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Children (Basel, Switzerland) Feb 2024Down Syndrome (DS) is the most common chromosomal abnormality compatible with life. The life of patients suffering from DS can be strongly impacted by Recurrent... (Review)
Review
Down Syndrome (DS) is the most common chromosomal abnormality compatible with life. The life of patients suffering from DS can be strongly impacted by Recurrent Respiratory tract Infections (RRIs), leading to an increased rate of hospitalisation, a higher need for intensive care and fatality. With a literature review, we summarise here the main etiological factors for RRI in this category of patients, particularly focusing on airway malformations such as tracheomalacia, tracheal bronchus and bronchomalacia, comorbidities associated with the syndrome, like congenital heart diseases, dysphagia, gastroesophageal reflux, musculoskeletal involvement and obesity, and immunologic impairments, involving both innate and adaptive immunity. For these patients, a multidisciplinary approach is imperative as well as some preventive strategies, in particular vaccinations in accordance with their national schedule for immunization.
PubMed: 38397357
DOI: 10.3390/children11020246 -
Paediatric Respiratory Reviews Jan 2016Despite acute respiratory and chronic respiratory and gastro-intestinal complications, most infants and children with a history of oesophageal atresia /... (Review)
Review
Despite acute respiratory and chronic respiratory and gastro-intestinal complications, most infants and children with a history of oesophageal atresia / trachea-oesophageal fistula [OA/TOF] can expect to live a fairly normal life. Close multidisciplinary medical and surgical follow-up can identify important co-morbidities whose treatment can improve symptoms and optimize pulmonary and nutritional outcomes. This article will discuss the aetiology, classification, diagnosis and treatment of congenital TOF, with an emphasis on post-surgical respiratory management, recognition of early and late onset complications, and long-term clinical outcomes.
Topics: Aftercare; Bronchial Hyperreactivity; Bronchomalacia; Child; Child, Preschool; Comorbidity; Deglutition Disorders; Esophageal Atresia; Esophageal Motility Disorders; Esophageal Stenosis; Gastroesophageal Reflux; Humans; Infant; Infant, Newborn; Respiratory Aspiration; Tracheoesophageal Fistula; Tracheomalacia; Vocal Cord Dysfunction
PubMed: 25800226
DOI: 10.1016/j.prrv.2015.02.005 -
BMJ Case Reports Feb 2017
Topics: Aged; Bronchomalacia; Fatal Outcome; Female; Humans; Lung Diseases, Fungal; Mucormycosis
PubMed: 28209649
DOI: 10.1136/bcr-2017-219342 -
Journal of Veterinary Internal Medicine 2023Principal and lobar bronchial collapse is increasingly recognized as an isolated entity.
BACKGROUND
Principal and lobar bronchial collapse is increasingly recognized as an isolated entity.
OBJECTIVE
Retrospectively describe the procedure and outcomes of dogs undergoing bronchial stenting at a single referral hospital.
ANIMALS
Nine client-owned dogs with variable degrees of collapse of the left principal bronchus (LPB), lobar bronchus 1 (LB1), and lobar bronchus 2 (LB2), and with clinically relevant signs of respiratory dysfunction.
METHODS
Data were collected from patient records. All dogs underwent stenting of the LPB and LB2. Anatomic and functional impairment grades were assigned to each case before and 4 weeks after stenting. Data regarding response to stenting and complications were evaluated.
RESULTS
Bronchial stenting was considered successful in all cases, with all dogs experiencing improved quality of life (QOL), and decreased functional impairment grade at 4 weeks post-stenting. Follow-up of >6 months was available for 6 dogs and of these, 5 were alive at 12 months, 3 were alive at 18 months, and 1 was alive at 24 months. Stent-related complications occurred in 4 dogs, and were resolvable in 3. Two dogs developed pneumothorax, 1 developed recurrent pneumonia, and 1 developed new-onset coughing. All dogs had mild and manageable coughing post-stenting.
CONCLUSIONS AND CLINICAL IMPORTANCE
Stenting of the LBP and LB2 might be an effective option for dogs with advanced collapse of these bronchi and associated signs. Although all included dogs had resolution or improvement of clinical signs considered life-threatening or as affecting QOL, ongoing coughing is expected. Patient selection appears important with regard to achieving successful outcomes.
Topics: Humans; Dogs; Animals; Quality of Life; Retrospective Studies; Bronchi; Trachea; Stents; Dog Diseases
PubMed: 37695258
DOI: 10.1111/jvim.16859 -
Journal of Pediatric Surgery Nov 2022Tracheobronchomalacia (TBM), a condition where an abnormality of the tracheal walls causes collapse during the respiratory cycle, is a common cause of airway obstruction...
OBJECTIVES
Tracheobronchomalacia (TBM), a condition where an abnormality of the tracheal walls causes collapse during the respiratory cycle, is a common cause of airway obstruction in childhood. TBM can present with a large spectrum of disease severity and underlying pathologies that may be managed medically and surgically, and it is not always clear which patients would most benefit from surgical intervention. We aim to describe the incidence, patient characteristics, and predictors of surgical intervention in a large cohort of paediatric patients.
METHODS
We performed a retrospective review of all children diagnosed with TBM to a paediatric Otolaryngology unit in the west of Scotland between 2010 and 2020. Odds ratios for clinical predictors of surgery were calculated using logistic regression with uni- and multivariate analysis.
RESULTS
249 patients were identified of which 219 proceeded to data collection. Primary malacia was noted in 161 (73.5%) and secondary in 58 (26.5%). Causes of secondary malacia included compression by the innominate artery (11%) and vascular rings (7.8%). Surgical interventions were performed in 28 patients (12.8%) including division of vascular ring, aortopexy, and surgical tracheostomy. Multivariate analysis showed secondary TBM, acute life-threatening events, and difficulty weaning from mechanical ventilation were independent risk factors for surgical intervention.
CONCLUSIONS
TBM can present with a myriad of airway symptoms and is frequently associated with other airway and mediastinal pathologies necessitating multiple interventions. Children aged <1 year present with a more severe form of the disease and the presence of particular independent risk factors may indicate a need for surgical intervention.
Topics: Airway Obstruction; Child; Humans; Incidence; Retrospective Studies; Trachea; Tracheobronchomalacia; Vascular Ring
PubMed: 35718546
DOI: 10.1016/j.jpedsurg.2022.05.005 -
Journal of the American Veterinary... Sep 2022To describe the current standard of care among specialists for the routine diagnostic evaluation and medical management of stable tracheal collapse in dogs, identifying...
OBJECTIVE
To describe the current standard of care among specialists for the routine diagnostic evaluation and medical management of stable tracheal collapse in dogs, identifying gaps between practice and scientific evidence to facilitate the development of future prospective studies. A secondary objective was to describe the perceived incidence of selected comorbid disorders in dogs with tracheal collapse and the diagnostic tests performed to evaluate for those disorders.
SAMPLE
180 veterinary specialists in 22 countries.
PROCEDURES
An electronic survey was sent to 4 specialty listservs to target diplomates. Respondents completed multiple-choice and free-response questions related to the diagnostic evaluation and treatment of a theoretical stable dog with suspected tracheal collapse.
RESULTS
Most respondents routinely utilized radiography, tracheobronchoscopy, and fluoroscopy to diagnose tracheal collapse and performed airway sampling, sedated airway examination, and echocardiograms to rule out comorbidities. The most frequently perceived comorbid disorders included chronic bronchitis, bronchomalacia, and myxomatous mitral valve disease. Respondents most often prescribed opioid antitussives, glucocorticoids, anxiolytics, and antibiotics as treatments. Less frequently, they utilized bronchodilators and nonopioid medications for cough.
CLINICAL RELEVANCE
Despite a lack of published guidelines, specialists have similar approaches in their diagnostic and therapeutic approach to a stable dog with suspected tracheal collapse and believe evaluating for comorbid disorders is important. A description of a typical diagnostic approach and knowledge of realistic treatment goals will assist the general practitioner managing dogs with stable tracheal collapse. Additionally, gaps between current practices established via this survey and data supporting those practices exist, specifically concerning the use of antibiotics and nonopioid medications for cough, representing areas for further study.
Topics: Animals; Dogs; Cough; Prospective Studies; Dog Diseases; Radiography; Fluoroscopy; Tracheal Diseases
PubMed: 36166502
DOI: 10.2460/javma.22.03.0108 -
PloS One 2019Canine bronchomalacia (CBM) is a structural airway disease leading to chronic cough and intermittent respiratory distress, primarily affecting elderly dogs of small...
Canine bronchomalacia (CBM) is a structural airway disease leading to chronic cough and intermittent respiratory distress, primarily affecting elderly dogs of small breeds. Results of blood gas analysis have been reported in dogs with several diseases, but not yet in those with CBM. Eleven dogs with CBM were recruited in this study. Most dogs presented with mild hypoxemia and normocapnia, and all with increased alveolar-arterial difference for O2 (A-aDO2). In computed tomography, abnormal lung patterns, such as atelectasis and parenchymal band, were detected in all dogs, consistent with the regions affected by CBM. We conclude that CBM causes abnormal lung patterns and results in impaired oxygenation. Blood gas analysis is a useful tool for detecting mild pulmonary lesions and concurrent CBM.
Topics: Animals; Blood Gas Analysis; Bronchomalacia; Cough; Dog Diseases; Dogs; Female; Hypoxia; Lung; Male; Oxygen; Pulmonary Atelectasis; Pulmonary Gas Exchange; Tomography, X-Ray Computed
PubMed: 31891639
DOI: 10.1371/journal.pone.0227194 -
The Veterinary Quarterly Dec 2023Dynamic lower airway obstruction is the primary component of canine bronchomalacia, but the ventilatory function remains underinvestigated. This prospective study...
Dynamic lower airway obstruction is the primary component of canine bronchomalacia, but the ventilatory function remains underinvestigated. This prospective study analyzed tidal breathing characteristics in 28 dogs, comprising 14 with severe bronchomalacia diagnosed by bronchoscopy versus 14 without respiratory disease. Spirometry was conducted in all dogs. Bronchoscopy with bronchoalveolar lavage or brush under anesthesia was performed in 14 dogs with cough and expiratory effort. Severe bronchomalacia was defined by the severity of collapse and total number of bronchi affected. Ventilatory characteristics were compared between groups. Results revealed that dogs with severe bronchomalacia had lower minute volume (218 vs 338 mL/kg, = .039) and greater expiratory-to-inspiratory time ratio (1.55 vs 1.35, = .01) compared to control dogs. The tidal breathing pattern of dogs with bronchomalacia was different from that of normal dogs, and the pattern differed from the concave or flat expiratory curves typical of lower airway obstruction. Compared to control dogs, dogs with severe bronchomalacia had a significantly prolonged low-flow expiratory phase ( < .001) on the flow-time plot and a more exponential shape of the expiratory curve ( < .001) on the volume-time plot. Flow-time index ExpLF/Te (>0.14) and volume-time index Vt-AUCexp (≤31%) had a high ROC-AUC (1.00, 95% confidence interval 0.88 to 1.00) in predicting severe bronchomalacia. In conclusion, the tidal breathing pattern identified here indicates abnormal and complicated ventilatory mechanics in dogs with severe bronchomalacia. The role of this pulmonary functional phenotype should be investigated for disease progression and therapeutic monitoring in canine bronchomalacia.
Topics: Dogs; Animals; Bronchomalacia; Bronchoscopy; Prospective Studies; Respiration; Airway Obstruction; Phenotype; Dog Diseases
PubMed: 37616027
DOI: 10.1080/01652176.2023.2252518 -
Methodist DeBakey Cardiovascular Journal 2016Roughly 10% of lung transplant recipients experience airway complications. Although the incidence has decreased dramatically since the first lung transplants were... (Review)
Review
Roughly 10% of lung transplant recipients experience airway complications. Although the incidence has decreased dramatically since the first lung transplants were performed in the 1960s, airway complications have continued to adversely affect outcomes. Bronchoscopic interventions such as balloon dilation, airway stenting, and endobronchial electrocautery play an important role in ameliorating the morbidity and mortality associated with these complications. This review describes the array of bronchoscopic interventions used to treat airway complications after lung transplant and how these techniques can be used in nontransplant settings as well.
Topics: Airway Obstruction; Argon Plasma Coagulation; Bronchial Fistula; Bronchomalacia; Bronchoscopy; Dilatation; Granuloma, Respiratory Tract; Humans; Lung; Lung Transplantation; Risk Factors; Stents; Surgical Wound Dehiscence; Treatment Outcome
PubMed: 28298961
DOI: 10.14797/mdcj-12-4s1-18 -
Case Reports in Obstetrics and... 2016Absent pulmonary valve syndrome (APVS) is a rare congenital heart disease with severe pulmonary insufficiency, characterized with aneurysmal dilation in the pulmonary...
Absent pulmonary valve syndrome (APVS) is a rare congenital heart disease with severe pulmonary insufficiency, characterized with aneurysmal dilation in the pulmonary artery and one or both of its branches. We presented a rare case with APVS and literature review in this letter. Prenatal USG examination of the fetus at the 26th week of gestation revealed severe polyhydramnios, dilatation at right ventricle, and abnormal appearance of the heart. At the 31st gestational week, the baby was born with cesarean section. The newborn had right heart failure but had no hydrops fetalis. Therefore, severe respiratory distress observed in the infant has been associated with pulmonary complications. The infant, who had respiratory acidosis according to blood gas analysis, was intubated and attached to mechanical ventilator. Despite progressively increased respiratory support and other interventions, the infant died on the 3rd day of admission. Compression against bronchial tree and esophagus due to dilated pulmonary artery and its branches may inevitably lead to bronchomalacia and polyhydramnios. In conclusion, presence of polyhydramnios and the possibility of severe bronchomalacia should be kept in mind; and due to the risk of early neonatal mortality, delivery should be performed in a center where pediatric heart surgery is available.
PubMed: 27579200
DOI: 10.1155/2016/3641453