Measuring Outcomes After Stent Placement: An Interview With Gaetane C. Michaud, MD
In the last of this 6-part series, Gaetane C. Michaud, MD, chief of interventional pulmonary medicine at New York University (NYU) Langone Medical Center and associate professor of medicine, discusses patient quality-of-life improvements and other clinical outcomes after airway stenting with Pulmonology Advisor.
My favorite story involves my patient who came into the office after having had her coils put in and she said, "Dr Michaud, I did something really bad. I walked around the grocery store without my oxygen. I forgot it!" And I said, "If you can walk around the grocery store without your oxygen because you forgot it, that tells me you are doing markedly better." That is a typical story of what happens with these patients who are big responders. Another patient says, "I go to the Hobby Lobby to buy yarn. I don't really need yarn, but I like that I can get to the back of the store to where the yarn."
We have gotten caught up in the side effects of the coils, and we've thought about pneumothoraces, pneumonias, and hemoptysis, and I have some theories about that: They may be heralds of response. Something is happening in that airway that is leading to those symptoms. And certainly for the patients that I've had that have had a pneumothorax, I'm not sure it was because the lung was injured. I think what happens is that you get a lot of tension and the lung pulls off the chest wall. That amount of tension probably is what is causing these inflammatory responses. What ends up happening after that is that they will often get a little bit of airway hemorrhage, and that's why they're getting the hemoptysis. Then, when they go on to getting these pneumonias. I think the pneumonias are an inflammatory response. And they do resolve, and they often resolve with some fibrosis, which actually probably is a good thing.
Some of the best measures of outcome are being able to go to the back of the store and to be able to walk without oxygen, and so on. Not all patients will come off oxygen, but a lot of them have marked increases in their exercise tolerance. I think for patients who have that markedly impaired quality of life and exercise intolerance, the ability to actually do your activities of daily living without impairment is a really big factor. It is much more important than what any pulmonary function number shows us. I think also that the ability to live longer and stay out of hospital is significant.
Rehospitalizations are really important because they impair quality of life. One of the things that we don't realize is that with recurrent exacerbations, people become very deconditioned very quickly. They don't rebound and respond as well to treatments. So, the ability to reduce hospitalizations and to keep people feeling better longer is extremely important.