennifer Toth, MD; Kevin L. Kovitz, MD, FCCP; Cynthia Ray, MD, FCCP; Sara Greenhill, MD, FCCP; Roberto F. Casal, MD; Francisco A. Almeida, MD, FCCP; Momen M. Wahidi, MD, FCCP; George A. Eapen, MD, FCCP; David Feller-Kopman, MD, FCCP; Rodolfo C. Morice, MD, FCCP; Sadia Benzaquen, MD; Alain Tremblay, MDCM, FCCP; Michael Simoff, MD, FCCP; on behalf of the AQuIRE Bronchoscopy Registry

BACKGROUND: There is significant variation between physicians in terms of how they perform therapeutic bronchoscopy, but there are few data on whether these differences impact effectiveness.

METHODS: This was a multicenter registry study of patients undergoing therapeutic bronchoscopy for malignant central airway obstruction. The primary outcome was technical success, defined as reopening the airway lumen to > 50% of normal. Secondary outcomes were dyspnea as measured by the Borg score and health-related quality of life (HRQOL) as measured by the SF-6D.

RESULTS: Fifteen centers performed 1,115 procedures on 947 patients. Technical success was achieved in 93% of procedures. Center success rates ranged from 90% to 98% (P = .02). Endobronchial obstruction and stent placement were associated with success, whereas American Society of Anesthesiology (ASA) score > 3, renal failure, primary lung cancer, left mainstem disease, and tracheoesophageal fistula were associated with failure. Clinically significant improvements in dyspnea occurred in 90 of 187 patients measured (48%). Greater baseline dyspnea was associated with greater improvements in dyspnea, whereas smoking, having multiple cancers, and lobar obstruction were associated with smaller improvements. Clinically significant improvements in HRQOL occurred in 76 of 183 patients measured (42%). Greater baseline dyspnea was associated with greater improvements in HRQOL, and lobar obstruction was associated with smaller improvements.

CONCLUSIONS: Technical success rates were high overall, with the highest success rates associated with stent placement and endobronchial obstruction. Therapeutic bronchoscopy should not be withheld from patients based solely on an assessment of risk, since patients with the most dyspnea and lowest functional status benefitted the most.

Chest. 2015;147(5):1282-1298. doi:10.1378/chest.14-1526