Can flow-volume loops be used to diagnose exercise induced laryngeal obstructions? A comparison study examining the accuracy and inter-rater agreement of flow volume loops as a diagnostic tool

TY - JOUR

T1 - Can flow-volume loops be used to diagnose exercise induced laryngeal obstructions?

T2 - A comparison study examining the accuracy and inter-rater agreement of flow volume loops as a diagnostic tool

AU - Christensen, Pernille M

AU - Maltbæk, Niels

AU - Jørgensen, Inger M

AU - Nielsen, Kim G

PY - 2013/9

Y1 - 2013/9

N2 - Background: Pre-and post-exercise flow-volume loops are often recommended as an easy non-invasive method for diagnosing or excluding exercise-induced laryngeal obstructions in patients with exercise-related respiratory symptoms. However, at present there is no evidence for this recommendation. Aims: To compare physician evaluated pre-and post-exercise flow-volume loops and flow data with laryngoscopic findings during exercise. Methods: Data from 100 consecutive exercise tests with continuous laryngoscopy during the test were analysed. Laryngoscopic images were compared with the corresponding pre-and post-exercise flow-volume loops assessed by four separate physicians and with data from the loops (forced inspiratory flow (FIF) at 25% vs. FIF at 75% of forced inspiratory vital capacity (FIVC), forced expiratory flow at 50% of forced expiratory volume vs. FIF at 50% of FIVC, and FIVC vs. FIF at 50% of FIVC). Results: There was no significant association between the laryngoscopic findings and the flow-volume data. There was no agreement between the four physicians in their assessment of the flow-volume loops (kappa <0.00), and none of the individual physician's assessments were significantly associated with the laryngoscopic findings. Conclusions: Exercise-induced laryngeal obstructions cannot be diagnosed or excluded by physician evaluated pre-and post-exercise flow-volume loops or flow data alone.

AB - Background: Pre-and post-exercise flow-volume loops are often recommended as an easy non-invasive method for diagnosing or excluding exercise-induced laryngeal obstructions in patients with exercise-related respiratory symptoms. However, at present there is no evidence for this recommendation. Aims: To compare physician evaluated pre-and post-exercise flow-volume loops and flow data with laryngoscopic findings during exercise. Methods: Data from 100 consecutive exercise tests with continuous laryngoscopy during the test were analysed. Laryngoscopic images were compared with the corresponding pre-and post-exercise flow-volume loops assessed by four separate physicians and with data from the loops (forced inspiratory flow (FIF) at 25% vs. FIF at 75% of forced inspiratory vital capacity (FIVC), forced expiratory flow at 50% of forced expiratory volume vs. FIF at 50% of FIVC, and FIVC vs. FIF at 50% of FIVC). Results: There was no significant association between the laryngoscopic findings and the flow-volume data. There was no agreement between the four physicians in their assessment of the flow-volume loops (kappa <0.00), and none of the individual physician's assessments were significantly associated with the laryngoscopic findings. Conclusions: Exercise-induced laryngeal obstructions cannot be diagnosed or excluded by physician evaluated pre-and post-exercise flow-volume loops or flow data alone.

KW - Adolescent

KW - Adult

KW - Airway Obstruction

KW - Child

KW - Cohort Studies

KW - Exercise

KW - Exercise Test

KW - Feasibility Studies

KW - Female

KW - Forced Expiratory Flow Rates

KW - Forced Expiratory Volume

KW - Humans

KW - Inspiratory Capacity

KW - Laryngeal Diseases

KW - Laryngoscopy

KW - Male

KW - Vocal Cord Dysfunction

KW - Young Adult

U2 - 10.4104/pcrj.2013.00067

DO - 10.4104/pcrj.2013.00067

M3 - Journal article

C2 - 23955336

SN - 1471-4418

VL - 22

SP - 306

EP - 311

JO - Primary Care Respiratory Journal

JF - Primary Care Respiratory Journal

IS - 3

ER -