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Anaesthesia Jan 2018Postoperative pulmonary complications are a major determinant of outcome for patients and consume huge resources within hospital, particularly in critical care.... (Review)
Review
Postoperative pulmonary complications are a major determinant of outcome for patients and consume huge resources within hospital, particularly in critical care. Prediction and anticipation of postoperative pulmonary complications are vital for patient selection and, in some cases, for informed patient consent. Being able to assess the likelihood of postoperative pulmonary complications also allows research into methods to reduce them by allowing allocation of patients to the appropriate arms of research trials. Some patients have pre-operative characteristics or belong to patient groups such as those with chronic obstructive pulmonary disease or obstructive sleep apnoea, where techniques and evidence-based guidance to avoid or reduce complications are becoming established. Intra-operative ventilation and the use of lung-protective ventilation may be helpful during major surgery, but studies looking at reduced tidal volumes, recruitment and levels of positive end-expiratory pressure, have this far only led to a degree of consensus in terms of tidal volume, although parameters that predispose to postoperative pulmonary complications are becoming clearer. Optimal postoperative care in terms of analgesia, positioning, physiotherapy and mobilisation is another developing area. Techniques such as continuous positive airways pressure, non-invasive ventilation and high-flow nasal humidified oxygen appear to show some benefit, but the exact roles, pressures and timings of each are currently being explored. Much remains to be researched and developed into evidence-based practice.
Topics: Anesthesia; Humans; Postoperative Complications; Respiration Disorders; Respiration, Artificial
PubMed: 29313906
DOI: 10.1111/anae.14137 -
Archivos de Bronconeumologia Oct 2019
Topics: Humans; Noise, Transportation; Respiration Disorders; Risk Factors
PubMed: 30971362
DOI: 10.1016/j.arbres.2019.03.005 -
Developmental Medicine and Child... Jun 2019Respiratory problems have a significant impact on morbidity and mortality in patients with cerebral palsy (CP). In particular, recurrent aspiration, impaired airway... (Review)
Review
Respiratory problems have a significant impact on morbidity and mortality in patients with cerebral palsy (CP). In particular, recurrent aspiration, impaired airway clearance, spinal and thoracic deformity, impaired lung function, poor nutritional status, and recurrent respiratory infections negatively affect respiratory status. Bronchopulmonary dysplasia may contribute to pulmonary problems, but asthma is not more common in CP than in the general population. We discuss treatment options for each of these factors. Multiple coexisting and interacting factors that influence the respiratory status of patients with CP should be recognized and effectively addressed to reduce respiratory morbidity and mortality. WHAT THIS PAPER ADDS: Respiratory problems are a significant cause of morbidity in patients with cerebral palsy (CP). Respiratory status in patients with CP is influenced by recurrent aspiration and impaired airway clearance. Spinal and thoracic deformity, impaired lung function, poor nutrition, and respiratory infections also negatively affect respiratory status. These factors should all be addressed to reduce respiratory problems in patients with CP.
Topics: Cerebral Palsy; Child; Humans; Respiration Disorders
PubMed: 30320434
DOI: 10.1111/dmcn.14060 -
Drug and Alcohol Dependence Jan 2019Little evidence is available on the association of e-cigarettes with health indices. We investigated the association of e-cigarette use with diagnosed respiratory...
OBJECTIVES
Little evidence is available on the association of e-cigarettes with health indices. We investigated the association of e-cigarette use with diagnosed respiratory disorder among adults in data from the Behavioral Risk Factor Surveillance Survey (BRFSS).
METHODS
The 2016 Hawaii BRFSS, a cross-sectional random-dial telephone survey, had 8087 participants; mean age was 55 years. Items asked about e-cigarette use, cigarette smoking, and being diagnosed by a health professional with (a) asthma or (b) chronic obstructive pulmonary disease. Multivariable analyses tested associations of e-cigarette use with the respiratory variables controlling for smoking and for demographic, physical, and psychosocial variables.
RESULTS
Controlling for the covariates and smoking there was a significant association of e-cigarette use with chronic pulmonary disorder in the total sample (AOR = 2.58, CI 1.36-4.89, p < 0.01) and a significant association with asthma among nonsmokers (AOR = 1.33, CI 1.00-1.77, p < 0.05). The associations were stronger among nonsmokers than among smokers. Results were similar for analyses based on relative risk and absolute risk. There was also a greater likelihood of respiratory disorder for smokers, females, and persons with overweight, financial stress, and secondhand smoke exposure.
CONCLUSIONS
This is the first study to show a significant independent association of e-cigarette use with chronic respiratory disorder. Several aspects of the data are inconsistent with the possibility that e-cigarettes were being used for smoking cessation by persons with existing respiratory disorder. Theoretical mechanisms that might link e-cigarettes use and respiratory symptoms are discussed.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Cross-Sectional Studies; Electronic Nicotine Delivery Systems; Female; Hawaii; Humans; Male; Middle Aged; Prevalence; Respiration Disorders; Risk Factors; Smoking Cessation; Surveys and Questionnaires; Vaping; Young Adult
PubMed: 30472577
DOI: 10.1016/j.drugalcdep.2018.10.004 -
Thorax Apr 2015Recent scientific developments have radically changed the way we look at the vast 'non-coding' part of our genome. It is now clear that this genomic 'dark matter' is... (Review)
Review
Recent scientific developments have radically changed the way we look at the vast 'non-coding' part of our genome. It is now clear that this genomic 'dark matter' is transcribed into myriads of RNA species that act behind the scenes to veto, or boost, the production of proteins in our cells. As a consequence, non-coding RNAs (ncRNAs) represent an additional layer of regulation for fundamental biological processes such as organ development, tissue repair and immunity. It also follows that disturbances in ncRNA networks (among which microRNAs and long ncRNAs are the best studied) can give rise to a whole range of pathological conditions. Increasing preclinical and translational evidence places ncRNAs as key players in a wide spectrum of diseases affecting the lung. In this concise review, we will provide essential concepts of ncRNA science, with special emphasis on discoveries relevant to the pulmonary physician.
Topics: Biomarkers; Genetic Predisposition to Disease; Humans; Molecular Targeted Therapy; RNA, Untranslated; Respiration Disorders
PubMed: 25378544
DOI: 10.1136/thoraxjnl-2014-206404 -
Sleep Medicine Clinics Dec 2016Traditional techniques to assess respiratory disturbances during sleep allow the accurate diagnosis of moderate and severe cases of obstructive sleep apnea but have... (Review)
Review
Traditional techniques to assess respiratory disturbances during sleep allow the accurate diagnosis of moderate and severe cases of obstructive sleep apnea but have serious limitations in mild obstructive sleep apnea and cases with signs of obstructive breathing during sleep without apneas and hypopneas. This article describes advantages and limitations of available techniques to measure obstructive breathing during sleep by measuring flow limitation, respiratory effort, and snoring. Standardization of these techniques is crucial for moving the field further and understanding the pathophysiologic role of obstructive breathing itself, and not solely focusing on the associated outcomes of arousals and oxygen desaturations.
Topics: Apnea; Humans; Respiration Disorders; Snoring
PubMed: 28118867
DOI: 10.1016/j.jsmc.2016.07.004 -
Respiration; International Review of... 2016Subacute-acute, hyperacute, or even catastrophic and fulminant respiratory events occur in almost all classic connective tissue disorders (CTDs); they may share systemic... (Review)
Review
Subacute-acute, hyperacute, or even catastrophic and fulminant respiratory events occur in almost all classic connective tissue disorders (CTDs); they may share systemic life-threatening manifestations, may precipitously lead to respiratory failure requiring ventilatory support as well as a combination of specific therapeutic measures, and in most affected patients constitute the devastating end-of-life event. In CTDs, acute respiratory events may be related to any respiratory compartment including the airways, lung parenchyma, alveolar capillaries, lung vessels, pleura, and ventilatory muscles. Acute respiratory events may also precipitate disease-specific extrapulmonary organ involvement such as aspiration pneumonia and lead to digestive tract involvement and heart-related respiratory events. Finally, antirheumatic drug-related acute respiratory toxicity as well as lung infections related to the rheumatic disease and/or to immunosuppression complete the spectrum of acute respiratory events. Overall, in CTDs the lungs significantly contribute to morbidity and mortality, since they constitute a common site of disease involvement; a major site of infections related to the 'mater' disease; a major site of drug-related toxicity, and a common site of treatment-related infectious complications. The extreme spectrum of the abovementioned events, as well as the 'vicious' coexistence of most of the aforementioned manifestations, requires skills, specific diagnostic and therapeutic means, and most of all a multidisciplinary approach of adequately prepared and expert scientists. Avoiding lung disease might represent a major concern for future advancements in the treatment of autoimmune disorders.
Topics: Connective Tissue Diseases; Humans; Lung Diseases; Respiration Disorders
PubMed: 26938462
DOI: 10.1159/000444535 -
Acta Biochimica Et Biophysica Sinica Jul 2022Obstructive sleep apnea (OSA) is a common respiratory disorder characterized by partial obstruction of upper respiratory tract and repetitive cessation of breathing... (Review)
Review
Obstructive sleep apnea (OSA) is a common respiratory disorder characterized by partial obstruction of upper respiratory tract and repetitive cessation of breathing during sleep. The etiology behind OSA is associated with the occurrence of intermittent hypoxemia, recurrent arousals and intrathoracic pressure swings. These contributing factors may turn on various signaling mechanisms including elevated sympathetic tone, oxidative stress, inflammation, endothelial dysfunction, cardiovascular variability, abnormal coagulation and metabolic defect ( ., insulin resistance, leptin resistance and altered hepatic metabolism). Given its close tie with major cardiovascular risk factors, OSA is commonly linked to the pathogenesis of a wide array of cardiovascular diseases (CVDs) including hypertension, heart failure, arrhythmias, coronary artery disease, stroke, cerebrovascular disease and pulmonary hypertension (PH). The current standard treatment for OSA using adequate nasal continuous positive airway pressure (CPAP) confers a significant reduction in cardiovascular morbidity. Nonetheless, despite the availability of effective therapy, patients with CVDs are still deemed highly vulnerable to OSA and related adverse clinical outcomes. A better understanding of the etiology of OSA along with early diagnosis should be essential for this undertreated disorder in the clinical setting.
Topics: Cardiovascular Diseases; Humans; Leptin; Positive-Pressure Respiration; Risk Factors; Sleep Apnea, Obstructive
PubMed: 35838200
DOI: 10.3724/abbs.2022084 -
Environmental Geochemistry and Health Dec 2023According to epidemiological studies, particulate matter (PM) is an important air pollutant that poses a significant threat to human health. The relationship between... (Meta-Analysis)
Meta-Analysis Review
According to epidemiological studies, particulate matter (PM) is an important air pollutant that poses a significant threat to human health. The relationship between particulate matter and respiratory diseases has been the subject of numerous studies, but these studies have produced inconsistent findings. The purpose of this systematic review was to examine the connection between outdoor particulate matter (PM and PM) exposure and respiratory disorders (COPD, lung cancer, LRIs, and COVID-19). For this purpose, we conducted a literature search between 2012 and 2022 in PubMed, Web of Science, and Scopus. Out of the 58 studies that were part of the systematic review, meta-analyses were conducted on 53 of them. A random effect model was applied separately for each category of study design to assess the pooled association between exposure to PM and PM and respiratory diseases. Based on time-series and cohort studies, which are the priorities of the strength of evidence, a significant relationship between the risk of respiratory diseases (COPD, lung cancer, and COVID-19) was observed (COPD: pooled HR = 1.032, 95% CI: 1.004-1.061; lung cancer: pooled HR = 1.017, 95% CI: 1.015-1.020; and COVID-19: pooled RR = 1.004, 95% CI: 1.002-1.006 per 1 μg/m increase in PM). Also, a significant relationship was observed between PM and respiratory diseases (COPD, LRIs, and COVID-19) based on time-series and cohort studies. Although the number of studies in this field is limited, which requires more investigations, it can be concluded that outdoor particulate matter can increase the risk of respiratory diseases.
Topics: Humans; Particulate Matter; Respiration Disorders; Respiratory Tract Diseases; Lung Neoplasms; COVID-19; Pulmonary Disease, Chronic Obstructive
PubMed: 38153542
DOI: 10.1007/s10653-023-01807-1 -
Respiratory Research Jan 2019Originally, studies on exhaled droplets explored properties of airborne transmission of infectious diseases. More recently, the interest focuses on properties of exhaled... (Review)
Review
BACKGROUND
Originally, studies on exhaled droplets explored properties of airborne transmission of infectious diseases. More recently, the interest focuses on properties of exhaled droplets as biomarkers, enabled by the development of technical equipment and methods for chemical analysis. Because exhaled droplets contain nonvolatile substances, particles is the physical designation. This review aims to outline the development in the area of exhaled particles, particularly regarding biomarkers and the connection with small airways, i e airways with an internal diameter < 2 mm.
MAIN BODY
Generation mechanisms, sites of origin, number concentrations of exhaled particles and the content of nonvolatile substances are studied. Exhaled particles range in diameter from 0.01 and 1000 μm depending on generation mechanism and site of origin. Airway reopening is one scientifically substantiated particle generation mechanism. During deep expirations, small airways close and the reopening process produces minute particles. When exhaled, these particles have a diameter of < 4 μm. A size discriminating sampling of particles < 4 μm and determination of the size distribution, allows exhaled particle mass to be estimated. The median mass is represented by particles in the size range of 0.7 to 1.0 μm. Half an hour of repeated deep expirations result in samples in the order of nanogram to microgram. The source of these samples is the respiratory tract ling fluid of small airways and consists of lipids and proteins, similarly to surfactant. Early clinical studies of e g chronic obstructive pulmonary disease and asthma, reported altered particle formation and particle composition.
CONCLUSION
The physical properties and content of exhaled particles generated by the airway reopening mechanism offers an exciting noninvasive way to obtain samples from the respiratory tract lining fluid of small airways. The biomarker potential is only at the beginning to be explored.
Topics: Airway Remodeling; Animals; Biomarkers; Exhalation; Humans; Particle Size; Pulmonary Surfactants; Respiration Disorders; Surface-Active Agents
PubMed: 30634967
DOI: 10.1186/s12931-019-0970-9