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Thorax May 2024Airway obstruction is defined by spirometry as a low forced expiratory volume in 1 s (FEV) to forced vital capacity (FVC) ratio. This impaired ratio may originate from a...
BACKGROUND
Airway obstruction is defined by spirometry as a low forced expiratory volume in 1 s (FEV) to forced vital capacity (FVC) ratio. This impaired ratio may originate from a low FEV (classic) or a normal FEV in combination with a large FVC (dysanaptic). The clinical implications of dysanaptic obstruction during childhood and adolescence in the general population remain unclear.
AIMS
To investigate the association between airway obstruction with a low or normal FEV in childhood and adolescence, and asthma, wheezing and bronchial hyperresponsiveness (BHR).
METHODS
In the BAMSE (Barn/Child, Allergy, Milieu, Stockholm, Epidemiology; Sweden) and PIAMA (Prevention and Incidence of Asthma and Mite Allergy; the Netherlands) birth cohorts, obstruction (FEV:FVC ratio less than the lower limit of normal, LLN) at ages 8, 12 (PIAMA only) or 16 years was classified as classic (FEV
obstruction. Cross-sectional and longitudinal associations between these two types of obstruction and respiratory health outcomes were estimated by cohort-adjusted logistic regression on pooled data. RESULTS
The prevalence of classic obstruction at ages 8, 12 and 16 in the two cohorts was 1.5%, 1.1% and 1.5%, respectively. Dysanaptic obstruction was slightly more prevalent: 3.9%, 2.5% and 4.6%, respectively. Obstruction, regardless of FEV, was consistently associated with higher odds of asthma (dysanaptic obstruction: OR 2.29, 95% CI 1.40 to 3.74), wheezing, asthma medication use and BHR compared with the normal lung function group. Approximately one-third of the subjects with dysanaptic obstruction in childhood remained dysanaptic during adolescence.
CLINICAL IMPLICATIONS
Children and adolescents with airway obstruction had, regardless of their FEV level, a higher prevalence of asthma and wheezing. Follow-up and treatment at these ages should be guided by the presence of airway obstruction.
Topics: Humans; Child; Forced Expiratory Volume; Adolescent; Male; Female; Asthma; Respiratory Sounds; Airway Obstruction; Vital Capacity; Sweden; Spirometry; Prevalence; Cross-Sectional Studies; Bronchial Hyperreactivity; Netherlands
PubMed: 38514183
DOI: 10.1136/thorax-2023-220952 -
NEJM Evidence Oct 2023BACKGROUND: Mucus plugs in asthmatic airways are associated with airway obstruction and the activity of inflammatory cytokines, specifically interleukin (IL)-5 and... (Clinical Trial)
Clinical Trial
BACKGROUND: Mucus plugs in asthmatic airways are associated with airway obstruction and the activity of inflammatory cytokines, specifically interleukin (IL)-5 and IL-13, and they may provide an opportunity for targeted therapy. This analysis of the CASCADE (Study to Evaluate Tezepelumab on Airway Inflammation in Adults With Uncontrolled Asthma) placebo-controlled trial used computed tomography (CT) imaging to assess mucus plugs in patients with moderate-to-severe, uncontrolled asthma who received tezepelumab or placebo. METHODS: CASCADE was an exploratory, double-blind, placebo-controlled trial examining the anti-inflammatory effect of tezepelumab. Patients (aged 18 to 75 years old) were randomly assigned 1:1 to 210 mg tezepelumab or placebo every 4 weeks subcutaneously for at least 28 weeks. An expert radiologist, blinded to treatment groups and time points, objectively scored 18 lung segments for the presence of mucus plugs in CT scans obtained before and after treatment; greater numbers of mucus plugs resulted in higher mucus plug scores. RESULTS: Absolute change from baseline (mean [±standard deviation]) in mucus plug score was −1.7±2.6 in patients receiving tezepelumab (n=37) and 0.0±1.4 in patients receiving placebo (n=45). At baseline, mucus plug scores correlated positively with levels of inflammatory biomarkers (blood eosinophils, eosinophil-derived neurotoxin, fractional exhaled nitric oxide, IL-5, and IL-13) and negatively with lung function measures (prebronchodilator forced expiratory volume in 1 second and forced mid-expiratory flow). In tezepelumab recipients, reductions in mucus plug scores were correlated with improvements in lung function and reductions in blood eosinophil count and levels of eosinophil-derived neurotoxin, a biomarker of eosinophilic degranulation. CONCLUSIONS: Tezepelumab was associated with a reduction in occlusive mucus plugs versus placebo in a randomized controlled trial in patients with moderate-to-severe, uncontrolled asthma. (Funded by AstraZeneca and Amgen Inc.; ClinicalTrials.gov number, NCT03688074.)
Topics: Humans; Airway Obstruction; Antibodies, Monoclonal, Humanized; Asthma; Mucus
PubMed: 38320181
DOI: 10.1056/EVIDoa2300135 -
Current Pediatric Reviews 2024Allergic rhinitis is a prevalent condition among children, with its occurrence reaching up to 40% of the general population in some geographical areas. A type 2 immunity... (Review)
Review
Allergic rhinitis is a prevalent condition among children, with its occurrence reaching up to 40% of the general population in some geographical areas. A type 2 immunity sustains allergic rhinitis. Consequently, type 2 inflammation leads to eosinophilic infiltrate of the nasal mucosa. Allergic inflammation causes the symptom occurrence. Typical nasal symptoms include nasal itching, sneezing, watery rhinorrhea, and nasal congestion. Nasal congestion depends on vasodilation and increased mucus production. These conditions result in nasal obstruction. Nasal obstruction is closely associated with type 2 inflammation. Allergic rhinitis usually occurs in association with other allergic conditions, in particular allergic conjunctivitis and asthma. The effective management of allergic rhinitis involves avoiding triggering allergens and employing pharmacological treatments as per ARIA guidelines. These treatments may include intranasal/oral antihistamines or/and nasal corticosteroids. In particular, antihistamines are particularly indicated for symptoms consequent to mediators' release, mainly concerning histamine. These histamine-dependent symptoms include itching, sneezing, and rhinorrhea. Nasal obstruction, being associated with inflammation, is responsive to corticosteroids, administered mostly intranasally. The fixed combination of a topical antihistamine plus a topical corticosteroid is very effective, but is indicated for adolescents only. However, nasal lavage is safe, cheap, and adequate, thus its use is prevalent. Namely, nasal lavage allows to remove secretions, allergens, mediators. In addition, hypertonic solutions exert a decongestant activity. On the other hand, the allergen-specific immunotherapy is still the only causal treatment. Nutraceuticals have also been used to relieve symptoms. The objective of this review is to explore and compare the traditional and new therapeutic approaches for pollen-induced allergic rhinitis in children.
Topics: Child; Adolescent; Humans; Nasal Obstruction; Histamine; Sneezing; Rhinitis, Allergic; Histamine Antagonists; Adrenal Cortex Hormones; Allergens; Inflammation; Rhinorrhea; Pruritus
PubMed: 37702169
DOI: 10.2174/1573396320666230912103108 -
Otolaryngologic Clinics of North America Mar 2024Optimal surgical and medical management of obstructive sleep apnea (OSA) requires clinically reliable identification of patterns and sites of upper airway obstruction. A... (Review)
Review
Optimal surgical and medical management of obstructive sleep apnea (OSA) requires clinically reliable identification of patterns and sites of upper airway obstruction. A wide variety of modalities has been used to evaluate upper airway obstruction. Drug-induced sleep endoscopy (DISE) and cine MRI are increasingly used to identify upper airway obstruction sites, to characterize airway obstruction patterns, to determine optimum medical and surgical treatment, and to plan individualized surgical management. Here, the authors provide an overview of the applications of DISE and cine MRI in assessing upper airway obstruction in children and adults with OSA.
PubMed: 38519293
DOI: 10.1016/j.otc.2024.02.020 -
Otolaryngologic Clinics of North America Jun 2024Optimal surgical and medical management of obstructive sleep apnea requires clinically reliable identification of patterns and sites of upper airway obstruction. A wide... (Review)
Review
Optimal surgical and medical management of obstructive sleep apnea requires clinically reliable identification of patterns and sites of upper airway obstruction. A wide variety of modalities have been used to evaluate upper airway obstruction. Drug-induced sleep endoscopy (DISE) and cine MRI are increasingly used to identify upper airway obstruction sites, to characterize airway obstruction patterns, to determine optimum medical and surgical treatment, and to plan individualized surgical management. Here, we provide an overview of the applications of DISE and cine MRI in assessing upper airway obstruction in children and adults with obstructive sleep apnea.
Topics: Humans; Sleep Apnea, Obstructive; Endoscopy; Child; Polysomnography; Magnetic Resonance Imaging, Cine; Adult
PubMed: 38485538
DOI: 10.1016/j.otc.2024.02.002 -
Rhinology Oct 2023Patients with septal deviation and/or turbinal hypertrophy may experience olfactory disfunction (OD). The aim of this study was to analyse the effect of septoplasty...
BACKGROUND
Patients with septal deviation and/or turbinal hypertrophy may experience olfactory disfunction (OD). The aim of this study was to analyse the effect of septoplasty and/or turbinoplasty on both lateralized and bilateral olfactory function.
METHODOLOGY
Prospective study of 47 patients with nasal obstruction secondary to septal deviation and/or turbinal hypertrophy and 20 healthy controls. The Barcelona Olfactory test (BOT-8), a new supraliminal orthonasal subjective olfactometry, was applied 3 times in a row (in each nostril separately and in both simultaneously). The 8 items were applied randomly to minimize the possible risk of learning. The test has not established the minimal clinically important difference (MCID). Anterior rhinomanometry and acoustic rhinometry were performed. All participants self-assessed smell loss and nasal obstruction using a visual analogue scale (VAS) and completed questionnaires for nasal obstruction (Nasal Obstruction Symptom Evaluation, NOSE) and for quality of life (QoL), using disease-specific (SinoNasal Outcome Test-22, SNOT-22) and generic (Short Form-12 Health Survey, SF-12) questionnaires. Nasal measurements and questionnaires were performed preoperatively and 12 months after surgery.
RESULTS
Before surgery, patients reported worse VAS on smell loss and on nasal obstruction compared to controls. Patients scored lower BOT-8 than controls. Lateralized preoperative olfactory function showed that all BOT-8 characteristics were lower at the narrow side than the wider one. Smell function and QoL improved significantly one year after surgery.
CONCLUSIONS
Nasal septal deviation and turbinal hypertrophy lead to an olfactory impairment on the obstructed nostril. Nasal surgery provides a positive outcome on olfactory function, as well as on subjective and objective outcomes.
Topics: Humans; Smell; Quality of Life; Nasal Obstruction; Prospective Studies; Anosmia; Treatment Outcome; Rhinoplasty; Nasal Septum; Nose Deformities, Acquired
PubMed: 37475674
DOI: 10.4193/Rhin22.461 -
Journal of Applied Physiology... May 2024Smaller mean airway tree caliber is associated with airflow obstruction and chronic obstructive pulmonary disease (COPD). We investigated whether airway tree caliber...
Smaller mean airway tree caliber is associated with airflow obstruction and chronic obstructive pulmonary disease (COPD). We investigated whether airway tree caliber heterogeneity was associated with airflow obstruction and COPD. Two community-based cohorts (MESA Lung, CanCOLD) and a longitudinal case-control study of COPD (SPIROMICS) performed spirometry and computed tomography measurements of airway lumen diameters at standard anatomical locations (trachea-to-subsegments) and total lung volume. Percent-predicted airway lumen diameters were calculated using sex-specific reference equations accounting for age, height, and lung volume. The association of airway tree caliber heterogeneity, quantified as the standard deviation (SD) of percent-predicted airway lumen diameters, with baseline forced expired volume in 1-second (FEV), FEV/forced vital capacity (FEV/FVC) and COPD, as well as longitudinal spirometry, were assessed using regression models adjusted for age, sex, height, race-ethnicity, and mean airway tree caliber. Among 2,505 MESA Lung participants (means ± SD age: 69 ± 9 yr; 53% female, mean airway tree caliber: 99 ± 10% predicted, airway tree caliber heterogeneity: 14 ± 5%; median follow-up: 6.1 yr), participants in the highest quartile of airway tree caliber heterogeneity exhibited lower FEV (adjusted mean difference: -125 mL, 95%CI: -171,-79), lower FEV/FVC (adjusted mean difference: -0.01, 95%CI: -0.02,-0.01), and higher odds of COPD (adjusted odds ratio: 1.42, 95%CI: 1.01-2.02) when compared with the lowest quartile, whereas longitudinal changes in FEV and FEV/FVC did not differ significantly. Observations in CanCOLD and SPIROMICS were consistent. Among older adults, airway tree caliber heterogeneity was associated with airflow obstruction and COPD at baseline but was not associated with longitudinal changes in spirometry. In this study, by leveraging two community-based samples and a case-control study of heavy smokers, we show that among older adults, airway tree caliber heterogeneity quantified by CT is associated with airflow obstruction and COPD independent of age, sex, height, race-ethnicity, and dysanapsis. These observations suggest that airway tree caliber heterogeneity is a structural trait associated with low baseline lung function and normal decline trajectory that is relevant to COPD.
Topics: Humans; Female; Male; Aged; Pulmonary Disease, Chronic Obstructive; Spirometry; Lung; Forced Expiratory Volume; Case-Control Studies; Vital Capacity; Middle Aged; Longitudinal Studies; Tomography, X-Ray Computed; Airway Obstruction; Aged, 80 and over
PubMed: 38420676
DOI: 10.1152/japplphysiol.00694.2022 -
Current Opinion in Pulmonary Medicine Jan 2024This review provides an overview of the evolving field of airway stenting (AS), highlighting its relevance in the management of central airway obstruction (CAO). It... (Review)
Review
PURPOSE OF REVIEW
This review provides an overview of the evolving field of airway stenting (AS), highlighting its relevance in the management of central airway obstruction (CAO). It discusses recent advancements, including 3D-printed silicone stents (3DPSS), metallic stents, biodegradable stents (BS), and drug-eluting stents (DES), which are transforming clinical practice. The review underscores the ongoing challenges in patient selection, stent choice, and long-term management in the context of an evolving landscape.
RECENT FINDINGS
Innovations, particularly 3DPSS, have shown promise in providing patient-specific solutions. These stents offer improved symptom relief, enhanced quality of life, and lower complication rates, especially for complex airway diseases. The use of BS and DES is explored, raising prospects for future applications.
SUMMARY
The evolution of AS reflects a deepening understanding of airway obstructions. Recent innovations, such as 3DPSS, BS, and DES, show considerable promise in addressing the limitations of conventional stents. However, challenges related to complications, patient selection, and long-term management persist, demanding further research. Wide practice variations in the management of AS highlight the need for more clinical data and standardized guidelines. The search for the ideal stent continues, driven by the pursuit of better outcomes for patients with CAO.
Topics: Humans; Quality of Life; Stents; Airway Obstruction; Treatment Outcome
PubMed: 37937587
DOI: 10.1097/MCP.0000000000001032 -
Facial Plastic Surgery : FPS Dec 2023Early reductive rhinoplasty techniques focused on hump reduction and tip plasty with minimal focus on treating or preserving the integrity and width of the middle vault....
Early reductive rhinoplasty techniques focused on hump reduction and tip plasty with minimal focus on treating or preserving the integrity and width of the middle vault. With time, rhinoplasty surgeons noted the aesthetic and functional complications of the deformities that may occur in the middle vault with reduction techniques and developed methods to treat and also avoid these complications. Thus, the importance of protecting the integrity of the middle third of the nose has been increasingly emphasized over the years. Primary deformities of the middle vault that result in nasal obstruction require attention of the rhinoplasty surgeon, as well as preservation of support structures of the middle vault and internal nasal valve to minimize secondary deformities and functional compromise after rhinoplasty surgery.
Topics: Humans; Esthetics, Dental; Nose; Rhinoplasty; Nasal Obstruction; Nose Deformities, Acquired; Nasal Septum
PubMed: 37536369
DOI: 10.1055/a-2148-2141