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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 -
A&A Practice Jun 2023Airway obstruction during anesthesia is a common occurrence with potentially serious outcomes. Increasingly, patients are older, heavier, and more likely to have...
Airway obstruction during anesthesia is a common occurrence with potentially serious outcomes. Increasingly, patients are older, heavier, and more likely to have obstructive sleep apnea-all heightened risk factors for airway complications. These patients undergo procedures where distal pharyngeal tissues can relax, obstructing the airway. As a result, there is a need for airway devices that can stent open distal pharyngeal tissues to maintain adequate ventilation. To physically address this problem, the new distal pharyngeal airway (DPA) prevents airway obstruction and enables providers to maintain ventilation.
Topics: Humans; Pharynx; Sleep Apnea, Obstructive; Respiration; Airway Obstruction; Anesthesia
PubMed: 37335861
DOI: 10.1213/XAA.0000000000001691 -
Journal of Veterinary Emergency and... Jan 2022Increased airway resistance due to upper airway obstruction is a common cause of respiratory distress. An upper airway exam is an inexpensive and quick diagnostic...
BACKGROUND
Increased airway resistance due to upper airway obstruction is a common cause of respiratory distress. An upper airway exam is an inexpensive and quick diagnostic procedure that can serve to localize a disease process, confirm a definitive diagnosis, and offer therapeutic benefits.
DESCRIPTION
The upper airway examination consists of an external evaluation of the head and neck as well as a sedated examination of the oral cavity, the pharyngeal cavity, larynx, and nasal passages.
SUMMARY
An upper airway examination should be performed in patients with increased inspiratory effort or increased upper respiratory noise (eg, stertor or stridor). A complete, sedated upper airway examination should be considered for patients with clinical signs of upper airway disease for which a cause is not obvious from the physical examination.
KEY POINTS
Indications for an upper airway examination include sneezing, nasal discharge or epistaxis, reduced or absent nasal airflow, change in phonation, inspiratory difficulty, and audible respiratory sounds. Upper airway examination helps localize pathological processes and allows the clinician to confirm or exclude several differential diagnoses. Pre-oxygenation of the patient for 3-5 minutes prior to sedation will help increase the amount of time available before hypoxemia occurs, should complications arise. Upon completion of the upper airway examination, it is important to monitor the patient carefully and ensure a safe recovery. Careful planning to ensure the availability of necessary equipment and preparation of the team to react during and after the airway examination will minimize the risks of examination to patients with upper airway disease.
Topics: Airway Obstruction; Animals; Dog Diseases; Dogs; Dyspnea; Hypoxia; Larynx; Respiratory Sounds; Trachea
PubMed: 35044069
DOI: 10.1111/vec.13124 -
Archivos de Bronconeumologia Sep 2020
Topics: Airway Obstruction; Foreign Bodies; Humans
PubMed: 31668773
DOI: 10.1016/j.arbres.2019.08.008 -
Clinical Rheumatology Apr 2021This study aims to assess the prevalence and clinical correlates of small airway obstruction (SAO) in patients with systemic sclerosis (SSc).
OBJECTIVES
This study aims to assess the prevalence and clinical correlates of small airway obstruction (SAO) in patients with systemic sclerosis (SSc).
METHODS
Sixty-nine consecutive patients with SSc (63 women and 6 men) were included. Lung function tests, including assessment of lung diffusing capacity, were performed in all patients. Patients were considered to have SAO when the maximal expiratory flow at 25% of the forced vital capacity (MEF) was lower than 60% as predicted. High-resolution computed tomography (HRCT) of the lung was performed in all patients with MEF < 60%. We assessed the relationship of SAO in our patients with large airway obstruction, decreased lung diffusing capacity, HRCT findings, disease duration, disease subtype, scleroderma-specific antibodies, and smoking.
RESULTS
SAO was noticed in 46/69 (66.6%) of patients with SSc. Restrictive lung disease was found in 4/69 (5.8%), obstruction of large airways in 18/69 (26.1%), and decreased lung diffusing capacity in 47/69 (68.1%) of patients. No difference in gender, age, disease duration, disease subtype, and scleroderma-specific antibodies was found between patients with and without SAO. Eighteen out of forty-six (39.1%) patients with SAO had decreased forced expiratory volume in 1 sec (FEV) and the Tiffeneau-Pinelli index, indicating presence of coexistent large airway obstruction. Twenty out of forty-six (43.5%) patients with SAO had associated decreased lung diffusing capacity, while 8/46 (17.4%) of patients had isolated SAO. HRCT patterns of interstitial lung disease (ILD) were found more frequently in patients with SAO and decreased lung diffusing capacity, compared with patients with SAO and normal diffusing capacity (75% vs 11.5%, p = 0.008). We have noticed that tobacco smokers among SSc patients with SAO have more common associated obstructive lung disease on spirometry (58.8% vs 15.4%, p = 0.004). On the other hand, isolated SAO and SAO associated with impaired diffusing capacity were equally frequent among smokers and non-smokers.
CONCLUSION
Patients with SSc have commonly SAO. It can be considered clinical feature of undiagnosed asthma or chronic obstructive pulmonary disease (COPD), if isolated or associated with large airway obstruction, especially in tobacco smokers. On the other hand, SAO associated with decreased lung diffusing capacity was found to be not related to smoking, and may indicate a possible prominent bronchiolar involvement within SSc-related interstitial lung disease Key Points • Small airway obstruction in patients with systemic sclerosis can be considered a clinical feature of undiagnosed obstructive lung disease, if isolated or associated with large airway obstruction, especially in tobacco smokers. • Obstruction of small airways, associated with decreased lung diffusing capacity, may indicate a possible prominent bronchiolar involvement within systemic sclerosis-related interstitial lung disease.
Topics: Airway Obstruction; Female; Humans; Lung; Male; Prevalence; Pulmonary Diffusing Capacity; Scleroderma, Systemic; Vital Capacity
PubMed: 32827283
DOI: 10.1007/s10067-020-05353-4 -
Journal of Pediatric Orthopedics Apr 2020Obstructive lung disease occurs in 30% of children with early onset scoliosis (EOS); changes in degree of airway obstruction over time have not been reported.
BACKGROUND
Obstructive lung disease occurs in 30% of children with early onset scoliosis (EOS); changes in degree of airway obstruction over time have not been reported.
METHODS
Longitudinal patterns of incidental, persistent, and progressive airway obstruction were retrospectively analyzed in a cohort of children with EOS with at least 1 forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC) value <85% on serial spirometric assessments over a ≥3-year observation period. The prevalence of clinical features and the severity of coronal and sagittal spine deformities for each group at the beginning and end of the study period were compared.
RESULTS
Airway obstruction was incidental in 12 (24%) and persistent in 37 (76%) of 49 children with EOS. Twenty of 37 (54%) of those with persistent obstruction developed progressive airway obstruction. The decline in FEV1/FVC over 6±2 years was insignificant in the incidental group (4%±2%) and the persistent nonprogressive group (7%±4%) but significant in the progressive group (13%±4%, t test; P=0.002). In total, 29% of the 49 children at the onset and 57% at the end of the study had airway obstruction. The incidental, persistent nonprogressive, and progressive groups did not differ with regard to age, diagnosis distribution, or sex. The initial coronal curve size, apex, direction of the curve, and degree of kyphosis were statistically similar among the 3 groups. Coronal curve magnitude inversely correlated with FEV1/FVC at the end but not the beginning of the study (r=-0.19, P=0.002). Six of 19 responded to bronchodilator treatment, suggesting concurrent asthma. Airway obstruction did not relate to restrictive pulmonary abnormalities measured by FVC at first or last timepoints [slope=-0.076 (95% confidence interval, -0.99 to 0.038; P=0.19)]. Changes in degrees of airway obstruction and restrictive lung disease over time did not correlate [slope=-0.125 (95% confidence interval, -0.294 to 0.044; P=0.14)].
CONCLUSIONS
Children with EOS and progressive airway obstruction represent an important subgroup which may require new surgical and nonsurgical treatment strategies to prevent loss of lung function over time.
Topics: Adolescent; Age of Onset; Airway Obstruction; Child; Disease Progression; Female; Humans; Male; Prevalence; Respiratory Function Tests; Retrospective Studies; Scoliosis; Severity of Illness Index; United States
PubMed: 32132449
DOI: 10.1097/BPO.0000000000001262 -
Respiration; International Review of... 2022Malignant central airway obstruction (CAO) is a debilitating complication of primary lung cancer and pulmonary metastases. Therapeutic bronchoscopy is used to palliate... (Review)
Review
BACKGROUND
Malignant central airway obstruction (CAO) is a debilitating complication of primary lung cancer and pulmonary metastases. Therapeutic bronchoscopy is used to palliate symptoms and/or bridge to further therapy. Microwave ablation (MWA) heats tissue by creating an electromagnetic field around an ablation device. We present a pilot study utilizing endobronchial MWA via flexible bronchoscopy as a novel modality for the management of malignant CAO.
METHODS
Therapeutic bronchoscopy with a flexible MWA probe was performed in 8 cases. We reviewed tumor size, previous ablative techniques, number of applications, ablation time, amount of energy delivered, rate of successful recanalization, complications, and 30-day follow-up.
RESULTS
Successful airway recanalization was achieved in all cases. No complications were noted. In 1 case, tumor in-growth within a silicone stent was ablated with no damage to the stent.
DISCUSSION
Endobronchial MWA is a novel technique for tumor destruction while maintaining an airway axis. The oven effect and air gap around a tumor allow for safe and effective tissue devitalization and hemostasis without a thermal effect on structures surrounding the airway.
Topics: Airway Obstruction; Bronchoscopy; Humans; Lung Neoplasms; Microwaves; Pilot Projects
PubMed: 35316812
DOI: 10.1159/000522544 -
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 -
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 -
Journal of Cardiothoracic and Vascular... Sep 2019Corrective treatment of expiratory central airway collapse (ECAC) consists of placement of airway stents or tracheobronchoplasty (TBP). The indication for corrective... (Review)
Review
Corrective treatment of expiratory central airway collapse (ECAC) consists of placement of airway stents or tracheobronchoplasty (TBP). The indication for corrective treatment is severe central airway collapse (>90 %), and severe symptoms that cause decline in quality of life. Patients are selected to undergo a trial of tracheal "Y" stent placement. If symptoms improve (positive trial) they undergo a TBP, provided they are good surgical candidates. Patients who are considered poor surgical candidates because of the severity of comorbidities can be offered permanent stenting to palliate symptoms. The anesthetic management of airway stent placement and TBP is complex. This article reviews the medical management and corrective treatment of ECAC, anesthetic management of airway stent placement, and considerations during TBP.
Topics: Adult; Airway Management; Airway Obstruction; Anesthesia; Exhalation; Humans; Pulmonary Atelectasis; Risk Reduction Behavior; Stents; Tracheobronchomalacia; Treatment Outcome
PubMed: 30279066
DOI: 10.1053/j.jvca.2018.09.009