title: Therapeutic bronchoscopy for malignant central airway obstruction: success rates and impact on dyspnea and quality of life.
abstract: 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.
authors.affiliation: Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX. Electronic address: dost@mdanderson.org.
authors.forename: David E
authors.initials: DE
authors.lastname: Ost
authors.affiliation: Reliant Medical Group, Worcester, MA.
authors.forename: Armin
authors.initials: A
authors.lastname: Ernst
authors.affiliation: Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Horiana B
authors.initials: HB
authors.lastname: Grosu
authors.affiliation: Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Xiudong
authors.initials: X
authors.lastname: Lei
authors.affiliation: Department of Pulmonary and Critical Care Medicine, Henry Ford Hospital, Detroit, MI.
authors.forename: Javier
authors.initials: J
authors.lastname: Diaz-Mendoza
authors.affiliation: Department of Thoracic Oncology, Papworth Hospital, Cambridge, England.
authors.forename: Mark
authors.initials: M
authors.lastname: Slade
authors.affiliation: Respiratory Institute, Cleveland Clinic Foundation, Cleveland, OH.
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Gildea
authors.affiliation: Respiratory Institute, Cleveland Clinic Foundation, Cleveland, OH.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Machuzak
authors.affiliation: Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Jimenez
authors.affiliation: Penn State Cancer Institute, Hershey, PA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Toth
authors.affiliation: University of Illinois Hospital and Health Sciences Center, Chicago, IL.
authors.forename: Kevin L
authors.initials: KL
authors.lastname: Kovitz
authors.affiliation: Department of Pulmonary and Critical Care Medicine, Henry Ford Hospital, Detroit, MI.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Ray
authors.affiliation: Department of Pulmonary and Critical Care Medicine, Boston University, Boston, MA; Department of Interventional Pulmonology, Chicago Chest Center, Chicago, IL.
authors.forename: Sara
authors.initials: S
authors.lastname: Greenhill
authors.affiliation: Department of Internal Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University Medical Center, Durham, NC.
authors.forename: Roberto F
authors.initials: RF
authors.lastname: Casal
authors.affiliation: Respiratory Institute, Cleveland Clinic Foundation, Cleveland, OH.
authors.forename: Francisco A
authors.initials: FA
authors.lastname: Almeida
authors.affiliation: Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Momen M
authors.initials: MM
authors.lastname: Wahidi
authors.affiliation: Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: George A
authors.initials: GA
authors.lastname: Eapen
authors.affiliation: Department of Pulmonary and Critical Care Medicine, Johns Hopkins Hospital, Baltimore, MD.
authors.forename: David
authors.initials: D
authors.lastname: Feller-Kopman
authors.affiliation: Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Rodolfo C
authors.initials: RC
authors.lastname: Morice
authors.affiliation: Department of Pulmonary and Critical Care, Baylor College of Medicine, Houston, TX; Department of Pulmonary, Critical Care, and Sleep Medicine, University of Cincinnati, Cincinnati, OH.
authors.forename: Sadia
authors.initials: S
authors.lastname: Benzaquen
authors.affiliation: Department of Pulmonary and Critical Care Medicine, University of Calgary, Calgary, AB, Canada.
authors.forename: Alain
authors.initials: A
authors.lastname: Tremblay
authors.affiliation: Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Michael
authors.initials: M
authors.lastname: Simoff
mesh_terms: D000402:Airway Obstruction / Q000150:complications / Q000209:etiology* / Q000601:surgery*; D001999:Bronchoscopy; D004417:Dyspnea / Q000209:etiology / Q000601:surgery*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications*; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012074:Remission Induction