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. 2013 Sep;22(3):306-11.
doi: 10.4104/pcrj.2013.00067.

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

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Free PMC article

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

Pernille M Christensen et al. Prim Care Respir J. .
Free PMC article

Abstract

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.

Conflict of interest statement

The authors declare that they have no conflicts of interest in relation to this article.

Figures

Figure 1
Figure 1. Overview of the rater agreement in cases where at least one rater found no laryngeal obstruction and where at least one rater found laryngeal obstruction
Figure 2
Figure 2. Total laryngeal obstruction (arytenoid rotation and glottic closure) at maximum exertion verified laryngoscopically and grated ad modum CLE-score against rater evaluation
Figure 3
Figure 3. Box-plots comparing rater evaluation with the degree of laryngeal obstruction of arytenoid rotation (AR) and glottic closure (GC) types grated using Eilomea, excluding moderate/severe degrees of the other type of obstruction
Figure 4
Figure 4. Box-plots comparing degree of total laryngeal obstruction (arytenoid rotation (AR) and glottic closure (GC) grated ad modum Maat) with each of the suggested FVL variables (post-exercise value divided bythe pre-exercise value)
Figure 5
Figure 5. Scatter-plots comparing degrees of laryngeal obstruction of arytenoid rotation (AR) and glottic closure (GC) types (using Eilomea, excluding moderate/ severe degrees of the other type of obstruction) with each of the suggested FVL variables (post-exercise value divided by the the pre-exercise value)

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