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Laryngo- Rhino- Otologie May 2024
Topics: Humans; Turbinates; Hypertrophy; Rhinoplasty; Germany; Female; Nasal Obstruction; Male; Adult; Cost-Benefit Analysis; Middle Aged
PubMed: 38697079
DOI: 10.1055/a-2219-0574 -
Facial Plastic Surgery : FPS Dec 2023Lateral wall insufficiency is a commonly encountered etiology of nasal obstruction, resulting from dynamic collapse at the level of the internal or external nasal valve....
Lateral wall insufficiency is a commonly encountered etiology of nasal obstruction, resulting from dynamic collapse at the level of the internal or external nasal valve. Various management strategies exist to strengthen the lateral wall or stent the nasal valves to relieve nasal obstruction, and range from noninvasive devices, minimally invasive implants, or surgical reconstructive techniques. Surgical options to address the nasal valves are selected based on each patient's anatomic findings, aesthetic and functional goals, and surgeon preference. This article describes the anatomy and physiology of the nasal sidewall and nasal valves and diagnosis of lateral wall insufficiency, and provides a framework for treatment options.
Topics: Humans; Nasal Obstruction; Rhinoplasty; Esthetics, Dental; Nose; Plastic Surgery Procedures
PubMed: 37709288
DOI: 10.1055/s-0043-1773767 -
Respiratory Research Sep 2023Rhinovirus infections commonly evoke asthma exacerbations in children and adults. Recurrent asthma exacerbations are associated with injury-repair responses in the... (Review)
Review
BACKGROUND
Rhinovirus infections commonly evoke asthma exacerbations in children and adults. Recurrent asthma exacerbations are associated with injury-repair responses in the airways that collectively contribute to airway remodeling. The physiological consequences of airway remodeling can manifest as irreversible airway obstruction and diminished responsiveness to bronchodilators. Structural cells of the airway, including epithelial cells, smooth muscle, fibroblasts, myofibroblasts, and adjacent lung vascular endothelial cells represent an understudied and emerging source of cellular and extracellular soluble mediators and matrix components that contribute to airway remodeling in a rhinovirus-evoked inflammatory environment.
MAIN BODY
While mechanistic pathways associated with rhinovirus-induced airway remodeling are still not fully characterized, infected airway epithelial cells robustly produce type 2 cytokines and chemokines, as well as pro-angiogenic and fibroblast activating factors that act in a paracrine manner on neighboring airway cells to stimulate remodeling responses. Morphological transformation of structural cells in response to rhinovirus promotes remodeling phenotypes including induction of mucus hypersecretion, epithelial-to-mesenchymal transition, and fibroblast-to-myofibroblast transdifferentiation. Rhinovirus exposure elicits airway hyperresponsiveness contributing to irreversible airway obstruction. This obstruction can occur as a consequence of sub-epithelial thickening mediated by smooth muscle migration and myofibroblast activity, or through independent mechanisms mediated by modulation of the β agonist receptor activation and its responsiveness to bronchodilators. Differential cellular responses emerge in response to rhinovirus infection that predispose asthmatic individuals to persistent signatures of airway remodeling, including exaggerated type 2 inflammation, enhanced extracellular matrix deposition, and robust production of pro-angiogenic mediators.
CONCLUSIONS
Few therapies address symptoms of rhinovirus-induced airway remodeling, though understanding the contribution of structural cells to these processes may elucidate future translational targets to alleviate symptoms of rhinovirus-induced exacerbations.
Topics: Child; Adult; Humans; Rhinovirus; Airway Remodeling; Endothelial Cells; Bronchodilator Agents; Asthma; Airway Obstruction
PubMed: 37773065
DOI: 10.1186/s12931-023-02529-9 -
Facial Plastic Surgery : FPS Jun 2024The nose has several important functions including inspiration, humidification of air, and filtering of allergens. The nose also has a major role in facial harmony as...
The nose has several important functions including inspiration, humidification of air, and filtering of allergens. The nose also has a major role in facial harmony as the central focal point. Patients will present to the rhinoplasty surgeon in an effort to fix the inability to breathe through the nose or correct a perceived nasal deformity in the shape of the nose. Choosing the optimal techniques to effectively change the nose requires a thorough understanding of nasal anatomy and nasal mechanics. Ultimately, a complete nasal evaluation is essential in identifying what corresponds to a patient's complaints and how those issues can be addressed surgically or perhaps nonsurgically. When the nose is divided into subunits, and a systematic nasal analysis is performed, one can be confident that all components of the nasal skeleton have been assessed.
Topics: Humans; Rhinoplasty; Nose; Nasal Obstruction
PubMed: 38198819
DOI: 10.1055/s-0043-1777839 -
NEJM Evidence Oct 2023Asthma researchers have long recognized that abnormal mucus production and clearance play a role in the pathophysiology of asthma. Mucus plugs are known to be common in...
Asthma researchers have long recognized that abnormal mucus production and clearance play a role in the pathophysiology of asthma. Mucus plugs are known to be common in patients with severe asthma, and mucus plug scores, for which higher scores indicate more severe plugging, are directly correlated with airflow obstruction and markers of eosinophilic airway inflammation (i.e., higher scores or marker levels are associated with more severe obstruction). Other work has shown that mucus plugs were associated with distal deficits in regional ventilation as delineated by hyperpolarized gas magnetic resonance imaging..
Topics: Humans; Airway Obstruction; Mucus; Asthma; Lung; Eosinophilia; Biological Therapy
PubMed: 38320185
DOI: 10.1056/EVIDe2300179 -
Seminars in Fetal & Neonatal Medicine Oct 2023The ex-utero intrapartum treatment (EXIT) procedure was originally developed to reverse tracheal occlusion in fetuses with severe congenital diaphragmatic hernia that... (Review)
Review
The ex-utero intrapartum treatment (EXIT) procedure was originally developed to reverse tracheal occlusion in fetuses with severe congenital diaphragmatic hernia that underwent fetal tracheal occlusion. The EXIT procedure has since been applied to a wide range of indications, but the primary indication remains securing a patent airway and providing respiratory support in fetuses with anticipated difficult airways. The authors review perinatal management of the anticipated difficult airway and their single-institution's experience with the EXIT procedure.
Topics: Pregnancy; Female; Humans; Cesarean Section; Tracheostomy; Hernias, Diaphragmatic, Congenital; Fetus; Airway Obstruction
PubMed: 38030438
DOI: 10.1016/j.siny.2023.101485 -
The Journal of Allergy and Clinical... Jun 2024Nasal obstruction is the subjective perception and objective state of insufficient airflow through the nose. Nasal congestion, conversely, describes a state of not just... (Review)
Review
Nasal obstruction is the subjective perception and objective state of insufficient airflow through the nose. Nasal congestion, conversely, describes a state of not just inadequate airflow or obstructive phenomena but also pressure- and mucus-related states to the patient. Nasal receptors belonging to the transient receptor potential (TRP) protein family mediate the sense of nasal patency via the trigeminal nerve. The transient receptor potential melastatin-8 (TRPM8) responds to temperatures around 8°C to 22°C, and is stimulated by menthol and other cooling agents. The radiant effects of airflow create heat loss to activate these receptors and humans perceive this as nasal patency rather than the direct detection of airflow. The thermovascular state of the mucosa, in conditions such as rhinitis, influence TRPM8 activation. Nasal endoscopy can show signs of rhinitis and should be considered an essential part of the workup of nasal congestion. Efforts to relieve nasal congestion need to manage the mucosal state and surgery needs to ensures that the nasal cavity mucosa is exposed to the cooling effects of airflow rather than simply creating a passage to the nasopharynx.
Topics: Humans; Nasal Obstruction; Nasal Mucosa; TRPM Cation Channels; Endoscopy; Rhinitis
PubMed: 38677589
DOI: 10.1016/j.jaip.2024.04.028 -
American Journal of Respiratory and... Nov 2023Spirometry is essential for diagnosis and assessment of prognosis in patients with chronic obstructive pulmonary disease (COPD). To identify FEV trajectories and their...
Spirometry is essential for diagnosis and assessment of prognosis in patients with chronic obstructive pulmonary disease (COPD). To identify FEV trajectories and their determinants on the basis of annual spirometry measurements among individuals with and without airway obstruction (AO) and to assess mortality in relation to trajectories. From 2002 through 2004, individuals with AO (FEV/VC < 0.70, = 993) and age- and sex-matched nonobstructive (NO) referents were recruited from population-based cohorts. Annual spirometry until 2014 was used in joint-survival latent-class mixed models to identify lung function trajectories. Mortality data were collected during 15 years of follow-up. Three trajectories were identified among the subjects with AO and two among the NO referents. Trajectory membership was driven by baseline FEV% predicted (FEV%pred) in both groups and also by pack-years in subjects with AO and current smoking in NO referents. Longitudinal FEV%pred depended on baseline FEV%pred, pack-years, and obesity. The trajectories were distributed as follows: among individuals with AO, 79.6% in AO trajectory 1 (FEV high with normal decline), 12.8% in AO trajectory 2 (FEV high with rapid decline), and 7.7% in AO trajectory 3 (FEV low with normal decline) (mean, 27, 72, and 26 ml/yr, respectively) and, among NO referents, 96.7% in NO trajectory 1 (FEV high with normal decline) and 3.3% in NO trajectory 2 (FEV high with rapid decline) (mean, 34 and 173 ml/yr, respectively). Hazard for death was increased for AO trajectories 2 (hazard ratio [HR], 1.56) and 3 (HR, 3.45) versus AO trajectory 1 and for NO trajectory 2 (HR, 2.99) versus NO trajectory 1. Three different FEV trajectories were identified among subjects with AO and two among NO referents, with different outcomes in terms of FEV decline and mortality. The FEV trajectories among subjects with AO and the relationship between low FVC and trajectory outcome are of particular clinical interest.
Topics: Adult; Humans; Lung; Forced Expiratory Volume; Vital Capacity; Pulmonary Disease, Chronic Obstructive; Airway Obstruction; Spirometry; Prednisone
PubMed: 37460250
DOI: 10.1164/rccm.202211-2166OC -
Pediatric Pulmonology Nov 2023Plastic bronchitis is a term used to describe group of life-threatening disorders characterized by the presence of large obstructing casts in the airways. Eosinophilic... (Review)
Review
Plastic bronchitis is a term used to describe group of life-threatening disorders characterized by the presence of large obstructing casts in the airways. Eosinophilic plastic bronchitis is a subtype of plastic bronchitis that occurs mainly in children and has not been well-described in the literature. Patients may have a history of asthma or atopy, but many do not. They often present with cough and wheezing, and frequently have complete collapse of one lung seen on imaging. The severity of presentation varies depending on the location of the casts, ranging from mild symptoms to severe airway obstruction and death. Bronchoscopy is often required to both diagnose and treat this condition. A variety of medical therapies have been used, although no formal studies have evaluated their efficacy. Symptoms may resolve after initial cast removal, but in some patients, cast formation recurs. Here, we report a case series of nine patients with eosinophilic plastic bronchitis and review the existing literature of this condition.
Topics: Child; Humans; Bronchitis; Asthma; Lung; Airway Obstruction; Bronchoscopy
PubMed: 37606213
DOI: 10.1002/ppul.26650 -
Clinical Chemistry and Laboratory... Sep 2023Over 3% of asthmatic patients are affected by a particularly severe form of the disease ("severe asthma", SA) which is often refractory to standard treatment. Airway... (Review)
Review
Over 3% of asthmatic patients are affected by a particularly severe form of the disease ("severe asthma", SA) which is often refractory to standard treatment. Airway remodeling (AR), which can be considered a critical characteristic of approximately half of all patients with SA and currently thought to be the main mechanism triggering fixed airway obstruction (FAO), seems to be a key factor affecting a patient's outcome. Despite the collective efforts of internationally renowned experts, to date only a few biomarkers indicative of AR and no recognizable biomarkers of lung parenchymal remodeling have been identified. This work examines the pathogenesis of airway and lung parenchymal remodeling and the serum biomarkers that may be able to identify the severe asthmatic patients who may develop FAO. The study also aims to examine if Krebs von den Lungen-6 (KL-6) could be considered a diagnostic biomarker of lung structural damage in SA.
Topics: Humans; Lung Diseases, Interstitial; Biomarkers; Asthma; Airway Obstruction; Mucin-1
PubMed: 36989607
DOI: 10.1515/cclm-2022-1323