Although spirometry is a standard diagnostic tool for obstructive lung diseases, it is rarely performed, and the quality of basic spirometry is low in many countries. The impulse oscillometry system (IOS) is a non-invasive method that requires minimal patient cooperation and, therefore, can be performed even in the pediatric population. It has been also suggested that IOS may help to clarify the relationship between small airway disease and the underlying mechanisms of chronic obstructive pulmonary disease (COPD). The primary objective of the study was to compare IOS parameters in COPD patients with those in healthy individuals. Our secondary objective was to determine the relationship between IOS parameters and standard pulmonary function tests (PFTs). Our hypothesis was that airway resistance detected by IOS would be higher in COPD patients than in controls. Hence, IOS would provide findings comparable to and correlated with those of standardized PFTs for small airway obstruction. A total of 104 subjects (62 patients with COPD and 42 healthy non-smoking individuals) were included in the study. All subjects underwent spirometry, diffusing capacity for carbon monoxide (DLCO), lung-volume measurements, and IOS. COPD patients showed significant decreases in forced expiratory volume in one second (FEV1), forced vital capacity (FVC), FEV1/FVC, FEF 25-75, and DLCOadj, and significant increases in residual volume (RV) and total lung capacity (TLC) compared with the control group. In terms of IOS parameters, R5%, Z5%, Fres, and R5-R20/R5% values were significantly higher in the COPD group (P = 0.029, P = 0.022, P = 0.009, P = 0.004, respectively). The reactance area (AX) value, defined as the AX, was also significantly increased in the COPD group (P = 0.004). The correlation between FEF 25-75% (L/s) and R5-R20 was moderate and negative (r = -0.491, P < 0.001). A weak correlation (r = 0.240, P = 0.017) was also found between the RV/TLC ratio and R5-R20. This study showed that airway resistance was increased in the COPD group and that IOS parameters were associated with measures of small-airway function in standard PFTs. IOS can be used as a non-invasive, patient-friendly method that complements PFTs by providing a comprehensive assessment of COPD pathology and pathophysiological changes and detecting changes in symptomatic patients.

Research suggests that intracapsular tonsillectomy (ICT) is less morbid than extracapsular tonsillectomy. It is underutilized, in part, because of concerns regarding its effectiveness and the possible need for repeat surgery in the future. We conducted long-term follow-up patient interviews to evaluate symptom control and incidence of revision tonsillectomy in children who had undergone ICT years earlier. A computerized collection of office notes and operative reports was queried to identify children undergoing ICT in the years 2010-2023 at an academic pediatric otolaryngology practice. We contacted these families and assessed persistence of recurrent sore throat, snoring, and upper airway obstruction and need for revision or completion tonsillectomy. 219/610 (35.9%) families of children and teenagers operated on during the study period were successfully contacted. 181/219 (82.6%) contacts elected to participate in the study. Median age at surgery was 7.6 years (range = 1.2, 21.4). Median follow-up time was 8.7 years (range = 1.9, 15.3). ICT controlled snoring/upper airway obstruction (95/104-91.3%) and severe recurrent sore throat (72/77-93.5%), with 167/181 (92.3%) respondents reporting symptom resolution. 10/181 (5.5%) respondents reported postoperative bleeding. 6/181 (3.3%) patients reported undergoing a second tonsillectomy, four of which were for upper airway obstruction. 1/181 (0.6%) child was treated for peritonsillar abscess after intracapsular tonsillectomy. Intracapsular tonsillectomy is effective both short- and long-term for the control of symptoms of upper airway obstruction and recurrent sore throat. This study provides a modest reinforcement of existing literature that suggests significant benefit from ICT as a treatment option.

Airway obstruction time and outcomes after foreign body airway obstruction: a nationwide prospective cohort study from the MOCHI registry.

Anaphylaxis is a sudden onset multiorgan allergic reaction that infrequently but regularly causes fatalities which may be preventable with appropriate organ support. There is limited data about the type of organ failure leading to death or near-fatal episodes resulting in permanent neurological disability. To assist clinicians facing anaphylaxis in diverse clinical settings, we aimed to quantify the frequency of organ failure type contributing to death or neurological disability from anaphylaxis according to allergen trigger. Systematic review of published peer-reviewed literature. Three databases were searched to January 2025: MEDLINE from 1946, Embase from 1947 and Web of Science from 1900. Studies were eligible if they contained data about the type of clinical deterioration during anaphylaxis resulting in death or permanent neurological disability. No language restriction was implemented. Exclusion criteria were: hydatid anaphylaxis; five or more stings from an insect; death from acute atheromatous myocardial infarction and where anaphylaxis was only a differential diagnosis. We extracted information using pre-specified criteria to determine the primary organ failure involved: either upper airway obstruction, lower respiratory obstruction (bronchospasm) or cardiovascular failure. Baseline demographics including age and asthma status were collected along with the allergen trigger, time course and treatment. We reported frequencies according to allergen trigger for case reports and a narrative analysis of case series weighted by risk of bias assessment. 277 case studies and 14 case series were identified reporting 896 deaths and 28 disabilities. There were no other study types. Separate case series and case report analyses produced similar findings despite varying quality of published clinical data. Respiratory failure was the most common primary organ failure in case reports (73.4%), whereas primary cardiovascular failure was reported in 26.6% of case reports. Primary organ failure type differed in frequency by allergen trigger and was primarily caused by: respiratory failure when food was the allergen trigger (95%); respiratory failure in 65% of cases of drug allergen triggers; cardiovascular failure in 65% venom allergen triggers. In this review, respiratory failure (primarily bronchospasm) is the most common primary physiological event leading to decompensation in fatal anaphylaxis, particularly for food and drug allergen deaths. Emphasising the significance of respiratory involvement, particularly from bronchospasm, in both patient and clinician facing anaphylaxis treatment guidelines may help further reduce the risk of fatalities. Prospective anaphylaxis management registries or whole population data are needed to better capture primary organ failure present in fatal anaphylaxis to validate this finding. CRD42023434206.

Pulmonary hydatid disease (PH) remains a significant health challenge in children from endemic regions. The anesthetic and surgical management of PH is complex, particularly in the presence of ruptured cysts, which pose risks such as airway obstruction and anaphylaxis. A 10-year retrospective cohort study was conducted on children ≤ 18 years undergoing surgery for PH at our tertiary care center between January 2012 and December 2022. Data were collected from medical records, operative notes, and imaging reports. There were 37 cases with diagnosis of pulmonary hydatid disease in last decade, we have included 28 children with complete records. Three had bilateral disease, totaling 31 procedures. Ruptured cysts were noted in 12 cases. Common symptoms included cough, fever, and hemoptysis. One lung ventilation (OLV) was achieved in 96% of cases with DLT (45%), Arndt blocker (33%) and Fogarty blocker (13%) commonly used. Complications included desaturation (75%), transient bradycardia (29%), and three major perioperative events, all in children with ruptured cysts. The mean OLV duration was longer in complicated cases (3.42 vs. 2.3 h, p = 0.019). Postoperative air leaks occurred in 10 children, with three requiring re-surgery. All patients were extubated on-table, with mean length of stay of 7 days and no long-term morbidity or mortality. OLV is critical in minimizing spillage and facilitating surgical management in pediatric PH. The incidence of intraoperative complications was higher in those with bilateral Pulmonary hydatid disease. The duration of One Lung Ventilation (OLV) and hospital stay was prolonged in those with complicated pulmonary hydatid cyst.

Right ventricular strain as a predictor of surgical success in obstructive sleep apnea: Association with serum chemerin.

A systematic review, meta-analysis, and trial sequential analysis on association of circulating vascular cell adhesion molecule-1 (VCAM-1) levels in obstructive sleep apnea adults: A possible link between cardiovascular disease and obstructive sleep apnea.

Update on the pathogenetic hallmarks of chronic obstructive pulmonary disease.

Central airway obstruction (CAO) involves the narrowing of the trachea, carina, and main bronchi. This study describes a technique for placing a self-expanding metallic Y-stent using a single guidewire for the palliative management of inoperable malignant stenosis near the carina, evaluating its efficacy and safety. We conducted a retrospective analysis of all patients with severe malignant carinal stenosis who were treated with a customized self-expanding metallic Y-stent at our institution between January 2020 and December 2024. In all cases, the left bronchial branch of the stent was positioned using the Seldinger technique with a single guidewire. The single-guidewire Seldinger technique simplified the procedure, resulting in a significantly shorter stent placement time (38 vs. 51 min; p < 0.0001) and reduced general anesthesia time (53 vs. 71 min; p ≤ 0.0001) compared to a double-guidewire approach. Furthermore, it minimized the number of required X-ray exposures (0-1 vs. 4-5 images; p < 0.0001) and lowered the risk of guidewire dislodgement. No immediate complications were reported. The placement of a self-expanding Y-stent using a single left-sided guidewire is an efficacious and feasible approach for maintaining airway patency in patients with severe malignant carinal stenosis, offering a simpler and more efficient procedural alternative.

Mochi-related vs other food-related foreign body airway obstruction: outcomes from the MOCHI registry

ACCORDING TO THIS STUDY.

Beckwith-Wiedemann Syndrome (BWS) is a complex overgrowth disorder characterised primarily by macroglossia, omphalocele, and gigantism, along with a range of anatomical and metabolic abnormalities such as neonatal hypoglycaemia, embryonal tumours, visceromegaly, naevus flammeus, and anal dimple. Airway management in paediatric patients poses a significant challenge for anaesthesiologists. Anaesthetic management in patients with BWS is demanding because macroglossia may cause difficult mask ventilation, intubation, and extubation. These patients often require repeated anaesthetic exposure for the correction of macroglossia and associated abnormalities, and their perioperative management can be taxing for anaesthesiologists. Therefore, the anaesthetic management of children with BWS is particularly challenging due to the combination of age-related physiological limitations and disease-specific abnormalities. Here, the authors present the case of a five-month-old female infant diagnosed with BWS, with macroglossia, naevus flammeus, and an anal dimple, who underwent surgical reduction of macroglossia. The patient also demonstrated additional systemic findings including non-obstructing hydrocephalus, syringohydromyelia, hepatosplenomegaly, and enlarged kidneys on imaging, further increasing the complexity of anaesthetic care. Given the likelihood of a difficult airway, comprehensive preoperative evaluation, meticulous preparation, and well-structured backup strategies for airway management, endotracheal intubation, and intraoperative haemodynamic management are critical to navigating the anaesthetic complexities in patients with BWS. In addition, vigilant postoperative monitoring is essential due to the risk of airway obstruction and hypoglycaemia. The present case underscores the importance of multidisciplinary coordination and individualised anaesthetic planning to ensure safe perioperative outcomes.

Emerging roles of IL-9 and Th9 cells in respiratory viral illnesses.

Patients with myasthenia gravis are at high risk of fatal airway complications due to impaired swallowing mechanics. We present a prehospital resuscitation case involving complete airway obstruction leading to cardiopulmonary arrest in a young patient with myasthenia gravis. A 21-year-old Han Chinese female patient with a reported history of myasthenia gravis developed sudden respiratory arrest during oral intake. The diagnosis of myasthenia gravis was initially provided by on-scene witnesses (classmates), and later confirmed by family who reported her medication regimen. Prehospital interventions-including modified Heimlich maneuvers, rapid endotracheal intubation, and advanced cardiac life support-achieved return of spontaneous circulation within 10minutes. Persistent hypoxia and hemodynamic instability were managed during transport. The patient was transferred to the hospital intensive care unit but subsequently died due to the consequences of prolonged cerebral hypoxia. Myasthenia-gravis-associated bulbar weakness predisposes patients to catastrophic aspiration events. This case highlights three critical prehospital strategies: (1) modified supine-position Heimlich maneuvers for intubated arrest patients, (2) time-critical airway clearance using direct laryngoscopy, and (3) multidisciplinary coordination between telemedicine dispatchers and field responders. Our findings highlights the unique challenges of managing airway obstruction in patients with myasthenia gravis and proposes an integrated prehospital strategy for airway management. This case underscores that successful prehospital return of spontaneous circulation is possible in patients with myasthenia gravis with acute airway obstruction; however, prevention remains paramount due to the risk of fatal outcomes. It emphasizes the need for integrated prehospital strategies, patient education on aspiration risk, and protocolized airway algorithms for neuromuscular disorders.

Background: The study investigates the influence of epiglottis morphology on airflow dynamics and mechanical loading using computational fluid dynamics (CFD) in patients with obstructive sleep apnea (OSA), where the epiglottis may contribute to upper airway obstructions during sleep. Methods: A two-stage analysis was conducted: first, using a simplified airway model with two distinct epiglottis shapes (flat and curved), and second, using patient-specific 3D airway geometries derived from computed tomography (CT) scans. The simplified model enabled isolated analysis of flow-related aerodynamic forces and torques acting on the epiglottis across varying flow rates and inclination angles. Results: Results showed that the flat-shaped epiglottis was subjected to higher aerodynamic loads, particularly at lower flow rates, indicating increased susceptibility to collapse. These findings were corroborated by simulations on patient-specific 3D airway models. Conclusions: The study confirms that epiglottis morphology plays a critical role in the pathogenesis of OSA and underscores the potential of CFD for personalized assessment and treatment planning.

ObjectiveTo screen for obstructive sleep apnea (OSA) in nonsyndromic patients with cleft lip and/or palate in Saudi Arabia and to identify factors associated with positive OSA screening results.DesignCross-sectional analytical study.SettingCleft lip and palate clinic, Madinah, Saudi Arabia.Patients, ParticipantsA total of 231 nonsyndromic patients aged 2 to 18 years with cleft lip and/or palate. Patients with syndromic diagnoses were excluded.InterventionsParticipants and their guardians completed a structured, 37-item interview-based questionnaire administered by the investigator. Responses were recorded through an online form and analyzed after data cleaning.Main Outcome Measure(s)Screening outcomes for OSA risk and associations between OSA status and demographic or clinical variables.ResultsThe mean age of participants was 7.5 ± 3.7 years, and 55.4% were male. Most patients were underweight (70%), followed by those with healthy body mass index (21.2%). No significant differences were found between OSA-positive and OSA-negative groups across demographic or clinical variables, except for the OSA risk score, which was significantly higher in the OSA-risk group.ConclusionsChildren with cleft lip and/or palate may exhibit mild OSA symptoms, including snoring and noisy breathing. Routine clinical screening remains essential to detect early signs of airway obstruction. While polysomnography is the diagnostic gold standard, further research is needed to clarify its correlation with clinical findings in this patient population.

Obstructive sleep apnea (OSA), defined by repetitive airway obstruction during sleep, is significantly underdiagnosed, mainly due to the resource-intensive and time-consuming nature of sleep assessment technologies. Machine learning analysis of the tracheal breathing sounds (TBS) whilst awake offers an alternative approach for OSA quick screening. This study aimed to address the challenge of wakefulness OSA detection using TBS recorded with an inexpensive microphone in a noisy environment. Data of 247 individuals with various degrees of OSA severity were analyzed. Recorded data were segmented into inspiration and expiration phases, followed by acoustic features extraction, feature reduction, and classification. A two-level ensemble architecture was implemented. Nine sub-classifiers were stratified by anthropometric profiles. Each sub-classifier was constructed as an ensemble of bagged decision trees, with a final prediction via probability-based voting. The proposed algorithm achieved an accuracy of 77.1%, sensitivity of 84.3%, and specificity of 59.9%. Although these results have lower performance than those obtained previously using a high-quality microphone in a quiet room, they demonstrate that acoustic OSA detection whilst awake remains feasible, even in very noisy environments. Nevertheless, microphone quality emerged as a key determinant of classification performance.

Background: This study investigated the association between tongue strength, measured using the Iowa Oral Performance Instrument (IOPI), and upper airway collapse patterns observed during drug-induced sleep endoscopy (DISE) in patients with obstructive sleep apnea syndrome (OSAS). Methods: Thirty patients who underwent polysomnography, DISE, and tongue pressure measurement were retrospectively analyzed. Upper airway collapse was assessed using the VOTE classification. The tongue strength task performed using the IOPI requires participants to compress an air-filled bulb placed on the hard palate with anterior tongue to generate maximum isometric tongue pressure. Group comparisons and ordinal logistic regression with Firth's penalized likelihood were performed to evaluate associations between tongue pressure and collapse patterns. Results: The participants had a mean age of 41.5 ± 12.5 years, including 27 males and 3 females. The mean tongue strength was 50.4 ± 15.3 kPa, with no significant sex-related differences. Patients with tongue strength <40 kPa showed significantly higher odds of tongue base collapse (adjusted OR 12.79, 95% CI 1.30-126.91) and epiglottic collapse (adjusted OR 54.05, 95% CI 1.66-1760.25). No significant differences were observed for velum or oropharyngeal collapse. Conclusions: Lower tongue strength was associated with increased likelihood of tongue base collapse during DISE. Tongue strength measurement may serve as a practical, non-invasive tool for identifying patients with reduced tongue muscle function and potential tongue-related airway obstruction.

Stridor in infants is a frequent but non-specific clinical sign, indicating partial upper airway obstruction. The causes vary according to age and include congenital anomalies, infections, trauma or space-occupying lesions. Among the rare aetiologies is the subglottic haemangioma, a benign vascular tumour that may lead to significant respiratory impairment if not diagnosed early.

Asthma is a chronic disease characterized by chronic inflammation, hyperresponsiveness, and reversible obstruction of the lower respiratory tract (RT). Airway muscles (ASM) play a central role in the pathophysiology of asthma, being essential for the narrowing and remodeling of the RT. Local hyperthermia of the ASM, achieved by bronchial thermoplasty (BT) and inhalation of a heated helium-oxygen mixture (thermal heliox, t-He/O 2 ), reduces the ASM mass and contractile activity, which may have a positive pathogenetic effect on the symptoms and course of asthma. The aim of this review is to study the relationship between the temperature of the ASM and the functional state in patients with asthma, as well as the therapeutic effect of thermotherapy in this disease based on an analysis of the literature from PubMed and Google Scholar. Methods. 85 publications in PubMed and Google Scholar were selected by searching the following key words: “ASM”, “contraction of ASM”, “relaxation of ASM”, “hyperreactivity of the airways”, “chronic inflammation”, “asthma”, “hyperthermia of the airways”, “bronchial thermoplasty”, “thermal helium-oxygen mixture” (t-He/O 2 ). Results. Based on literature data, an assessment was made of the clinical efficacy and safety of two methods of thermal modulation of ASM: BT and inhalation of t-He/O 2 . Local hyperthermia of the ASM, achieved by BT and inhalation of a t-He/O 2 reduces the mass and contractile activity of ASM, which may have a positive pathogenetic effect on the symptoms and further course of BA. Conclusion. Studying the role of temperature in maintaining local inflammation and the development of bronchial obstruction syndrome is not only of great scientific importance, but also has unquestionable practical value for the development of new promising methods of treating asthma.