title: [Treatment of malignant central airways obstruction by rigid bronchoscopy].
abstract: BACKGROUND
  Endobronchial resection is now the standard treatment for tracheobronchial narrowing due to malignancy. The clinical and functional respiratory improvement has been evaluated previously but only in heterogeneous population.
  
  
  METHODS
  Between February 2009 and February 2011, we conducted a prospective single centre study at the University Hospital of Lille. Twenty-five patients with malignant tracheobronchial stenosis received a clinical and functional respiratory evaluation before and after a rigid bronchoscopy procedure to reduce the obstruction followed where appropriate by placement of an endobronchial stent.
  
  
  RESULTS
  Thirteen patients (52%) had primary lung cancer and in 12 the tumor had another origin. Nineteen patients (76%) received a stent after bronchial unblocking. Clinically, all patients felt an improvement in their dyspnea estimated by the Borg score with a median improvement of -2 points [-1; -4] following the procedure (P<0.001). In 96% the dyspnea visual analogic scale improved by 40 mm [27; 67] (P<0.0001). The FEV1 increased significantly after unblocking by 9% [-3.5; 28.5] (P<0.05). The Rint decreased significantly by -0.19 kPa/L per second [-0.06; -0.023] (P=0.001). Correlations between scales of dyspnea and spirometric values were not significant (P>0.05). The survival rate at 1 year was 29%.
  
  
  CONCLUSIONS
  Interventional bronchoscopy decreases dyspnea. It modestly improves respiratory function and decreases the Rint. However, lung function and dyspnea scales are not correlated. No spirometry factor can predict clinical dyspnea response but an elevated Borg dyspnea scale might be a good indicator.
authors.affiliation: Service d'endoscopie respiratoire, pôle des maladies respiratoires, hôpital Calmette, CHRU de Lille, 59000 Lille, France. Electronic address: bhuret@ahnac.com.
authors.forename: B
authors.initials: B
authors.lastname: Huret
authors.affiliation: Service d'explorations fonctionnelles respiratoires, hôpital Calmette, CHRU de Lille, 59000 Lille, France.
authors.forename: T
authors.initials: T
authors.lastname: Perez
authors.affiliation: Service d'endoscopie respiratoire, pôle des maladies respiratoires, hôpital Calmette, CHRU de Lille, 59000 Lille, France.
authors.forename: X
authors.initials: X
authors.lastname: Dhalluin
authors.affiliation: Service de réanimation polyvalente, centre hospitalier Jean-Bernard, 59322 Valenciennes, France.
authors.forename: F
authors.initials: F
authors.lastname: Dewavrin
authors.affiliation: Service d'endoscopie respiratoire, pôle des maladies respiratoires, hôpital Calmette, CHRU de Lille, 59000 Lille, France.
authors.forename: P-P
authors.initials: PP
authors.lastname: Ramon
authors.affiliation: Service d'endoscopie respiratoire, pôle des maladies respiratoires, hôpital Calmette, CHRU de Lille, 59000 Lille, France.
authors.forename: C
authors.initials: C
authors.lastname: Fournier
mesh_terms: D000368:Aged; D000402:Airway Obstruction / Q000209:etiology / Q000601:surgery*; D000403:Airway Resistance; D020680:Bronchoscopes; D001999:Bronchoscopy / Q000295:instrumentation / Q000379:methods*; D002277:Carcinoma / Q000150:complications / Q000556:secondary / Q000601:surgery*; D003251:Constriction, Pathologic; D004417:Dyspnea / Q000209:etiology; D004938:Esophageal Neoplasms / Q000473:pathology; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D011446:Prospective Studies; D012129:Respiratory Function Tests; D012720:Severity of Illness Index; D012907:Smoking / Q000009:adverse effects; D013147:Spirometry; D015607:Stents
keywords: Bronchoscopie rigide; Malignant tracheobronchial stenosis; Prothèse; Resistance measurement; Respiratory function test; Rigid bronchoscopy; Résistance des voies aériennes; Stent; Sténose trachéo-bronchique maligne; Épreuve fonctionnelle respiratoire