ABSTRACT
Airway obstruction, whether from benign or malignant processes, is a significant cause of morbidity and mortality. The various endoscopic modalities discussed in this textbook are becoming increasingly recognized as an integral component of therapy for tracheobronchial stenosis and tracheobronchomalacia. Many, although not all, patients with benign diseases can be relatively "cured" with these therapies. Most patients with locally advanced lung cancer and endobronchial metastases are not candidates for curative resections. As such, the best we can hope to do is extend their life to some degree and to palliate their symptoms. Although there have been suggestions that interventional bronchoscopic procedures may prolong the life of patients with major airway obstruction, and our experience bears this out in select patients, this has not been conclusively demonstrated in controlled studies. Even if we cannot prolong the life of all or most patients, the ability to palliate symptoms effectively with these procedures is worthwhile. The question to be asked, then, is do interventional procedures atJfJyil~Mt(litiMl3f~ion produce changes in
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symptoms and quality of life? Unfortunately, the number of studies in the literature which have evaluated changes in quality of life are far less than the number of studies which merely report technical successes and changes in airway dimensions. In addition, most studies have noted changes in performance status scores or dyspnea scores, which can be used as proxy measurements for quality of life, but are not true measures of quality of life.[I]
In this chapter, we will review the studies using various bronchoscopic modalities that have included results on changes in quality of life, functional status, and symptoms, particularly dyspnea, following the intervention. In terms of dyspnea, we will focus on studies which used recognized and validated dyspnea indices rather than report on all studies which only described dyspnea as "being improved." In addition, we will also review studies which describe changes in pulmonary function, as this has been used to gauge efficacy of the intervention and impact on the patient population. Changes in pulmonary function, however, may not correlate with changes in quality of life or symptoms and may not be an appropriate study endpoint. For reference purposes, the Karnofsky performance scale is provided in Table I and the Eastern Cooperative Oncology Group (ECOG) performance scale is provided in Table 2. The Hugh-Jones dyspnea index, which is similar to other dyspnea indices, is noted in Table 3.
