Impact of Inhaled Corticosteroids on Recurrence Outcomes in Idiopathic Subglottic Stenosis

Introduction: Idiopathic subglottic stenosis (iSGS) is a recurrent airway disease commonly treated with endoscopic intervention. This study evaluated the impact of inhaled corticosteroid on iSGS disease outcomes.

Methods: We performed a retrospective cohort study of iSGS patients treated at a tertiary academic center between 2002 and 2024. Subjects underwent laser wedge excision (primary patients) or balloon dilation (secondary patients) and were grouped by inhaled corticosteroid exposure versus no use. Primary outcomes were recurrence rate (recurrences per year) and time to first recurrence. Analysis accounted for age, surgery type, follow-up duration, and concomitant medication use. Statistical analysis included Mann–Whitney U testing, Kaplan–Meier analysis with log-rank testing, multivariable Poisson regression with follow-up time as an offset, and Cox proportional hazards modeling.

Results: Sixty-three patients were included (33 inhaled corticosteroid users, 30 non-users), with similar age between groups (51.3 vs 51.1 years, p=0.94). Median recurrence rates were 0.45 per year (IQR 0.22–0.71) in ICS users versus 0.34 per year (IQR 0.26–0.56) in non-users (p=0.80). Median time to first recurrence was 17 months versus 22 months, respectively (p=0.57). Inhaled corticosteroid use was not associated with recurrence rate (rate ratio 1.08; 95% CI 0.81–1.43; p=0.61) or time to first recurrence (hazard ratio 0.70; 95% CI 0.31–1.60; p=0.40). Primary disease treated with laser wedge excision was associated with a 51% lower recurrence rate than secondary patients (p < 0.0001).

Conclusions: In our study, inhaled corticosteroid use following initial endoscopic management of idiopathic subglottic stenosis was not associated with reduced recurrence rates or prolonged time to recurrence. These findings highlight the need for further investigation into effective adjuvant medical therapies for iSGS.