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Medicina (Kaunas, Lithuania) Jun 2019: Changing to a different spirometry reference equation can result in misinterpretation of spirometric findings. Currently, there is limited data about any discordance...
Effect of the Application of the Global Lung Initiative 2012 Spirometry Reference Equation on the Diagnosing and Classifying Degree of Airway Obstruction in Thai Adults Aged 40 to 80 Years Old.
: Changing to a different spirometry reference equation can result in misinterpretation of spirometric findings. Currently, there is limited data about any discordance between the interpretations of airway obstruction (AO) using the Global Lungs Initiative (GLI) 2012 and the currently employed Thai reference equations (Siriraj) in Thai adults. Therefore, this study aimed to determine differences in diagnosis around AO and classification of the severity of AO using the GLI2012 and Siriraj reference equations in Thai adults. : We analyzed spirometric results from Thai adults aged 40-80 years old ( 2084), which were collected at the Lung Health Center, Maharaj Nakorn Chiang Mai Hospital, Chiang Mai, Thailand between January 2005 and December 2015. The diagnoses concerning the AO were interpreted using the GLI2012 and Siriraj reference equations. The severity of AO in each case was classified into five grades, including mild, moderate, moderately severe, severe, or very severe. McNemar's test was used to analyze differences in diagnosis of AO and classification of the level of severity. The Kappa statistic was used to determine agreements of diagnosis of AO and classification of severity between the two reference equations. : There were significant differences in both diagnosis of AO and their classifying severity level between the two reference equations (-value < 0.001). However, the levels of agreement between the two reference equations were moderate to very good in different age and sex groups (Kappa values ranged from 0.62 to 0.78 for the diagnosis of AO and 0.54 to 0.89 for the classification of severity). : Changing from the Siriraj to the GLI2012 reference equations underestimates the proportion of airway obstruction in Thai adults.
Topics: Adult; Aged; Aged, 80 and over; Airway Obstruction; Female; Global Health; Humans; Male; Middle Aged; Spirometry; Thailand
PubMed: 31234279
DOI: 10.3390/medicina55060295 -
The European Respiratory Journal Jan 2000The basic therapeutic principles in paediatric chest physiotherapy (CPT) are identical to those applied in adults. However, the child's growth and development results in... (Review)
Review
The basic therapeutic principles in paediatric chest physiotherapy (CPT) are identical to those applied in adults. However, the child's growth and development results in continuing changes in respiratory structure and function, and the requirement for different applications of CPT in each age group. Forced expiratory manoeuvres and coughing serve as basic mechanisms for mobilization and transport of secretions, but the reduced bronchial stability after birth requires special techniques in very young patients. High externally applied transthoracic pressures have to be avoided in order to prevent interruption of airflow. In addition, airway patency is maintained by the application of back pressure and by liberal use of continuous positive airway pressure. Since sympathomimetic bronchodilators might further decrease bronchial stability, their use must be individualized in newborns and young infants. Inspiration is a basic mechanism for inflating alveolar space behind obstructing mucus plugs. Due to a highly unstable chest, the premature baby, newborn and infant cannot distend their lung parenchyma to the same extent as can older patients. Consequently all chest physiotherapy strategies applied in this age group have to incorporate appropriate techniques for raising lung volume. Positioning serves to redistribute ventilation, but the young infant's response to gravitational forces differs substantially from that of the adult, and consequently strategies used in older patients have to be modified. In addition, the therapist has to consider pathology such as bronchial instability lesions and airway hyperresponsiveness and has to adjust the therapeutic response accordingly. It is particularly important to consider the special vulnerability of newborns and young infants and to modify therapeutic interventions to avoid the harm that could otherwise be inflicted. Consideration of these differences between infant, child and adult and careful analysis of the available mucus clearance techniques allows tailoring of an individualized therapeutic approach to the paediatric patient.
Topics: Adult; Airway Obstruction; Airway Resistance; Bronchial Hyperreactivity; Child; Child, Preschool; Humans; Infant, Newborn; Mucociliary Clearance; Physical Therapy Modalities; Pressure; Respiratory Mechanics
PubMed: 10678646
DOI: 10.1183/09031936.00.15119600 -
Chest May 2015There is significant variation between physicians in terms of how they perform therapeutic bronchoscopy, but there are few data on whether these differences impact...
BACKGROUND
There is significant variation between physicians in terms of how they perform therapeutic bronchoscopy, but there are few data on whether these differences impact effectiveness.
METHODS
This was a multicenter registry study of patients undergoing therapeutic bronchoscopy for malignant central airway obstruction. The primary outcome was technical success, defined as reopening the airway lumen to > 50% of normal. Secondary outcomes were dyspnea as measured by the Borg score and health-related quality of life (HRQOL) as measured by the SF-6D.
RESULTS
Fifteen centers performed 1,115 procedures on 947 patients. Technical success was achieved in 93% of procedures. Center success rates ranged from 90% to 98% (P = .02). Endobronchial obstruction and stent placement were associated with success, whereas American Society of Anesthesiology (ASA) score > 3, renal failure, primary lung cancer, left mainstem disease, and tracheoesophageal fistula were associated with failure. Clinically significant improvements in dyspnea occurred in 90 of 187 patients measured (48%). Greater baseline dyspnea was associated with greater improvements in dyspnea, whereas smoking, having multiple cancers, and lobar obstruction were associated with smaller improvements. Clinically significant improvements in HRQOL occurred in 76 of 183 patients measured (42%). Greater baseline dyspnea was associated with greater improvements in HRQOL, and lobar obstruction was associated with smaller improvements.
CONCLUSIONS
Technical success rates were high overall, with the highest success rates associated with stent placement and endobronchial obstruction. Therapeutic bronchoscopy should not be withheld from patients based solely on an assessment of risk, since patients with the most dyspnea and lowest functional status benefitted the most.
Topics: Airway Obstruction; Bronchoscopy; Dyspnea; Female; Humans; Lung Neoplasms; Male; Middle Aged; Quality of Life; Remission Induction
PubMed: 25358019
DOI: 10.1378/chest.14-1526 -
International Journal of Chronic... 2014Maximal inspiratory pressure (MIP) is a marker for assessing the degree of respiratory muscle dysfunction. Muscle dysfunction represents a pathophysiological feature of...
Maximal inspiratory pressure (MIP) is a marker for assessing the degree of respiratory muscle dysfunction. Muscle dysfunction represents a pathophysiological feature of chronic obstructive pulmonary disease. We aimed to determinate the MIP value in patients with airway obstruction, to evaluate the change in MIP with bronchodilator drug, and to show the relationship between the changes in MIP and disease characteristics. We evaluated 21 patients with airway obstruction at the Department of Pulmonary Medicine, Samsun Medicalpark Hospital, Samsun, Turkey. We performed pulmonary function tests, measurement of MIP values, and reversibility tests with salbutamol. The baseline spirometry results were: mean forced vital capacity (FVC), 3,017±1,020 mL and 75.8%±20.8%; mean forced expiratory volume in 1 second (FEV1), 1,892±701 mL and 59.2%±18.2%; FEV1/FVC, 62.9%±5.5%; peak expiratory flow, 53%±19%. The pre-bronchodilator MIP value was 62.1±36.9 cmH2O. The reversibility test was found to be positive in 61.9% of patients with salbutamol. The absolute change and percentage of change in FEV1 were 318±223 mL and 19.8%±16.7%, respectively. The MIP value was increased by 5.5 cmH2O (8.8%) and was 67.7±30.3 cmH2O after bronchodilation. There was no significant relationship between age, FEV1, reversibility, and change in MIP with bronchodilator. However, the increase in MIP with bronchodilator drug was higher in patients with low body mass index (<25 kg/m(2)). We noted a 13.1% increase in FVC, a 19.8% increase in FEV1, a 20.2% increase in peak expiratory flow, and an 8.8% increase in MIP with salbutamol. In conclusion; MIP increases with bronchodilator therapy, regardless of changes in lung function, in patients with airway obstruction. The reversibilty test can be used to evaluate change in MIP with salbutamol.
Topics: Adult; Aged; Aged, 80 and over; Airway Obstruction; Albuterol; Bronchodilator Agents; Forced Expiratory Volume; Humans; Inhalation; Lung; Male; Middle Aged; Predictive Value of Tests; Pressure; Respiratory Function Tests; Respiratory Muscles; Spirometry; Turkey; Vital Capacity
PubMed: 24833899
DOI: 10.2147/COPD.S58584 -
The Journal of Pediatrics Dec 2011
Review
Topics: Airway Obstruction; Eating; Humans; Infant; Infant, Newborn; Pierre Robin Syndrome
PubMed: 21885059
DOI: 10.1016/j.jpeds.2011.07.033 -
Zhongguo Fei Ai Za Zhi = Chinese... Jun 2020Airway stent placement is the effective regimen for central airway obstruction (CAO), while its application scenarios varied. This study aimed to make clinical... (Comparative Study)
Comparative Study
BACKGROUND
Airway stent placement is the effective regimen for central airway obstruction (CAO), while its application scenarios varied. This study aimed to make clinical comparison of airway stent placement in the intervention room and operating room.
METHODS
Patients underwent airway stent placement between 2014 and 2018 were included in this retrospective case-control study. Clinical performance of airway stent placement in intervention room and operating room were compared.
RESULTS
82 patients were included in this study, including 39 in the intervention room and 43 in the operating room. Patients treated in the intervention room had lower Charlson comorbidity index (CCI) (P=0.018) and received less Y-shaped stents (P<0.001). Better clinical response (P=0.026), more stents placed (P<0.001) and longer length of stent (P<0.001) were observed in operating room, while there was no significantly statistical difference of stent-related complications and post-stent survival rate between the two groups. Extracorporeal membrane oxygenation (ECMO) supported airway stent placement procedures were performed in the operating room, which provided definitive safety support for high-risk intervention.
CONCLUSIONS
Patients with CAO could benefit from the operating room scenario, and airway stent placement in the operating room is more suitable for patients with higher CCI scores and receiving more complicated procedures.
Topics: Airway Obstruction; Bronchoscopy; Case-Control Studies; Female; Humans; Male; Middle Aged; Operating Rooms; Retrospective Studies; Stents; Survival Rate; Treatment Outcome
PubMed: 32517449
DOI: 10.3779/j.issn.1009-3419.2020.104.09 -
Journal of Cardiothoracic and Vascular... Aug 2022EMERGENCY AIRWAY management strategies for patients with complications due to tracheobronchial stents are of growing interest to anesthesiologists. Although tracheal...
EMERGENCY AIRWAY management strategies for patients with complications due to tracheobronchial stents are of growing interest to anesthesiologists. Although tracheal stenting increasingly is used to manage tracheobronchial stenosis of both benign and malignant conditions, official guidelines for the perioperative airway management of patients with tracheobronchial stents in situ are lacking. Here, the authors discuss the management of airway obstruction from a tracheal stent strut protrusion and in-stent stenosis in a patient with a self-expanding nitinol tracheal stent in situ. They discuss the airway management strategy employed and outline a pragmatic airway management algorithm for patients with tracheal stents presenting with airway obstruction.
Topics: Airway Management; Airway Obstruction; Algorithms; Bronchoscopy; Constriction, Pathologic; Humans; Stents; Tracheal Stenosis
PubMed: 35227577
DOI: 10.1053/j.jvca.2022.01.028 -
CMAJ : Canadian Medical Association... Jan 1989We examined the records of 14 patients aged 7 months to 10 1/4 years who were treated for bacterial tracheitis from May 1982 to December 1987; the management protocol... (Review)
Review
We examined the records of 14 patients aged 7 months to 10 1/4 years who were treated for bacterial tracheitis from May 1982 to December 1987; the management protocol for 13 of the patients included the use of nasotracheal intubation. The infection was caused by Staphylococcus aureus in seven, Haemophilus influenzae in three, Branhamella catarrhalis in one and Streptococcus pneumoniae in one. Both H. influenzae and B. catarrhalis were isolated in another patient, and no organism was found in the remaining patient. In addition to the bacteria, viruses were cultured from the tracheal secretions of two patients. The mean duration of intubation was 7.6 days and of hospital stay 9.2 days. Twelve of the cases occurred during the cold months of the year (October to March). Of the three deaths only one occurred in the pediatric intensive care unit and was due to severe bronchospasm and an air leak that caused bilateral pneumothorax and pneumomediastinum. In one patient subglottic stenosis developed that necessitated tracheostomy. Healing began 5 to 9 days after the onset of symptoms, as demonstrated with the use of repeated fibreoptic bronchoscopy. We found that the airway could be safely managed with the use of a nasotracheal tube. Bronchoscopy helped to confirm the diagnosis, to remove adherent secretions and to monitor the course of the disease. The ventilation tube can be removed after the patient's temperature returns to normal, if there is an air leak around the tube, if the quantity and viscosity of the secretions decrease and if healing is observed at bronchoscopy.
Topics: Airway Obstruction; Bacterial Infections; Bronchoscopy; Child; Child, Preschool; Female; Humans; Infant; Intubation, Intratracheal; Male; Retrospective Studies; Seasons; Tracheitis
PubMed: 2642395
DOI: No ID Found -
European Respiratory Review : An... Jan 2024The aim of this review is to summarise evidence that became available after publication of the 2017 European Respiratory Society statement on the diagnosis and... (Review)
Review
The aim of this review is to summarise evidence that became available after publication of the 2017 European Respiratory Society statement on the diagnosis and management of obstructive sleep apnoea syndrome (OSAS) in 1- to 23-month-old children. The definition of OSAS in the first 2 years of life should probably differ from that applied in children older than 2 years. An obstructive apnoea-hypopnoea index >5 events·h may be normal in neonates, as obstructive and central sleep apnoeas decline in frequency during infancy in otherwise healthy children and those with symptoms of upper airway obstruction. A combination of dynamic and fixed upper airway obstruction is commonly observed in this age group, and drug-induced sleep endoscopy may be useful in selecting the most appropriate surgical intervention. Adenotonsillectomy can improve nocturnal breathing in infants and young toddlers with OSAS, and isolated adenoidectomy can be efficacious particularly in children under 12 months of age. Laryngomalacia is a common cause of OSAS in young children and supraglottoplasty can provide improvement in children with moderate-to-severe upper airway obstruction. Children who are not candidates for surgery or have persistent OSAS post-operatively can be treated with positive airway pressure (PAP). High-flow nasal cannula may be offered to young children with persistent OSAS following surgery, as a bridge until definitive therapy or if they are PAP intolerant. In conclusion, management of OSAS in the first 2 years of life is unique and requires consideration of comorbidities and clinical presentation along with PSG results for treatment decisions, and a multidisciplinary approach to treatment with medical and otolaryngology teams.
Topics: Infant; Infant, Newborn; Humans; Child, Preschool; Child; Sleep Apnea, Obstructive; Adenoidectomy; Tonsillectomy; Sleep Apnea, Central; Airway Obstruction
PubMed: 38296343
DOI: 10.1183/16000617.0121-2023 -
Canadian Respiratory Journal 2015Severe scoliosis may have a significant effect on respiratory function. The effect is most often restrictive due to severe anatomical distortion of the chest, leading to...
Severe scoliosis may have a significant effect on respiratory function. The effect is most often restrictive due to severe anatomical distortion of the chest, leading to reduced lung volumes, limited diaphragmatic excursion and chest wall muscle inefficiency. Bronchial compression by the deformed spine may also occur but is more unusual. Management options include a conservative approach using bracing and physiotherapy in mild cases, as well as surgical correction of the scoliosis in more severe cases. Bronchial stenting has also been used successfully as an alternative to surgical correction, and in cases in which spinal surgery was either unsuccessful or not feasible. The authors present a case involving a 52-year-old woman who exhibited symptomatic compression of the bronchus intermedius by severe residual scoliosis despite previous corrective surgery. She was treated with an indwelling bronchial stent.
Topics: Airway Obstruction; Bronchial Diseases; Constriction, Pathologic; Female; Humans; Middle Aged; Pulmonary Atelectasis; Respiratory Function Tests; Scoliosis; Stents; Tomography, X-Ray Computed
PubMed: 26083538
DOI: 10.1155/2015/640573