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Walter Vincken

Publications and source records attributed to Walter Vincken.

At least 19 recordsLinked to original sources
PubMed2006

Tracheal stenosis: a flow dynamics study.

Patients referred for treatment of tracheal stenosis typically are asymptomatic until critical narrowing of the airway occurs, which then requires immediate intervention. To understand how tracheal stenosis affects local pressure drops and explore how a dramatic increase in pressure drop could possibly be detected at an early stage, a computational fluid dynamics (CFD) study was undertaken. We assessed flow patterns and pressure drops over tracheal stenoses artificially inserted into a realistic three-dimensional upper airway model derived from multislice computed tomography images obtained in healthy men. Solving the Navier-Stokes equations (with a Yang-shih k-epsilon turbulence model) for different degrees of tracheal constriction located approximately one tracheal diameter below the glottis, the simulated pressure drop over the stenosis (DeltaP) was seen to dramatically increase only when well over 70% of the tracheal lumen was obliterated. At 30 l/min, DeltaP increased from 7 Pa for a 50% stenosis to, respectively, 46 and 235 Pa for 80% and 90% stenosis. The pressure-flow relationship in the entire upper airway model (between mouth and end of trachea) in the flow range 0-60 l/min showed a power law relationship with best-fit flow exponent of 1.77 in the absence of stenosis. The exponent became 1.92 and 2.00 in the case of 60% and 85% constriction, respectively. The present simulations confirm that the overall pressure drop at rest is only affected in case of severe constriction, and the simulated flow dependence of pressure drop suggests a means of detecting stenosis at a precritical stage.

Humans↗
PubMed2006

Bacterial cultures of the middle meatus and bronchoalveolar lavage in chronic rhinosinusitis.

UNLABELLED: The role of bacteria in chronic rhinosinusitis (CRS) is still debated and their effect on the lower airways is less known. The aim of this study was to identify the individual bacterial species in CRS and to correlate these microbiological data with the clinical findings and associated bacterial cultures of the lower airways. This prospective study included 25 CRS patients scheduled for functional endoscopic sinus surgery. Preoperatively, pulmonary function and CT examinations were performed together with endoscopic and clinical assessment. Under aseptic conditions, with the patient under general anesthesia, 25 bronchoalveolar lavages (BALs) via the endotracheal tube and 50 endoscopically guided middle meatal specimens were obtained. All the specimens were examined for aerobic and anaerobic bacteria and correlated to the associated neutrophilic cellular changes. Positive bacterial cultures were obtained in 71% of the middle meatal specimens and 8% of the BAL specimens. Three subgroups of lower airway involvement were identified, i.e. asthma, small airway disease (SAD) and normal lower airways. In SAD only, there was a significant correlation between the cultured bacteria of the left (p = 0.04) and the right (p = 0.04) middle meatus and the presence of local neutrophilia. In asthma, middle meatal bacterial cultures correlated with nasal blockage (p = 0.04) and CT Lund-Mackay score (p = 0.04). CONCLUSION: Middle meatal cultures were frequently positive, mainly aerobic Gram-positive bacteria. In SAD, a mixed flora of Gram-positive aerobic bacteria and anaerobic bacteria was observed that correlated with neutrophilic inflammation. BAL cultures do not show infection or colonization of the lower airways, despite functional abnormalities in 60% of the patients.

Adult↗
PubMed2006

Early detection of COPD: a case finding study in general practice.

OBJECTIVES: To estimate the prevalence of undiagnosed chronic obstructive pulmonary disease (COPD) in a population of general practice patients at risk for developing COPD. A further aim was to evaluate the presence of respiratory symptoms as a predictor for the diagnosis of COPD. METHODS: This study was conducted by eight general practitioners (GP) in six semi-rural general practices. During two consecutive months all patients attending their GP were included if they met the following criteria: current smokers between 40 and 70 yr of age, and a smoking history of at least 15 pack-years. A questionnaire regarding smoking history, respiratory symptoms, exposure to dust or chemical fumes, and history of respiratory diseases was completed for all patients. Subjects without known COPD were invited for spirometric testing. RESULTS: Off the 146 general practice patients included, 17.1% already had an established COPD diagnosis. Screening by spirometry revealed a 46.6% prevalence of COPD. Underdiagnosis of COPD was more frequent in the younger age categories (40-49 Yr; 50-59 Yr). Objective wheezing was the only sign that was significantly more frequent in COPD patients than in non-COPD patients (P<0.001). Patients with previously known COPD were significantly older, and complained more of chronic cough and fatigue than newly detected patients. CONCLUSION: Almost half of a general practice population of current smokers between 40 and 70 years of age, with a smoking history of at least 15 pack-years, was diagnosed with COPD, and roughly two thirds of these were newly detected as a result of the case finding programme.

Adult↗
PubMed2006

Small airway function improvement after smoking cessation in smokers without airway obstruction.

OBJECTIVE: Studying smokers with normal spirometry requires monitoring tools of the peripheral lung. A validated multiple breath washout technique was used to assess possible recovery of smoking-induced small airway malfunction in acinar and conductive lung zones. METHODS: Eighty-seven smokers with a smoking history of at least 10 pack-years but absence of spirometric airflow obstruction were invited for assessment of lung function and small airway function at baseline and after 1 wk, 3 mo, 6 mo, and 12 mo of smoking cessation. A control group of 16 persistent smokers was studied at the same time intervals. MEASUREMENTS AND MAIN RESULTS: Of the 87 smokers, 66, 32, 28, and 21% successfully ceased smoking for 1 wk, 3 mo, 6 mo, and 12 mo, respectively. Lung function parameters remained essentially unaffected by smoking cessation. Ventilation heterogeneity showed transient improvements after 1 wk in the acinar lung compartment with a return to baseline afterwards. By contrast, there were persistent improvements in the conductive airway compartment; for example, smokers who successfully quit smoking for 12 mo (n=18) showed a 30 and 42% reduction of conductive airways abnormality after 1 wk and 1 yr, respectively. CONCLUSIONS: Smokers with early signs of small airway malfunction who successfully quit smoking show sustained improvements of conductive airway malfunction. In contrast, acinar airway malfunction quickly returns to baseline after a transient improvement.

Adult↗
PubMed2006

The functional benefit of anti-inflammatory aerosols in the lung periphery.

BACKGROUND: The target of anti-inflammatory therapy in asthma is thought to be situated, at least partly, in the lung periphery, and inhaled steroid aerosols are being engineered to reach it. However, the potential effect of such aerosols cannot be fully evaluated by conventional lung function tests because these are insensitive to peripheral lung structure. OBJECTIVE: A prospective cohort study was conducted to investigate whether ultrafine steroid aerosols can elicit a response in the lung periphery, using a validated multibreath washout technique that can distinguish acinar from conductive lung zone function. METHODS: In 30 stable patients with asthma with a wide range of disease severity (FEV(1) 27% to 108% predicted), we assessed conductive and acinar airway function abnormality at baseline, with patients on a standard dry powder steroid aerosol and after switching them to an ultrafine steroid aerosol. RESULTS: Only in those patients with abnormal acinar airway function at baseline (n = 16) did acinar heterogeneity show a consistent improvement after switching to an ultrafine steroid aerosol; the improvement was also correlated with baseline acinar heterogeneity (r = -0.67; P = .007). Although all patients with asthma also presented conductive airway abnormality at baseline, no changes were observed in this lung zone with the switch to the ultrafine aerosol (P > .1). CONCLUSION: Among stable patients with asthma, those with acinar lung zone abnormality at baseline have the potential to receive functional benefit from an ultrafine steroid aerosol. Clinical studies comparing the efficacy of steroid aerosols targeted to the deep lung should at least include a measurement of peripheral lung zone function. CLINICAL IMPLICATIONS: A new noninvasive measure of small airways function reveals why, and for which particular patients with asthma, small steroid aerosol particles can be of therapeutic use.

Adolescent↗
PubMed2006

Fluorescein-enhanced autofluorescence thoracoscopy in patients with primary spontaneous pneumothorax and normal subjects.

RATIONALE: The exact site(s) and pathophysiology of air leakage in patients with primary spontaneous pneumothorax (PSP) are unknown. In one patient with PSP, fluorescein-enhanced autofluorescence thoracoscopy (FEAT) has shown areas of parenchymal abnormality unnoticed during white light thoracoscopy (WLT). OBJECTIVES: To prospectively perform and compare WLT and FEAT in patients with spontaneous pneumothorax and in normal subjects. METHODS: One-time FEAT and WLT inspection with systematic mapping of semiquantified lesions in 12 consecutive patients with PSP was compared with one-time FEAT and WLT during sequential bilateral thoracoscopy in 17 control subjects. RESULTS: WLT abnormalities (anthracosis, cobblestone malformation, and blebs/bullae) were more prevalent in PSP. FEAT, however, showed high-grade lesions in PSP only, which often were present at areas that were normal, or that only showed anthracosis at WLT. When blebs/bullae were present, bleb-associated FEAT abnormalities were only present in two. Actual fluorescein leakage was seen in two patients with PSP. CONCLUSIONS: Lungs in patients with PSP show significantly more abnormalities at WLT when compared with normal subjects. High-grade FEAT lesions were exclusively present in PSP, and predominantly at lung zones that appeared normal at white light inspection. These findings suggest that significant parenchymal abnormalities are not limited to lesions visible during WLT, such as blebs and bullae.

Adult↗
PubMed2006

Technical and functional assessment of 10 office spirometers: A multicenter comparative study.

STUDY OBJECTIVES: To investigate the technical properties and user friendliness of 10 office spirometers devoted for use in general practice, and to compare the results with standard diagnostic spirometers. DESIGN: Multicenter study. SETTING: Ten spirometer models were tested independently in three pulmonary function laboratories and by three general practitioners (GPs). MEASUREMENTS: The laboratories studied the technical quality of the office spirometers in terms of precision and agreement with standard spirometers, whereas the three GPs assessed their user friendliness. The spirometers tested were as follows: Spirobank (Medical International Research; Rome, Italy); Simplicity (Puritan Bennett; Pleasanton, CA); OneFlow (Clement Clarke International; Harlow, Essex, UK); Datospir 70 (Sibelmed; Barcelona, Spain); Datospir 120 (Sibelmed); SpiroPro (SensorMedics; Yorba Linda, CA); EasyOne (NDD; Zurich, Switzerland); MicroLoop (Micro Medical; Chatham, Kent, UK); SpiroStar (Medikro; Kuopio, Finland); and Pneumotrac (Vitalograph; Maids Moreton, Buckingham, UK). FVC and FEV1 were measured in 399 subjects. User friendliness was assessed by the three GPs using a questionnaire. RESULTS: The precision of FEV1 of the office and standard spirometers was comparable, but three office spirometers had > 200 mL limits of precision for FVC. Some devices presented a proportional difference on the FEV1 with standard spirometers, underestimating the small values. The limits of agreements between standard and some office spirometers for FEV1/FVC ratio was > 10%. The overall user friendliness was estimated as good. CONCLUSIONS: The global quality and user friendliness of several office spirometers make them acceptable for the detection of COPD, although differences between the laboratory and some of the office spirometers values suggest that the misclassification rates may be increased when using some models of office spirometers.

Adult↗
PubMed2006

Successful treatment of a giant emphysematous bulla by bronchoscopic placement of endobronchial valves.

Surgical bullectomy is the treatment of choice for giant emphysematous bulla. We report a case of successful nonsurgical treatment with bronchoscopic placement of one-way endobronchial valves that are currently under investigation for the treatment of end-stage emphysema. In patients who are poor surgical candidates, this noninvasive bronchoscopic treatment may represent a valuable alternative.

Blister↗
PubMed2006

Fungal cultures of different parts of the upper and lower airways in chronic rhinosinusitis.

The relation between fungi, upper and lower airways in chronic rhinosinusitis (CRS) patients are not clear yet. So the aim of this study was to identify the different cultured fungi in various sub-sites of the nasal cavity and lower airways in adult (CRS) patients and to correlate the cultured fungi to the associated cellular inflammatory changes. In the outpatient clinic a control group of 10 normal subjects was subjected to total nasal lavages to validate our mycological culture technique. Twenty-five adult CRS patients were enrolled in this prospective study. Under general anaesthesia before functional endoscopic sinus surgery (FESS) operation 50 nasal vestibular swabs, 25 bronchoalveolar lavages (BALs), 50 middle meatal lavages (MMLs) and 50 nasal cavity lavages (NCLs) were obtained in the operating room. These samples were processed for fungal culture and eosinophilic cellular counts. The intraoperative pathological specimens were examined using Haematoxylin and Eosin (H&E) and Gomori methanamine silver (GMS) staining. In the normal control group total nasal lavages showed 100% positive fungal cultures. In the CRS patient group the BALs showed positive fungal cultures in 28%. Nasal vestibule cultures were positive in 8%. Positive middle meatal cultures were obtained in 44% of the 25 CRS patients. Two cases (8%) with maxillary fungal ball showed a positive maxillary sinus culture but a negative middle meatal culture. Nasal cavity lavages were positive in 36%. Middle meatal eosinophilia was identified in 33.6% of the positive middle meatal fungal culture. Following the deShazo's criteria of diagnosis of allergic fungal rhinosinusits (AFRS), only 16% of the subjects in this study fulfilled the criteria. No correlation existed between fungal culture, cellular and other clinical parameters. Also no correlation existed between upper and lower airway positive cultures. In conclusion fungi seemed to be present in different percentages and types in different sub sites of the airways but without associated eosinophilia. There were no significant correlations between the fungal culture and clinical parameters of CRS nor were there significant correlations between fungal culture and objective lower airway involvement.

Adult↗
PubMed2005

Effects of inhaled ciclesonide and fluticasone propionate on cortisol secretion and airway responsiveness to adenosine 5'monophosphate in asthmatic patients.

The efficacy and systemic effects of ciclesonide, a novel glucocorticosteroid, inhaled via pressurized metered-dose inhaler (pMDI) were compared with fluticasone propionate pMDI in 26 patients with asthma, using a randomized, double blind, placebo-controlled, double dummy, 6-period crossover study design. Treatments were placebo, ciclesonide 320 microg (ex-actuator dose) once daily (o.d.), ciclesonide 640 microg o.d., ciclesonide 640 microg twice daily (b.i.d.), fluticasone propionate 440 microg (ex-actuator dose) b.i.d., and fluticasone propionate 880 microg b.i.d. The primary variable was area under the plasma cortisol concentration-time curve over 24 h (plasma cortisol AUC(0-24), relative to placebo) derived from samples taken every 2 h, on the 9th day of treatment. Secondary variables were 24-h urinary cortisol excretion and PC20 for adenosine 5'-monophosphate (AMP) (relative to placebo and expressed in doubling concentrations). Ciclesonide did not affect 24-h cortisol secretion. Fluticasone propionate suppressed cortisol secretion as demonstrated by a decrease in plasma cortisol AUC(0-24), relative to placebo, by 29% (95% CI 15-41) and 59% (95% CI 51-66) with 440 and 880 microg b.i.d., respectively. PC20 more than doubled with each active treatment, but no statistically significant dose-response effect could be established. It was concluded that moderate to high doses of fluticasone propionate suppressed cortisol secretion, that ciclesonide did not suppress cortisol secretion, and that all active treatments decreased hyperresponsiveness to AMP.

Adenosine Monophosphate↗
PubMed2005

Correlates of quality of life in patients with asthma.

BACKGROUND: Health-related quality of life (HRQOL) is a major outcome in asthma, but the relationships among HRQOL, characteristics of asthma, type of supervision, and sociodemographic characteristics of patients have not been thoroughly explored. OBJECTIVE: To identify major correlates of HRQOL in a survey of patients with asthma. METHODS: Patients with asthma were identified by their usual caregivers, either general practitioners or respiratory physicians. In a standardized interview, data were collected on patients' sociodemographic characteristics, medical history, medical resource use in the past 12 months, and asthma QOL. Intensity of asthma therapy was evaluated from the use of inhaled controllers and oral corticosteroids in the past 12 months, and number of asthma attacks during the same period was used as an indicator of level of asthma symptoms. RESULTS: Ninety-nine patients with asthma were identified (median age, 36 years; 62.6% women). In multivariate analysis, major correlates for lower HRQOL scores were having at least 5 asthma attacks and the number of medical visits in the past 12 months (P < .001 for both). Other significant positive associations were unemployment (P = .01) and female sex (P = .05), but not intensity of therapy, age, or type of asthma supervision (general practitioner vs respiratory physician). CONCLUSIONS: In this survey, HRQOL scores seem to be primarily related to asthma symptoms, as indicated by the number of attacks experienced by the patients and the frequency of medical contacts in a previous period. The relationships among HRQOL, therapy, and the determinants of control should be investigated in prospective studies.

Adolescent↗
PubMed2005

FEV1/FEV6 and FEV6 as an alternative for FEV1/FVC and FVC in the spirometric detection of airway obstruction and restriction.

STUDY OBJECTIVES: To evaluate the use of the FEV(1)/forced expiratory volume at 6 s of exhalation (FEV(6)) ratio and FEV(6) as an alternative for FEV(1)/FVC and FVC in the detection of airway obstruction and lung restriction, respectively. SETTING: Pulmonary function laboratory of the Academic Hospital of the Free University of Brussels. PARTICIPANTS: A total of 11,676 spirometric examinations were analyzed on subjects with the following characteristics: white race; 20 to 80 years of age; 7,010 men and 4,666 women; and able to exhale for at least 6 s. METHODS: Published reference equations were used to determine lower limits of normal (LLN) for FEV(6), FVC, FEV(1)/FEV(6), and FEV(1)/FVC. We considered a subject to have obstruction if FEV(1)/FVC was below its LLN. A restrictive spirometric pattern was defined as FVC below its LLN, in the absence of obstruction. From these data, sensitivity and specificity of FEV(1)/FEV(6) and FEV(6) were calculated. RESULTS: For the spirometric diagnosis of airway obstruction, FEV(1)/FEV(6) sensitivity was 94.0% and specificity was 93.1%; the positive predictive value (PPV) and negative predictive value (NPV) were 89.8% and 96.0%, respectively. The prevalence of obstruction in the entire study population was 39.5%. For the spirometric detection of a restrictive pattern, FEV(6) sensitivity was 83.2% and specificity was 99.6%; the PPVs and NPVs were 97.4% and 96.9%, respectively. The prevalence of a restrictive pattern was 15.7%. Similar results were obtained for male and female subjects. When diagnostic interpretation differed between the two indexes, measured values were close to the LLN. CONCLUSIONS: The FEV(1)/FEV(6) ratio can be used as a valid alternative for FEV(1)/FVC in the diagnosis of airway obstruction, especially for screening purposes in high-risk populations for COPD in primary care. In addition, FEV(6) is an acceptable surrogate for FVC in the detection of a spirometric restrictive pattern. Using FEV(6) instead of FVC has the advantage that the end of a spirometric examination is more explicitly defined and is easier to achieve.

Adult↗
PubMed2005

Correlation between the cytology of the nasal middle meatus and BAL in chronic rhinosinusitis.

The relation between chronic rhinosinusitis (CRS) and the associated lower airways involvement is not clear yet. In this context, the aim of this prospective study was to evaluate the correlation between middle meatal lavage (MML) and bronchoalveolar lavage (BAL) cytology in adult CRS patients. Based on clinical history and pulmonary function changes, CRS patients were divided into three subgroups: asthma, small airway disease (SAD) and normal lower airway (NLA) subgroups. Preoperatively, 50 MMLs and 25 BALs were performed in 25 CRS patients scheduled for FESS. At 1000X power microscopic magnifications, 48 MML and 24 BAL cytospin slides were examined for total and differential cell counts (DCC). This study showed that eosinophils were the dominant inflammatory cells in MMLs of the asthma subgroup and were significantly correlated to FEVI (p = 0.042) and Tiffineau index (p = 0.037). On the other hand, neutrophils were the dominant inflammatory cells in MMLs of the SAD subgroup and significantly correlated to FEF75% and Tiffinau index (p = 0.013 and p = 0.012 respectively). There was no significant correlation between MML and BAL cell differential counts in CRS patients (p > 0.05). The data showed that the lower airways involvement in CRS patients could be related to the dominant type of inflammatory cells in the upper airways.

Adult↗
PubMed2004

Fluorescein-enhanced autofluorescence thoracoscopy in primary spontaneous pneumothorax.

The exact site of air leakage in a patient with primary spontaneous pneumothorax is difficult to determine and locate. In particular, the role of rupture of emphysema-like changes (blebs and bullae) versus that of enhanced porosity of lung parenchyma in the pathophysiology of primary spontaneous pneumothorax remains unclear. This is the first description of a patient with recurrent primary spontaneous pneumothorax in whom inhalation of aerosolized fluorescein followed by autofluorescence thoracoscopy allowed in vivo localization of various lung areas of extensive subpleural fluorescein accumulation which were not, or only partly, visibly abnormal during normal white light thoracoscopy. No air leak was present at the time of thoracoscopy. No emphysema-like changes were seen. Our findings suggest substantial areas of parenchymal abnormality that remain unnoticed by white light thoracoscopic inspection of the parenchymal surface. In this respect, fluorescein-enhanced autofluorescence thoracoscopy may become an exciting tool in the study of the pathophysiology of primary spontaneous pneumothorax, and could prove useful in clinical practice in determining the sites of surgical staple resection whenever this treatment modality is considered.

Administration, Inhalation↗
PubMed2004

Noninvasive assessment of airway alterations in smokers: the small airways revisited.

It has been shown that structural changes in small airways of smokers with average smoking histories greater than 35 pack-years could be reflected in the single-breath washout test. The more sophisticated multiple breath washout test (MBW) has the potential to anatomically locate the affected small airways in acinar and conductive lung zones through increased phase III slope indices S(acin) and S(cond), respectively. Pulmonary function, S(acin), and S(cond) were obtained in 63 normal never-smokers and in 169 smokers classified according to smoking history (< 10 pack-years; 10-20 pack-years; 20-30 pack-years; > 30 pack-years). Compared with never-smokers, significant changes in S(acin) (p = 0.02), S(cond) (p < 0.001), and diffusing capacity (DL(CO); p < 0.001) were detected from greater than 10 pack-years onwards. Spirometric abnormality was significant only from greater than 20 pack-years onwards. In smokers with greater than 30 pack-years and DL(CO) less than 60% predicted, the presence of emphysema resulted in disproportionally larger S(acin) than S(cond) increases. We conclude that S(cond) and S(acin) can noninvasively detect airway changes from as early as 10 pack-years onwards, locating the earliest manifestations of smoking-induced small airways alterations around the acinar entrance. In these early stages, the associated DL(CO) decrease may be a reflection of ventilation heterogeneity rather than true parenchymal destruction. In more advanced stages of smoking-induced lung disease, differential patterns of S(acin) and S(cond) are characteristic of the presence of parenchymal destruction in addition to peripheral airways alterations.

Breath Tests↗
PubMed2004

Aerosol profile extracted from spacers as a determinant of actual dose.

PURPOSE: We propose a novel method to evaluate the efficacy of a pressurized metered dose inhaler (pMDI) in combination with a spacer, by not only considering the total dose extractable from the spacer but also the dependence of dose on the volume available for aerosol inhalation. METHODS: We studied volume-dependence of aerosol concentration during extraction from two commonly used plastic spacers (150 ml AerochamberPlus; 750 ml Volumatic) after a single puff of a 100 microg salbutamol pMDI (HFA-Ventolin), using laser photometric measurements. RESULTS: After a delay of is in each spacer, the aerosol peak dose for AerochamberPlus was 2-fold that for Volumatic (p < 0.001), with the peak appearing well within the first 0.5 L even for the largest spacer. The opposite dose relationship is reached when considering total cumulative dose, which was 2-fold higher for Volumatic than for AerochamberPlus (p < 0.001); >95% of total cumulative dose was extracted well within 3 L for the largest spacer. The 2-fold cumulative dose relationship was confirmed by chemical assay on an absolute filter [AerochamberPlus: 21.4+/-3.2 (SD) microg; Volumatic: 43.8+/-9.1 (SD) microg]. CONCLUSIONS: Actual aerosol dose available to patients during inhalation via spacers can only be done on the basis of a quantification of aerosol peak dose and cumulative dose as a function of extracted volume.

Administration, Inhalation↗
PubMed2004

Interventional bronchoscopy for treatment of tracheal obstruction secondary to benign or malignant thyroid disease.

STUDY OBJECTIVES: Surgery is the treatment of choice for symptomatic tracheal obstruction due to benign or malignant thyroid disease. In case of inoperability, or when surgery is refused, few therapeutic alternatives are available. Interventional bronchoscopic procedures have only been reported anecdotally. The objective of this study is to evaluate the results of interventional bronchoscopic procedures in the treatment of severe tracheal obstruction due to thyroid disease. STUDY DESIGN: Retrospective cohort analysis. SETTING: University hospital, tertiary referral center. PATIENTS: Thirty consecutive patients referred for bronchoscopic treatment of benign (n = 17) or malignant (n = 13) thyroid-related upper airway obstruction due to tracheomalacia, extrinsic compression, and/or tracheal ingrowth. Indications for bronchoscopic treatment were medical or surgical inoperability, prevention or treatment of tracheomalacia, and refusal of surgery. There were no procedure-related complications. INTERVENTIONS: Rigid bronchoscopy with dilatation, stenting and/or Nd-YAG laser treatment, and clinical follow-up. MEASUREMENTS AND RESULTS: Subjective improvement, pulmonary function tests, early and late complications, and survival. In the benign group, immediate (100% relief of dyspnea) and long-term (88% relief of dyspnea) results were excellent after airway stenting (21 stents used in 17 patients). There was one unrelated death 1 week after stenting in a 98-year-old patient. There were 6% and 30% short-term and long-term complications, respectively, that could be managed endoscopically. In the malignant group, Nd-YAG laser treatment (n = 3) and stenting (n = 13) yielded immediate and long-term success in 92% of patients. There were 15% short-term and 8% long-term complications. Median survival time was 540 days. CONCLUSIONS: Interventional bronchoscopic procedures including Nd-YAG laser treatment and stenting are valuable alternatives to surgery in inoperable thyroid-induced tracheal obstruction, or when surgery is refused.

Aged↗