Best of the Best Oral Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2020

Respiratory physiotherapy is safe in the management of patients post airway stent insertion. (#18)

Laura Daly 1 , Benjamin Hay 2 , Helen Seale 2 , David Fielding 1 , Farzad Bashirzadeh 1 , Peter Hopkins 2 , Morgan Windsor 1
  1. Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
  2. The Prince Charles Hospital , Brisbane , Queensland , Australia

Background: Airway stenting is an integral part of therapeutic endoscopic management of benign and malignant central airway diseases. Mucus plugging of the stent is a potentially life-threatening complication that is reported to occur in up to 25% of patients [1-3].  In Australia, there are currently no clear guidelines for the role of respiratory physiotherapists in the management of these patients.

Methods: A ten-year (2011-2020) retrospective audit analysed 47 patients who underwent tracheal or bronchial stenting across two major Queensland Health hospitals.

Aim: The primary aim was to describe respiratory physiotherapy interventions post airway stent insertion and any associated complications. A secondary aim was to describe the incidence of mucous plugging and lung infection in patients post procedure.

Results: Patients underwent airway stent insertion for either malignant (80.9%, n=38) or benign (17.3%, n=8) airway diseases. Increased sputum production post-airway stenting was reported in 85% (n=40) of patients while one-third (n=16) experienced mucous plugging.  Fourteen patients were diagnosed with a lung infection within 30 days of the procedure. Despite nearly all patients experiencing an increased sputum load post-procedure, only 29 patients were referred to physiotherapy for airway clearance intervention. Various airway clearance techniques were utilised including positive expiratory pressure, active cycle of breathing, percussion and vibration. There were no reported complications associated with physiotherapy intervention.

Conclusion: Airway stents result in the interruption of mucociliary clearance. Respiratory physiotherapy is a safe and viable intervention for these patients. A referral to physiotherapy for airway clearance intervention should be advocated for in patients post airway stent insertion. Further research is now required to establish the health and economic impact that respiratory physiotherapy has in the post-acute recovery of airway stenting.  

  1. 1. Madden, B.P., T.K. Loke, and A.C. Sheth, Do expandable metallic airway stents have a role in the management of patients with benign tracheobronchial disease? Ann Thorac Surg, 2006. 82(1): p. 274-8. 2. Huang, S., et al., Clinical assessment of airway stent placement in patients with malignant airway lesions. J Thorac Dis, 2018. 10(6): p. 3277-3288. 3. Jiang, J.H., et al., A Pilot Study of a Novel through-the-Scope Self-Expandable Metallic Airway Stents Delivery System in Malignant Central Airway Obstruction. Can Respir J, 2019. 2019: p. 7828526.