1. The Liverpool experience: The role of immunosuppression in treating vasculitic subglottic stenosis
- Author
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Alessandro Panarese, Sarah Hardy, Andrew Kinshuck, Vedika Dhunnoo, Christopher Webb, Janice Harper, and Matthew Zammit
- Subjects
Adult ,Male ,medicine.medical_specialty ,Subglottic stenosis ,medicine.medical_treatment ,Free interval ,Cohort Studies ,Young Adult ,stomatognathic system ,Fibrosis ,medicine ,Humans ,Anti-neutrophil cytoplasmic antibody ,Aged ,Retrospective Studies ,Immunosuppression Therapy ,business.industry ,Granulomatosis with Polyangiitis ,Immunosuppression ,Laryngostenosis ,Middle Aged ,medicine.disease ,Surgery ,Otorhinolaryngology ,Cohort ,Female ,Granulomatosis with polyangiitis ,business ,Airway - Abstract
Five Key Points • Subglottic stenosis (SGS) is the commonest tracheobronchial manifestation of granulomatosis with polyangiitis (GPA), with early recognition and treatment key to preventing its vasculitic progression and fibrosis. • Previous studies have shown SGS to be the first feature of GPA in 4% of cases. It is not uncommon to see negative biochemical (10% ANCA negative) and negative histological biopsies (77% of head and neck specimens are negative). • Our management strategy emphasized rapid SGS-GPA treatment with limited surgical manipulation of the airway and systemic immunosuppression (IS) to prevent evolution of SGS & concurrent systemic vasculitic relapse. • In our study early multi-disciplinary team involvement to deliver induction IS in the presence of active SGS-GPA led to a procedure free interval (PFI) of 31.3 months. This is a significant increase compared to other published studies. • Nineteen percent (4/21) of the cohort did not require any surgical input following induction IS.
- Published
- 2021