Can we use peak expiratory flow rate monitoring in recurrent respiratory papillomatosis?

BACKGROUND

Recurrent respiratory papillomatosis (RRP) is a chronic, HPV-induced disease characterized by the growth of benign, wart-like lesions within the upper aerodigestive tract, most commonly affecting the larynx. These lesions can lead to progressive voice changes and, in more severe cases, upper airway obstruction. Clinical evaluation, including flexible nasoendoscopic examination and symptom assessment, remains central to diagnosing and monitoring disease progression. However, due to the recurrent nature of RRP and the need for repeated surgical intervention, there is growing interest in identifying objective, non-invasive adjuncts to complement clinical evaluation and aid in disease monitoring.

AIM: To determine whether peak expiratory flow rate (PEFR) monitoring can serve as an effective adjunct for disease monitoring in RRP. To prove this, we aimed to demonstrate that post-operative PEFR values reflect expected clinical improvement when compared to pre-operative measurements, and that pre-operative PEFR correlates with disease severity when matched with intraoperative Derkay score.

METHODS

38 patients were enrolled between July 2021 and September 2022. Each patient had PEFR readings recorded at each visit. Patients requiring surgical intervention, pre-operative and post-operative PEFR were recorded and Derkay scored intraoperatively (n = 30).

RESULTS

Whilst the study size is small, the findings of this study do suggest that PEFR significantly improved post operatively, p value < 0.001, 95% CI; and PEFR correlated with disease severity showing an inversely proportional relationship between pre operative PEFR and intraoperative Derkay score, a medium correlation was observed between PEFR and disease severity (r = -.0.309, P > 0.05)

CONCLUSION

PEFR significantly improved in post-operative readings, indicating physiologic confirmation of the clinical observation that surgical debulking of respiratory papilloma causing upper airway obstruction results in functional improvements in airflow. PEFR correlates with disease severity, low PEFR correlated with higher Derkay scores.