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Chest Nov 2015
Topics: Airway Obstruction; Bronchoscopy; Dyspnea; Female; Humans; Lung Neoplasms; Male; Quality of Life
PubMed: 26527446
DOI: 10.1378/chest.15-1578 -
BMJ Case Reports Aug 2021We describe the case of a 33-year-old female smoker who presented to the Accident and Emergency department with a 1-day history of rapidly evolving airway compromise....
We describe the case of a 33-year-old female smoker who presented to the Accident and Emergency department with a 1-day history of rapidly evolving airway compromise. She had no preceding illness or other objective signs/symptoms on presentation, had a history of Chronic Obstructive Pulmonary Disease (COPD) and a previous opioid addiction. Following failed endotracheal intubation, the airway was secured with an emergency surgical tracheostomy. Subsequent direct laryngoscopy revealed a severely diseased glottis and supraglottic area, from which biopsy samples revealed a multiple drug-resistant strain of requiring specialist microbiology input and antifungal treatment. We describe the presentation, investigation, management and outcome of this rare case, along with a literature review of the subject.
Topics: Adult; Airway Obstruction; Candidiasis; Female; Humans; Intubation, Intratracheal; Laryngoscopy; Larynx; Tracheostomy
PubMed: 34353829
DOI: 10.1136/bcr-2021-242910 -
European Archives of... Apr 2017Exercise induced laryngeal obstruction (EILO) is a condition where inappropriate vocal cord or glottic closure occurs during exercise. This review of the literature... (Review)
Review
Exercise induced laryngeal obstruction (EILO) is a condition where inappropriate vocal cord or glottic closure occurs during exercise. This review of the literature provides an overview of the current understanding of the definition, epidemiology, diagnosis and management of EILO. Using The Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines the Cochrane, Embase, Ovid MEDLINE and PubMed databases were searched. Four search domains "exercise", "induced", "laryngeal" and "obstruction" were used. Primary searching found 469 records, 308 were excluded following screening of titles and citation. 100 were duplicates, a further 47 studies were excluded after applying inclusion and exclusion criteria. Two studies were identified following cross-referencing. A total of 15 studies were included. The last search date was 6/06/15. Average prevalence in the general adolescent population and athletes was 7.1 and 35.2 %, respectively. Dyspnoea was reported in 96.5, 99 and 100 % of three EILO patient cohorts. Two studies (n = 107) reported continuous laryngoscopy during exercise (CLE) testing could differentiate between patients and controls. In two studies (n = 33) the visual analogue scale (VAS) showed a beneficial effect of endoscopic supraglottoplasty (ES). Thirty-eight out of 43 patients who received two or more laryngeal control therapy sessions (LCT) had improvement or resolution of EILO symptoms. Exercise induced dyspnoea is the most common EILO symptom. EILO has a high occurrence in adolescents and athletes. The CLE test is the current gold standard for EILO diagnostics. Management of EILO includes both surgical and non-surgical interventions.
Topics: Adolescent; Airway Obstruction; Asthma, Exercise-Induced; Diagnosis, Differential; Dyspnea; Exercise; Female; Humans; Laryngeal Diseases; Laryngoscopy; Male; Prevalence; Vocal Cord Dysfunction
PubMed: 27730324
DOI: 10.1007/s00405-016-4338-1 -
International Journal of Surgery... May 2017A retrospective study. (Review)
Review
STUDY DESIGN
A retrospective study.
PURPOSE
To explore the risk factors for reintubation after airway obstruction following anterior cervical surgery.
STUDY BACKGROUND
Anterior cervical surgery is an effective surgical therapy for cervical spine disorders. As the anterior approach is adopted more frequently, some rare postoperative complications come under the spotlight, among which, airway obstruction is extremely detrimental. However, the risk factors and the pathogenesis of the airway obstruction still remain unknown. Therefore, finding out the incidence rate and the risk factors of airway obstruction after anterior cervical surgery weighs significantly on preventing airway obstruction.
METHODS
We retrospectively analyzed the history and follow-up data of 774 patients who underwent anterior cervical surgery during January 2007 and June 2016. The patients were divided into two groups according to the occurrence of airway obstruction complication. Patients' age, sex, smoking history, drinking history, the presence of diabetes, body mass index (BMI), course of disease, surgical method, the location of the surgical segment, operation duration and the number of surgical segments were recorded and analyzed. Univariate analysis was conducted for the foregoing factors which might associate with concurrent airway obstruction, to screen out statistically significant factors, followed by a multivariate logistic regression analysis to analyze the relationship between these factors and the incidence rate of reintubation for airway obstruction after anterior cervical surgery.
RESULTS
14 of 744 patients developed postoperative airway obstruction followed by reintubation, which makes the incidence rate of 1.81% (14/774) for patients having airway obstruction after anterior cervical surgery. Among the 14 patients, 12 (85.7%) developed airway obstruction within 48 h after surgery, and 2 (14.3%) postoperative showed delayed airway obstruction in 9-11d after surgery. All of them had reintubation. The results of univariate analysis showed that there were statistically significant differences in age, smoking history, body mass index (BMI), surgical method, the location of the surgical segment, operation duration and the number of surgical segments between the two groups (P < 0.05). Multivariate logistic regression analysis showed that age (OR = 2.038, 95% CI = 1.045-4.012), smoking (OR = 1.502, 95% CI = 1.012-2.375), BMI (OR = (OR = 1.807, 95% CI = 1.126-2.842), operation duration (OR = 2.503, 95% CI = 1.580-3.966), surgical method (OR = 3.386, 95% CI = 1.036-3.625), the location of the surgical segment (OR = 2.391, 95% CI = 1.085-5.159) and the number of surgical segments (OR = 2.512, 95% CI = 1.564-3.768) were the risk factors for airway obstruction and reintubation after anterior cervical surgery (P < 0.05).
CONCLUSIONS
Age, smoking, obesity, the number of surgical segments, surgical method and surgical segment location are the important factors which may induce airway obstruction after anterior cervical surgery and therefore led to the decision of reintubations.
Topics: Adult; Aged; Aged, 80 and over; Airway Obstruction; Body Mass Index; Cervical Vertebrae; China; Cohort Studies; Female; Humans; Intubation, Intratracheal; Male; Middle Aged; Multivariate Analysis; Postoperative Complications; Retrospective Studies; Risk Factors; Spinal Diseases
PubMed: 28315747
DOI: 10.1016/j.ijsu.2017.03.014 -
Annals of the American Thoracic Society Apr 2020Most studies determining the prevalence of airway obstruction are limited to short time periods. Because temporal trends of obstruction in populations are largely... (Observational Study)
Observational Study
Most studies determining the prevalence of airway obstruction are limited to short time periods. Because temporal trends of obstruction in populations are largely unknown, we determined the prevalence of airway obstruction over 20 years in yearly general population samples in Switzerland between 1993 and 2012. We analyzed data of 85,789 participants aged 35 years and older who provided spirometric measurements as part of the LuftiBus lung function campaign. We linked data from the 2003-2012 period to the Swiss National Cohort to adjust for annual population differences. Spirometry was performed without bronchodilation, according to American Thoracic Society guidelines. We used Global Lung Initiative (GLI) and Hankinson reference equations to identify obstruction. Obstruction prevalence increased between 1993 and 2012 from 6.1% (95% confidence interval [CI], 5.5 to 6.7) to 15.6% (95% CI, 13.8 to 17.3) based on GLI estimates and from 5.3% (95% CI, 4.7 to 5.9) to 15.4% (95% CI, 13.6 to 17.1) based on Hankinson estimates. When adjusted for participant demographics, air pollutant and occupational exposures, altitude, and season, the prevalence ratios of obstruction were 1.54 (95% CI, 1.22 to 1.93) and 1.65 (95% CI, 1.33 to 2.04) for GLI- and Hankinson-defined airway obstruction, respectively, for 2012 compared with 2003. Though prebronchodilator measurements likely overestimate the prevalence of airway obstruction in absolute terms compared with post-bronchodilator measurements, we found an increase in airway obstruction prevalence. Even with adjustment for several well-known risk factors for obstruction to make the populations across the years more comparable, we still saw a statistically significant increase in prevalence over this time period.
Topics: Adult; Aged; Airway Obstruction; Cohort Studies; Female; Forced Expiratory Volume; Humans; Logistic Models; Lung; Male; Middle Aged; Population Surveillance; Prevalence; Reference Values; Spirometry; Switzerland; Vital Capacity
PubMed: 31991089
DOI: 10.1513/AnnalsATS.201907-542OC -
Pediatric Critical Care Medicine : a... Oct 2021Post-extubation upper airway obstruction is the most common cause of extubation failure in children, but there are few data regarding long-term morbidity. We aim to...
OBJECTIVES
Post-extubation upper airway obstruction is the most common cause of extubation failure in children, but there are few data regarding long-term morbidity. We aim to describe the frequency of long-term airway sequelae in intubated children and determine the association with post-extubation upper airway obstruction.
DESIGN
Retrospective, post hoc analysis of previously identified prospective cohort of children in the pediatric/cardiothoracic ICU at Children's Hospital Los Angeles from July 2012 to April 2015. A single provider blinded to the upper airway obstruction classification reviewed the electronic medical records of all patients in the parent study, before and after the index extubation (extubation during parent study), to identify pre-index and post-index upper airway disease. Primary outcomes were prevalence of newly diagnosed airway anomalies following index extubation.
SETTING
Single center, tertiary, 391-bed children's hospital.
PATIENTS
From the parent study, 327 children younger than 18 years (intubated for at least 12 hr) were included if they received subsequent care (regardless of specialty) after the index extubation.
INTERVENTIONS
None.
MEASUREMENTS AND MAIN RESULTS
New airway anomalies were identified in 40 of 327 children (12.2%). Patients labeled with subglottic upper airway obstruction at the index extubation were more likely to be diagnosed with new airway anomalies on subsequent follow-up, receive long-term Otolaryngology follow-up, or receive airway surgery (all p ≤ 0.006). In multivariable modeling, upper airway obstruction as the primary reason for initial intubation (odds ratio, 3.71; CI, 1.50-9.19), reintubation during the index ICU admission (odds ratio, 4.44; CI, 1.67-11.80), pre-index airway anomaly (odds ratio, 3.31; CI, 1.36-8.01), and post-extubation subglottic upper airway obstruction (odds ratio, 3.50; CI, 1.46-8.34) remained independently associated with the diagnosis of new airway anomalies.
CONCLUSIONS
Post-extubation subglottic upper airway obstruction is associated with a three-fold greater odds of long-term airway morbidity. These patients may represent an at-risk population that should be monitored closely after leaving the ICU.
Topics: Airway Extubation; Airway Obstruction; Child; Humans; Intubation, Intratracheal; Prospective Studies; Retrospective Studies
PubMed: 33833205
DOI: 10.1097/PCC.0000000000002724 -
The European Respiratory Journal Jul 2020Lymphangioleiomyomatosis (LAM) is a rare, cystic lung disease with progressive pulmonary function loss caused by progressively proliferating LAM cells. The degree of...
Lymphangioleiomyomatosis (LAM) is a rare, cystic lung disease with progressive pulmonary function loss caused by progressively proliferating LAM cells. The degree of airway obstruction has not been well investigated within the pathogenesis of LAM.Using a combination of computed tomography (CT), microCT and histology, the site and nature of airway obstruction in LAM explant lungs was compared with matched control lungs (n=5 each). The total number of airways per generation, total airway counts, terminal bronchioles number and surface density were compared in LAM control. CT analysis demonstrated a reduced number of airways from generation 7 on (p<0.0001) in LAM compared with control, whereas whole-lung microCT analysis confirmed the three- to four-fold reduction in the number of airways. Specimen microCT analysis further demonstrated a four-fold decrease in the number of terminal bronchioles (p=0.0079) and a decreased surface density (p=0.0079). Serial microCT and histology images directly showed the loss of functional airways by collapse of airways on the cysts and filling of the airway by exudate.LAM lungs show a three- to four-fold decrease in the number of (small) airways, caused by cystic destruction which is the likely culprit for the progressive loss of pulmonary function.
Topics: Airway Obstruction; Bronchioles; Humans; Lung; Lung Neoplasms; Lymphangioleiomyomatosis
PubMed: 32108050
DOI: 10.1183/13993003.01965-2019 -
BMJ Open Respiratory Research Nov 2023Chronic airflow obstruction is a key characteristic of chronic obstructive pulmonary disease. We investigated whether isolated small airways obstruction is associated...
BACKGROUND
Chronic airflow obstruction is a key characteristic of chronic obstructive pulmonary disease. We investigated whether isolated small airways obstruction is associated with chronic airflow obstruction later in life.
METHODS
We used longitudinal data from 3957 participants of the multinational Burden of Obstructive Lung Disease study. We defined isolated small airways obstruction using the prebronchodilator mean forced expiratory flow rate between 25% and 75% of the forced vital capacity (FVC) (FEF) if a result was less than the lower limit of normal (
airways obstruction. We defined chronic airflow obstruction as post-bronchodilator FEV/FVC airways obstruction and chronic airflow obstruction at follow-up. We assessed discriminative and predictive ability by calculating the area under the receiver operating curve (AUC) and Brier score. We replicated our analyses in 26 512 participants of the UK Biobank study. RESULTS
Median follow-up time was 8.3 years. Chronic airflow obstruction was more likely to develop in participants with isolated small airways obstruction at baseline (FEF less than the LLN, OR: 2.95, 95% CI 1.02 to 8.54; FEV/FVC less than the LLN, OR: 1.94, 95% CI 1.05 to 3.62). FEF was better than the FEV/FVC ratio to discriminate future chronic airflow obstruction (AUC: 0.764 vs 0.692). Results were similar among participants of the UK Biobank study.
CONCLUSION
Measurements of small airways obstruction can be used as early markers of future obstructive lung disease.
Topics: Humans; Longitudinal Studies; Pulmonary Disease, Chronic Obstructive; Airway Obstruction; Vital Capacity; Forced Expiratory Volume
PubMed: 37989490
DOI: 10.1136/bmjresp-2023-002056 -
Respiratory Medicine Oct 2021Increasing evidence shows that environmental factors in childhood play a role in development of irreversible airway obstruction. We evaluated early-life and...
BACKGROUND
Increasing evidence shows that environmental factors in childhood play a role in development of irreversible airway obstruction. We evaluated early-life and preschool-age risk factors for irreversible airway obstruction in adolescence after bronchiolitis in infancy.
METHODS
This study is a secondary analysis of data collected during prospective long-term follow-up of our post-bronchiolitis cohort. Risk factor data were collected during hospitalisation and on follow-up visits at 5-7 and 10-13 years of ages. Lung function was measured from 103 participants with impulse oscillometry at 5-7 years of age and from 89 participants with flow-volume spirometry at 10-13 years of age.
RESULTS
Asthma diagnosis at <12 months of age showed a significant association with irreversible airway obstruction at 10-13 years of age independently from current asthma. Irreversible airway obstruction was less frequent in children with variant than wild genotype of the Toll-like receptor 4(TLR4) rs4986790, but the significance was lost in logistic regression adjusted for current asthma and weight status. Higher post-bronchodilator respiratory system resistance at 5 Hz and lower baseline and post-bronchodilator reactance at 5 Hz by impulse oscillometry at 5-7 years of age were associated with irreversible airway obstruction at 10-13 years of age.
CONCLUSION
Asthma diagnosis during the first living year and worse lung function at preschool age increased the risk for irreversible airway obstruction at 10-13 years of age after bronchiolitis. TLR4 rs4986790 polymorphism may be protective for development of irreversible airway obstruction after bronchiolitis.
Topics: Adolescent; Age Factors; Airway Obstruction; Airway Resistance; Asthma; Bronchiolitis; Child; Child, Preschool; Female; Follow-Up Studies; Genotype; Humans; Male; Oscillometry; Polymorphism, Genetic; Prospective Studies; Risk Factors; Spirometry; Time Factors; Toll-Like Receptor 4
PubMed: 34332337
DOI: 10.1016/j.rmed.2021.106545 -
Respiratory Care Sep 2016Obstructive fibrinous tracheal pseudomembrane (OFTP) is an uncommon complication that results after tracheal intubation. Herein, we perform a systematic review of the... (Review)
Review
Obstructive fibrinous tracheal pseudomembrane (OFTP) is an uncommon complication that results after tracheal intubation. Herein, we perform a systematic review of the PubMed and EmBase databases for all the cases describing OFTP. The systematic search yielded 28 citations describing 53 subjects with OFTP. The study population (61.1% females) comprised of both adults and pediatric subjects with a median (IQR) age of 40.5 (14.8-60.5) years. The median (IQR) size of endotracheal tube was 7.5 (6-9.3) mm with a median (IQR) duration of intubation of 36 (14-96) hours. The median (IQR) time to onset of symptoms after extubation was 24 (6-96) hours. Stridor was the most common symptom. The average delay in correctly identifying the OFTP was 26 hours. The diagnosis of tracheal pseudomembrane was confirmed by flexible bronchoscopy in 38 (70.4%) instances while rigid bronchoscopy was used in 46.3% subjects for removing the pseudomembrane. There were two deaths, one each in an adult and a pediatric subject. OFTP is a complication of tracheal intubation and presents with respiratory failure. The diagnosis can be confirmed by flexible bronchoscopy. Treatment involves removal of the obstructing membrane with either flexible or rigid bronchoscopy.
Topics: Airway Extubation; Airway Obstruction; Bronchoscopy; Humans; Intubation, Intratracheal; Respiratory Sounds; Tracheal Diseases
PubMed: 27247431
DOI: 10.4187/respcare.04662