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, Niels Maltbæk, Inger M Jørgensen, Kim G Nielsen, Pernille M Christensen, Niels Maltbæk, Inger M Jørgensen, Kim G Nielsen

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. Overview of the rater agreement…
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. Total laryngeal obstruction (arytenoid rotation…
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. Box-plots comparing rater evaluation with…
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. Box-plots comparing degree of total…
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. Scatter-plots comparing degrees of laryngeal…
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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