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Primary Care Respiratory Journal :... Sep 2010To study the prevalence of airway obstruction according to age, gender and smoking habits using spirometry, and to compare the results using different definitions,...
AIMS
To study the prevalence of airway obstruction according to age, gender and smoking habits using spirometry, and to compare the results using different definitions, classifications and spirometric reference values in an elderly population.
METHODS
A random sample of 2046 men and women in nine age cohorts (aged 60, 66, 72, 78, 81, 84, 87, 90 and 93 years) were drawn from the Swedish municipality registers. 1092 subjects performed spirometry of which 574 met ATS spirometric criteria.
RESULTS
According to GOLD criteria (FEV1/FVC <0.7) the prevalence of obstruction was 22.5% regardless of which one of three different spirometric reference values were used. Using the recently-changed Swedish National Guideline (SNG) recommendations--an FEV1/(F)VC ratio<0.7 in subjects younger than 65 years but an FEV1/(F)VC ratio<0.65 in subjects 65 years or older in order to define airway obstruction--the prevalence was 14.1% regardless of the applied spirometric reference values. Using the criterion FEV1/(F)VC < expected for age and gender (i.e. lower limit of normal, LLN) yielded the lowest prevalence of 10.1%.
CONCLUSIONS
The prevalence of pulmonary obstruction depends on the criteria used for defining airway obstruction and on which spirometric normal values are applied. Using an age-adjusted FEV1/(F)VC LLN quotient to define pulmonary obstruction can be recommended on the basis of our results.
Topics: Age Factors; Aged; Aged, 80 and over; Airway Obstruction; Cross-Sectional Studies; Female; Forced Expiratory Volume; Humans; Male; Middle Aged; Practice Guidelines as Topic; Prevalence; Reference Values; Risk Factors; Sex Factors; Smoking; Spirometry; Sweden; Vital Capacity
PubMed: 20228994
DOI: 10.4104/pcrj.2010.00011 -
American Journal of Veterinary Research Jan 2013To evaluate plasma concentrations of inflammatory mediators in dogs with brachycephalic airway obstruction syndrome, identify a possible role for these mediators in the...
OBJECTIVE
To evaluate plasma concentrations of inflammatory mediators in dogs with brachycephalic airway obstruction syndrome, identify a possible role for these mediators in the syndrome, and investigate the relationship between plasma concentrations of inflammatory mediators and severity of clinical signs.
ANIMALS
17 dogs with brachycephalic airway obstruction syndrome and 10 mesocephalic (control) dogs.
PROCEDURES
A blood sample was collected once from each dog. Plasma concentrations of interleukin (IL)-1β, tumor necrosis factor (TNF)-α, IL-6, IL-17A, IL-10, and IL-13 were measured with ELISAs. Nitric oxide (NO) concentrations were determined with a Griess test. For analysis, brachycephalic dogs were categorized into groups depending on weight (small [< 16 kg]) and large [≥ 16 kg]) or on whether they required medical or surgical treatment.
RESULTS
Compared with control dog values, plasma concentrations of TNF-α, IL-10, IL-13, and IL-17A were significantly higher in brachycephalic dogs and markedly so for brachycephalic dogs that required surgery; findings for small and large brachycephalic dogs did not differ. A similar pattern of differences between control and brachycephalic dogs was identified for plasma NO concentration. Plasma IL-1β and IL-6 concentrations in control and brachycephalic dogs did not differ.
CONCLUSIONS AND CLINICAL RELEVANCE
In brachycephalic dogs, plasma TNF-α, IL-10, IL-13, L-17A, and NO concentrations were higher than values in control dogs and appeared to be associated with disease severity. These variables may be useful as indicators of inflammatory processes associated with brachycephalic airway obstruction syndrome in dogs.
Topics: Airway Obstruction; Animals; Anti-Inflammatory Agents; Biomarkers; Cytokines; Dog Diseases; Dogs; Enzyme-Linked Immunosorbent Assay; Female; Inflammation Mediators; Male; Nitric Oxide
PubMed: 23270361
DOI: 10.2460/ajvr.74.1.155 -
Zhongguo Dang Dai Er Ke Za Zhi =... Apr 2023To study the clinical and bronchoscopic characteristics of tracheobronchial tuberculosis (TBTB) in children and to identify factors influencing residual airway...
OBJECTIVES
To study the clinical and bronchoscopic characteristics of tracheobronchial tuberculosis (TBTB) in children and to identify factors influencing residual airway obstruction or stenosis.
METHODS
The clinical data of children with TBTB were retrospectively collected. The children were divided into two groups based on the last bronchoscopic result within one year of follow-up: a group with residual airway obstruction or stenosis (=34) and a group without residual airway obstruction or stenosis (=58). A multivariate logistic regression analysis was used to identify the factors influencing residual airway obstruction or stenosis in children with TBTB. Receiver operating characteristic (ROC) curves were used to analyze the predictive value of the factors influencing residual airway obstruction or stenosis in children with TBTB.
RESULTS
A total of 92 children with TBTB were included, and the main symptoms were cough (90%) and fever (68%). In children under 1 year old, the incidence rates of dyspnea and wheezing were significantly higher than in other age groups (<0.008). Chest CT findings included mediastinal or hilar lymph node enlargement (90%) and tracheobronchial stenosis or obstruction (61%). The lymphatic fistula type was the main type of TBTB observed bronchoscopically (77%). All children received interventional treatment, and the effective rate was 84%. During one year of follow-up, 34 children had residual airway obstruction or stenosis. The TBTB diagnostic time and the initiation of interventional treatment were significantly delayed in the group with residual airway obstruction or stenosis compared with the group without residual airway obstruction or stenosis (<0.05). The multivariate logistic regression analysis showed that the TBTB diagnostic time was closely related to residual airway obstruction or stenosis in children (<0.05). ROC curve analysis showed that at the cut-off value of 92 days of TBTB diagnostic time, the area under the curve for predicting residual airway obstruction or stenosis in children with TBTB was 0.707, with a sensitivity of 58.8% and a specificity of 75.9%.
CONCLUSIONS
The clinical manifestations of TBTB are nonspecific, and symptoms are more severe in children under 1 year old. TBTB should be suspected in children with tuberculosis and chest imaging indicating airway involvement. Delayed diagnosis of TBTB is associated with the development of residual airway obstruction or stenosis.
Topics: Infant; Child; Humans; Bronchoscopy; Constriction, Pathologic; Bronchial Diseases; Retrospective Studies; Tuberculosis; Airway Obstruction
PubMed: 37073843
DOI: 10.7499/j.issn.1008-8830.2210116 -
Anesthesiology Dec 1991Difficulty in managing the airway is the single most important cause of major anesthesia-related morbidity and mortality. Successful management of a difficult airway... (Review)
Review
Difficulty in managing the airway is the single most important cause of major anesthesia-related morbidity and mortality. Successful management of a difficult airway begins with recognizing the potential problem. All patients should be examined for their ability to open their mouth widely and for the structures visible upon mouth opening, the size of the mandibular space, and ability to assume the sniff position. If there is a good possibility that intubation and/or ventilation by mask will be difficult, then the airway should be secured while the patient is still awake. In order for an awake intubation to be successful, it is absolutely essential that the patient be properly prepared; otherwise, the anesthesiologist will simply fulfill a self-defeating prophecy. Once the patient is properly prepared, it is likely that any one of a number of intubation techniques will be successful. If the patient is already anesthetized and/or paralyzed and intubation is found to be difficult, many repeated attempts at intubation should be avoided because progressive development of laryngeal edema and hemorrhage will develop and the ability to ventilate the lungs via mask consequently may be lost. After several attempts at intubation, it may be best to awaken the patient, do a semielective tracheostomy, or proceed with the case using mask ventilation. In the event that the ability to ventilate via mask is lost and the patient's lungs still cannot be ventilated, TTJV should be instituted immediately. Tracheal extubation of a patient with a difficult airway over a jet stylet permits a controlled, gradual, and reversible (in that ventilation and reintubation is possible at any time) withdrawal from the airway. Significant advances in the management of the difficult airway have occurred in recent years. Eighty percent of the 127 references in this article were published after 1985. However, there is much more to learn with regard to recognition of the difficult airway, preparation of the patient for an awake intubation, new techniques of endotracheal intubation, and establishment of gas exchange in patients who cannot be intubated or ventilated by mask. As the anesthesiologist's ability to manage the difficult airway significantly improves, respiratory-related morbidity and mortality will decrease.
Topics: Airway Obstruction; Algorithms; Anesthesia; Anesthesia, Endotracheal; Humans; Intubation, Intratracheal; Masks; Wakefulness
PubMed: 1824555
DOI: 10.1097/00000542-199112000-00021 -
Anaesthesia Mar 2000Cricoid pressure may cause airway obstruction. We investigated whether this is related to the force applied and to the technique of application. We recorded expired... (Clinical Trial)
Clinical Trial Randomized Controlled Trial
Cricoid pressure may cause airway obstruction. We investigated whether this is related to the force applied and to the technique of application. We recorded expired tidal volumes and inflation pressures during ventilation via a face-mask and oral airway in 52 female patients who were anaesthetised and about to undergo elective surgery. An inspired tidal volume of 900 ml was delivered using a ventilator. Ventilation was assessed under five different conditions: no cricoid pressure, backwards cricoid pressure applied with a force of 30 N, cricoid pressure applied in an upward and backward direction with a force of 30 N, backwards cricoid pressure with a force of 44 N and through a tracheal tube. An expired tidal volume of < 200 ml was taken to indicate airway obstruction. Airway obstruction did not occur without cricoid pressure, but did occur in one patient (2%) with cricoid pressure at 30 N, in 29 patients (56%) with 30 N applied in an upward and backward direction and in 18 (35%) patients with cricoid pressure at 44 N. Cricoid pressure applied with a force of 44 N can cause airway obstruction but if cricoid pressure is applied with a force of 30 N, airway obstruction occurs less frequently (p = 0.0001) unless the force is applied in an upward and backward direction.
Topics: Adult; Aged; Airway Obstruction; Anesthesia, General; Cricoid Cartilage; Female; Humans; Middle Aged; Pressure; Tidal Volume
PubMed: 10671836
DOI: 10.1046/j.1365-2044.2000.01205.x -
British Medical Journal Apr 1977
Topics: Airway Obstruction; Endoscopy; Humans
PubMed: 861512
DOI: 10.1136/bmj.1.6069.1157-b -
British Medical Journal May 1977
Topics: Airway Obstruction; Humans; Terminology as Topic
PubMed: 861576
DOI: 10.1136/bmj.1.6071.1283 -
Tracheobronchial stents in patients with malignant airway disease: Finnish tertiary care experience.Interactive Cardiovascular and Thoracic... Oct 2021Tracheobronchial stenting has an established role in the palliation of malignant central airway obstruction (CAO). The purpose of this study is to describe the...
OBJECTIVES
Tracheobronchial stenting has an established role in the palliation of malignant central airway obstruction (CAO). The purpose of this study is to describe the experience with self-expanding metal airway stents in 2 tertiary referral centres, covering a third of the population of Finland.
METHODS
Patients referred to and treated with airway stenting for malignant CAO using self-expanding metal-stents were identified from electronic patient records, and data were collected using a structured Endoscopic Lower Airway Management instrument. Statistical analysis to reveal factors affecting patient benefit and survival was carried out.
RESULTS
A total of 101 patients (mean age 65.8) and 116 procedures were identified. Procedure-related mortality was rare (3/101 patients) and complications infrequent. The median survival was 2.3 months [95% confidence interval (CI): 1.4-3.1). Stent benefit was not significantly affected by clinical characteristics. Survival was impacted by the use of adjunct procedures [hazard ratio (HR) 0.36, 95% CI: 0.23-0.58, P < 0.001), procedural urgency (HR 0.40; 95% CI: 0.23-0.71, P = 0.002) and post-treatment chemoradiotherapy (HR 0.29, 95% CI: 0.15-0.56, P < 0.001).
CONCLUSIONS
The beneficial impact observed supports the further use of tracheobronchial stenting in malignant CAO. The use of self-expanding metal stents is encouraged.
Topics: Aged; Airway Obstruction; Constriction, Pathologic; Finland; Humans; Palliative Care; Retrospective Studies; Stents; Tertiary Healthcare; Treatment Outcome
PubMed: 34021347
DOI: 10.1093/icvts/ivab147 -
Resuscitation Jun 2024Foreign body airway obstruction (FBAO) is a life-threatening condition. We aimed to quantify the impact of bystander FBAO interventions on survival and neurological... (Observational Study)
Observational Study
INTRODUCTION
Foreign body airway obstruction (FBAO) is a life-threatening condition. We aimed to quantify the impact of bystander FBAO interventions on survival and neurological outcomes.
METHODS
We conducted a Japan-wide prospective, multi-center, observational study including all FBAO patients who presented to the Emergency Department from April 2020 to March 2023. Information on bystander FBAO interventions was collected through interviews with emergency medical services personnel. Primary outcomes included 1-month survival and favorable neurologic outcome defined as Cerebral Performance Category 1 or 2. We performed a multivariable logistic regression and a Cox proportional hazards modeling to adjust for confounders.
RESULTS
We analyzed a total of 407 patients in the registry who had the median age of 82 years old (IQR 73-88). The FBAO incidents were often witnessed (86.5%, n = 352/407) and the witnesses intervened in just over half of the cases (54.5%, n = 192/352). The incidents frequently occurred at home (54.3%, n = 221/407) and nursing home (21.6%, n = 88/407). Common first interventions included suction (24.8%, n = 101/407) and back blow (20.9%, n = 85/407). The overall success rate of bystander interventions was 48.4% (n = 93/192). About half (48.2%, n = 196/407) survived to 1-month and 23.8% patients (n = 97/407) had a favorable neurological outcome. Adjusting for pre-specified confounders, bystander interventions were independently associated with survival (hazard ratio, 0.55; 95% CI, 0.39-0.77) and a favorable neurological outcome (adjusted OR, 2.18; 95% CI, 1.23-3.95).
CONCLUSION
Bystander interventions were independently associated with survival and favorable neurological outcome, however, they were performed only in the half of patients.
Topics: Humans; Male; Airway Obstruction; Female; Registries; Aged; Aged, 80 and over; Prospective Studies; Japan; Foreign Bodies; Emergency Medical Services; Cardiopulmonary Resuscitation
PubMed: 38582443
DOI: 10.1016/j.resuscitation.2024.110198 -
Respiratory Care Oct 2007Cough is an important component of airway clearance, particularly in individuals with intrinsic pulmonary disease, weakness of respiratory muscles, or central nervous... (Review)
Review
Cough is an important component of airway clearance, particularly in individuals with intrinsic pulmonary disease, weakness of respiratory muscles, or central nervous system disease that impairs breathing. The use of assisted cough to enhance airway clearance in individuals with neuromuscular disease is essential to produce and maintain peak cough flow above a minimum and thereby avoid retained secretions that cause infection, inflammation, and respiratory failure. Periodic insufflation of the lung above a reduced vital capacity is also important, to maintain range of motion of the thoracic cage and avoid progressive respiratory disability. Mechanical insufflation-exsufflation is a therapy in which the device (the CoughAssist In-Exsufflator is the only currently marketed insufflation-exsufflation device) gradually inflates the lungs (insufflation), followed by an immediate and abrupt change to negative pressure, which produces a rapid exhalation (exsufflation), which simulates a cough and thus moves secretions cephalad. Mechanical insufflation-exsufflation is used with patients with neuromuscular disease and muscle weakness due to central nervous system injury. Insufflation-exsufflation decreases episodes of respiratory failure, particularly during upper-respiratory-tract infection, and provides greater success in weaning from mechanical ventilation than do conventional methods. Alternatives to insufflation-exsufflation that can produce sufficient peak cough flow for airway clearance include (1) insufflation to maximum insufflation capacity (via breath-stacking with a bag and mask, a volume ventilator, or glossopharyngeal breathing) followed by a spontaneous cough, and (2) manually assisted cough with an abdominal thrust. The effectiveness of insufflation-exsufflation in patients with obstructive lung disease, such as chronic obstructive pulmonary disease or asthma, and in pediatric patients, is less clear.
Topics: Airway Obstruction; Cough; Equipment Design; Humans; Insufflation; Mucus
PubMed: 17894900
DOI: No ID Found