Bronchoscopic Intervention Reduces Dyspnea in Severely Symptomatic Patients With Central Malignant Airway Obstruction

Abstract

Context

Malignant central airway obstruction (MCAO) is a serious and often life-threatening condition.

Objectives

We aimed to investigate the effects of endoscopic interventions on dyspnea, Quality of life (qoL), and physiological measurements in patients with MCAO.

Methods

This was a single-center prospective cohort study. All patients referred to Uppsala University Hospital, Sweden, for bronchoscopic interventions due to MCAO between January 1, 2015, and December 31, 2019, were eligible for inclusion. Patients were evaluated pre- and postoperatively by heart rate (HR), respiratory rate (RR), forced expiratory volume in 1 second (FEV1), oxygen saturation. The NRS dyspnea scale, the Cancer Dyspnea Scale (CDS), the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core-30 (EORTC QLQ-C30) and QLQ-lung cancer-13 (EORTC-QLQ LC13), and ECOG-WHO Performance Status (ECOG-PS).

Results

The study group comprised 44 patients (56% women, 69.3 ± 6.8 years). No procedure-related deaths occurred. The first postoperative day the following measurements had decreased: RR (19.9 ± 4.9 vs. 17.1 ± 3.9, P = 0.0027), CDS score (13.6 ± 1.43 vs. 5.8 ± 4.9, P = 0.0003), NRS dyspnea score (5.6 ± 2.2 vs. 2.3 ± 2.4, P < 0.001). The FEV1 increased from 1.23 ± 0.45 to 1.51 ± 0.57, (P = 0.0014). At 1 month follow up the CDS score had decreased further to 5.2 ± 4.1, (P = 0.0001), the QLQ-C30 dyspnea score from 76.5 ± 25.7 to 41.2 ± 27.7, (P = 0.001) and the QLQ-LC13 dyspnea score from 62.5 ± 6.4 to 32.3 ± 5.5, (P = 0.003). The QLQ-C30 Global Health Scale (GHS) score increased from 33.9 ± 4.9 to 47.0 ± 18.7, (P = 0.0124). Significant changes were only seen in patients with preoperative ECOG PS ≥2.

Conclusion

Most patients with MCAO benefit from bronchoscopic intervention and those with worse ECOG PS may benefit even more in terms of symptom relief.