title: An index to objectively score supraglottic abnormalities in refractory asthma: learning, validation, and significance.
abstract: BACKGROUND
  Patients with refractory asthma frequently have elements of laryngopharyngeal reflux (LPR) with potential aspiration contributing to their poor control. We previously reported on a supraglottic index (SGI) scoring system that helps in the evaluation of LPR with potential aspiration. However, to further the usefulness of this SGI scoring system for bronchoscopists, a teaching system was developed that included both interobserver and intraobserver reproducibility.
  
  
  METHODS
  Five pulmonologists with expertise in fiber-optic bronchoscopy but novice to the SGI participated. A training system was developed that could be used via Internet interaction to make this learning technique widely available.
  
  
  RESULTS
  By the final testing, there was excellent interreader agreement (κ of at least 0.81), thus documenting reproducibility in scoring the SGI. For the measure of intrareader consistency, one reader was arbitrarily selected to rescore the final test 4 weeks later and had a κ value of 0.93, with a 95% CI of 0.79 to 1.00.
  
  
  CONCLUSIONS
  In this study, we demonstrate that with an organized educational approach, bronchoscopists can develop skills to have highly reproducible assessment and scoring of supraglottic abnormalities. The SGI can be used to determine which patients need additional intervention to determine causes of LPR and gastroesophageal reflux. Identification of this problem in patients with refractory asthma allows for personal, individual directed therapy to improve asthma control.
authors.forename: James T
authors.initials: JT
authors.lastname: Good
authors.forename: Donald R
authors.initials: DR
authors.lastname: Rollins
authors.forename: Douglas
authors.initials: D
authors.lastname: Curran-Everett
authors.forename: Steven E
authors.initials: SE
authors.lastname: Lommatzsch
authors.forename: Brendan J
authors.initials: BJ
authors.lastname: Carolan
authors.forename: Peter C
authors.initials: PC
authors.lastname: Stubenrauch
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Martin
mesh_terms: D001249:Asthma / Q000209:etiology / Q000473:pathology*; D001999:Bronchoscopy / Q000193:education* / Q000379:methods; D002983:Clinical Competence; D003937:Diagnosis, Differential; D004502:Education, Medical, Continuing / Q000379:methods*; D005931:Glottis / Q000002:abnormalities*; D006801:Humans; D057045:Laryngopharyngeal Reflux / Q000150:complications / Q000175:diagnosis; D059032:Learning Curve; D011446:Prospective Studies; D015272:Pulmonary Medicine / Q000193:education*; D012372:ROC Curve; D015203:Reproducibility of Results; D012720:Severity of Illness Index