Bronchial Cartilage Research Articles

Ganglia in the Human Fetal Lung.

Although pulmonary ganglia were considered to be an analogue of the myenteric ganglia of intestines in embryos, there seemed to be no morphological evaluation in the later stage of development. We conducted immunostainings of intrapulmonary nerves using 17 human fetuses at 14-18 and 28-34 weeks. The ganglion cells were small (15-20 μm in diameter) in the earlier group, but they increased in size (20-30 μm) in the late group. One ganglion, containing 5-30 cell bodies, was usually located "outside" of the bronchial smooth muscle or cartilage. In addition, a few ganglion was found beneath the mucosa of the trachea and principal bronchi. The highest density of ganglia (5-15 ganglia per section with 50 μm interval) was found at the origin of the subsegmental bronchi, but ganglia were absent along more peripheral bronchi those are responsible for contraction and obstruction of the airway. Therefore, in topographical relation between smooth muscle and nerve, intrapulmonary intrinsic neurons were different from intestinal myenteric neurons. Consequently, a previous hypothesis of "embryonic intramuscular bronchial ganglia" seemed not to be based on observations of the peripheral bronchus but on the central bronchus than the sub-subsegmental level. An extrinsic migration and redistribution of ganglia might occur at midterm to provide the final location outside of airway smooth muscles. Finally, no ganglion cell bodies were positive either for neuronal nitric oxide synthase or tyrosine hydroxylase. Instead of the classical entity of autonomic nerves, nonadrenergic noncholinergic (NANC) innervation might be dominant even in fetuses. Anat Rec, 302:2233-2244, 2019. © 2019 American Association for Anatomy.

Clinicopathologic predictors of metastasis of different regional lymph nodes in patients intraoperatively diagnosed with stage-I non-small cell lung cancer

BackgroundSelection of the best lymph node for dissection is a controversial topic in clinical stage-I non-small cell lung cancer (NSCLC). Here, we sought to identify the clinicopathologic predictors of regional lymph node metastasis in patients intraoperatively diagnosed with stage-I NSCLC.MethodsA retrospective review of 595 patients intraoperatively diagnosed as stage I non-small-cell lung cancer who underwent lobectomy with complete lymph node dissection was performed. Univariate and multivariable logistic regression analysis was performed to determine the independent predictors of regional lymph node metastasis.ResultsUnivariate logistic regression and multivariable analysis revealed three independent predictors of the presence of metastatic hilar lymph nodes, five independent predictors for lobe specific mediastinal lymph nodes, two independent predictors for lobe nonspecific mediastinal lymph nodes and two independent predictors for skipping mediastinal lymph nodes.ConclusionsA complete mediastinal lymph node dissection may be considered for patients suspected of nerve invasion and albumin (> 43.1 g/L) or nerve and vascular invasions. Lobe-specific lymph node dissection should probably be performed for patients suspected of pulmonary membrane invasion, vascular invasion, CEA (> 2.21 ng/mL), and tumor (> 1.6 cm) in the right lower lobe or mixed lobes. Hilar lymph node dissection should probably be performed for patients suspected of having bronchial mucosa and cartilage invasion, vascular invasion, and CEA (> 2.21 ng/mL).

Bronchial Cartilage Assessment with Model-Based GAN Regressor.

In the last two decades, several methods for airway segmentation from chest CT images have been proposed. The following natural step is the development of a tool to accurately assess the morphology of the bronchial system in all its aspects to help physicians better diagnosis and prognosis complex pulmonary diseases such as COPD, chronic bronchitis and bronchiectasis. Traditional methods for the assessment of airway morphology usually focus on lumen and wall thickness and are often limited due to resolution and artifacts of the CT image. Airway wall cartilage is an important characteristic related to airway integrity that has shown to be deteriorated during the airway disease process. In this paper, we propose the development of a Model-Based GAN Regressor (MBGR) that, thanks to a model-based GAN generator, generate synthetic airway samples with the morphological components necessary to resemble the appearance of real airways on CT at will and that simultaneously measures lumen, wall thickness, and amount of cartilage on pulmonary CT images. The method is evaluated by first computing the relative error on generated images to show that simulating the cartilage helps improve the morphological quantification of the airway structure. We then propose a cartilage index that summarizes the degree of cartilage of bronchial trees structures and perform an indirect validation with subjects with COPD. As shown by the results, the proposed approach paves the way for the use of CNNs to precisely and accurately measure small lung airways morphology, with the final goal to improve the diagnosis and prognosis of pulmonary diseases.

Regulatory role of Shh signaling pathway in lung development in fetal mice

To investigate the regulatory role of classical Shh signaling pathway in the development of the epithelium and mesenchyme (bronchial cartilage and smooth muscles) during lung development in fetal mice. Immunohistochemical technique was used to detect the expression of Shh signaling pathway receptor Smo and Pdgfr-α in murine fetal lungs to explore the spatial and temporal characteristics of their expression. Based on the interstitial specificity of Pdgfr-α expression, we constructed a Pdgfr-α-cre to establish a E12.5 - E16.5 transgenic mice with specific knockout of the key Shh signaling molecule Smo in the pulmonary interstitium with tamoxifen induction. Immunofluorescence technique was used to observe the epithelium and mesenchyme (bronchial cartilage and smooth muscle) during fetal lung development in the transgenic mice to assess the role of Shh signaling pathway in the epithelial-to-mesenchymal (EMT) transition during the lung development. Smo was highly expressed in the epithelial and stromal lung tissues in the pseudoglandular stage and was gradually lowered over time with its distribution mainly in the interstitial tissues. Pdgfr-α was enriched in the distal lung epithelial and mesenchy tissues in early embryonic lungs and gradually migrated to the proximal stroma until becoming concentrated around the main bronchial proximal stroma. We successfully specific established mouse models of specific mesenchymal Smo knockout. Compared with the control group, the transgenic mice during E12.5-E16.5 showed significantly reduced lung the volume and bronchial branching with also decreased expression of the proximal epithelial P63 (P<0.05). The transgenic mice exhibited alterations in the expression of α-smooth muscle actin with delayed bronchial cartilage development and decreased expression of mucoprotein. The temporospatial specific expression of Shh signaling pathway plays an important role in developmental regulation of mouse embryonic lung epithelium and mesenchyme (bronchial cartilage and smooth muscle).

Age-related lung tissue remodeling due to the local distribution of MMP-2, TIMP-2, TGF-β and Hsp70

Lung tissue remodeling requires complex interactions of matrix metalloproteinases (MMPs), tissue inhibitors of metalloproteinases (TIMPs), transforming growth factor (TGF) family and heat shock protein 70 (Hsp70). We evaluated the appearance and distribution of MMP-2, TIMP-2, TGF-β1 and Hsp70 in lung tissue using immunohistochemistry. Stained structures were graded semiquantitatively. Overall, more MMP-2, TIMP-2, TGF-β1 and Hsp70 were observed in bronchial cartilage, bronchial and alveola repithelium, and among alveolar macrophages. We evaluated mostly alveolar macrophages, bronchial epithelial cells and mucosal fibroblasts stained for TGF-β1, MMP-2 and TIMP-2. We also assessed strong or moderate correlations between numbers of cells containing TGF-β1, MMP-2, TIMP-2 in patients ≥ 60 years old. The presence of less TGF-β1 and more MMP-2, TIMP-2 and Hsp70 containing cells in all tissue groups indicated that local regulation was more dependent on MMP-2, TIMP-2 and Hsp70 distribution. Fewer TIMP-2, Hsp70 and TGF-β1 immunoreactive cells in younger individuals and increased expression of Hsp70 in elderly individuals demonstrated the influence of aging in lung remodeling. Findings of MMP-2, TIMP-2 and TGF-β1 immunoreactive cells in elderly individuals indicate lung remodeling due to aging.

Recurrent bronchitis as a clinical variant of functional changes of the respiratory system in children

Background. The high prevalence of acute respiratory infections in children, recurrent episodes of acute bronchitis remain to be one of the hot topics of pediatrics. The causes of recurrent exacerbations of bronchitis in children, despite the numerous research works on this issue, are not completely clear.&#x0D; Aim: to study the features of the clinic in children with recurrent bronchitis.&#x0D; Methods. There were 58 patients aged 3 to 12 years with recurrent bronchitis. A study demonstrated the close relationship between recurrent episodes of acute bronchitis not only with pre-preschool and preschool age (when bronchopulmonary tissue is not completely differentiated), with the influence of negative environmental factors, with bacterial, viral infection, but also with signs of connective tissue disorders (CTD) in them.&#x0D; Results. Revealing connective tissue insufficiency explains the causes of disorders of bronchial cartilage and connective tissue, that lead to the development of bronchial dyskinesia thus exacerbating the vulnerability of immature bronchopulmonary tissue along with autonomic dysfunction, typical for CTD. Involvement of several organs and systems in the CTD process changes the course of clinical symptoms of recurrent bronchitis. Probably by the main differentiation of tissues of organs at this age, including connective tissue, can be explained the fact that in 2/3 of the children observed by the age of 7 the manifestations of exacerbations of the disease ceased. In the half of the patients with recurrent episodes, who had bronchial obstruction in the first year of life, a allergy history, paroxysms of respiratory dyspnoea after an additional examination, – asthma was diagnosed; in one patient an aneurysm of the lung vessels was revealed.&#x0D; Conclusions. Basing on the conducted study, the use of the term “recurrent bronchitis” is advisable in children of the first seven years of life. In patients with continuing episodes of bronchitis bronchopulmonary pathology should be excluded; in patients with allergy history and symptoms of bronchial obstruction, spasmodic cough in previous episodes of bronchitis asthma should be excluded. The presence of symptoms of connective tissue disorders in children with recurrent bronchitis requires a careful examination of patients for the detection of comorbid diseases.

Inflammatory, anti-inflammatory and regulatory cytokines in relatively healthy lung tissue as an essential part of the local immune system.

The innate and adaptive immune systems in lungs are maintained not only by immune cells but also by non-immune tissue structures, locally providing wide intercellular communication networks and regulating the local tissue immune response. The aim of this study was to determine the appearance and distribution of inflammatory, anti-inflammatory and regulatory cytokines in relatively healthy lung tissue samples. We evaluated lung tissue specimens obtained from 49 patients aged 9-95 years in relatively healthy study subjects. Tissue samples were examined by hematoxylin and eosin staining. Interleukin-1 (IL-1), interleukin-4 (IL-4), interleukin-6 (IL-6), interleukin-7 (IL-7), and interleukin-10 (IL-10) were detected by an immunohistochemistry (IMH) method. The number of positive structures was counted semiquantitatively by microscopy. Non-parametric tests were used to analyse the data. IL-1-positive cells were mostly found in the bronchial cartilage and alveolar epithelium. Immunoreactive lung macrophages were also found. The numbers of IL-4, IL-6, IL-7, and IL-10 containing cells were also found in the bronchial epithelium (in addition to those previously listed). The number of positive structures varied from occasional to moderate, but was graded higher in cartilage. Overall, fewer IL-1-positive cells and more IL-10-positive cells were found. Almost no positive structures for all examined cytokines were found in connective tissue and bronchial glands. Relatively healthy lung tissue exhibits anti-inflammatory response patterns. The cytokine distribution and appearance suggest persistent stimulation of cytokine expression in lung tissue and indicate the presence of local regulatory and modulating patterns. The pronounced cytokine distribution in bronchial cartilage suggests the involvement of a compensatory local immune response in the supporting tissue.

The Morphometric Study of Main Bronchus in Korean Cadaver

This morphometric study of main bronchus was performed to provide the basic data necessary for anatomists, anesthetists and emergency medical technicians. A total of 48 cadavers, 33 men and 15 women, were used in this study. When it comes to their average age, men were 70 years old (50 to 91 years old), and women were 74 years old (47 to 92 years old). For this study, the length of the left and right main bronchi and the angle between them, and the first bronchial cartilage’s each anteroposterior diameter, transverse diameter, vertical height, and distance between posterior ends of cartilage were measured. As for the length, left length was longer than right length regardless of gender, and there was no significant difference between men and women. When it comes to anterorposterior diameter, transverse diameter, and distance between posterior ends of the first bronchial cartilage in main bronchi, the right side was longer and wider than left side regardless of gender, but statistical significance was shown only in the distance between posterior ends of cartilage. Vertical height of the first bronchial cartilage in main bronchi did not show any difference between the left and right and between men and women, and men cadavers had a very large individual difference from 2.35 mm to 9.22 mm. As for the angle of the main bronchi’s separation from trachea’s major axis, the left side was larger than the right side in both men and women cadavers and it was larger in men than women, but there was no significant statistical difference. Lastly, as for the length of the main bronchi, the right and left lengths in men were 16.83±1.36 and 37.26±1.42 mm respectively; and the right and left lengths in women were 16.90±2.26 and 36.08±3.39 mm respectively. These results are expected to be used as the basic clinical data useful for medical procedures of emergency care practitioners, anesthetists and emergency medical technicians.

Calcification of the lower respiratory tract in relation to flight development in Jamaican fruit bats (Phyllostomidae, Artibeus jamaicensis).

The production of echolocation calls in bats along with forces produced by contraction of thoracic musculature used in flight presumably puts relatively high mechanical loads on the lower respiratory tract (LRT). Thus, there are likely adaptations to prevent collapse or distortion of the bronchial tree and trachea during flight in echolocating bats. By clearing and staining (Alcian blue and Alizarin red) LRTs removed from nonvolant neonates, semivolant juveniles, volant subadults, and adult Jamaican fruit bats (Artibeus jamaicensis), I found that calcification of the tracheal, primary bronchial, and secondary bronchial (lobar) cartilage rings occurs over the span of about 3days and coincides with later developmental stages of flight and the increased production of echolocation calls. Tracheal rings that are immediately adjacent to the larynx calcified first, followed by more caudal tracheal rings and then the rings of the primary and secondary bronchi. I suggest that calcification of LRT cartilage rings in echolocating bats provides increased rigidity to counter the thoracic compressions incurred during flight. Calcification of the LRT rings is an adaptation to support the emission of laryngeally produced echolocation calls during flight in bats.

軟骨片を喀出した気管支結核の 1 手術例

軟骨片を喀出した気管支結核の 1 手術例

The association of congenital tracheobronchial stenosis and cardiovascular anomalies

ObjectivesCongenital tracheobronchial stenosis (CTBS) is a rare disorder characterized by the presence of focal or diffuse complete tracheal or bronchial cartilage rings resulting in a fixed lumen narrowing. The aim of this study was to expose the association of various cardiovascular (CV) anomalies with various types of CTBS. MethodsA retrospective review of 58 patients who had bronchoscopically proven CTBS between 1997 and 2011 was conducted. Totally, 48 cases who had received echocardiography, computed tomography and other examinations including cardiac catheterization were enrolled. There were 33 boys and 15 girls, and the median age of diagnosis was 4 months (0–44 months). The image findings of associated CV anomalies were reviewed and analyzed, along with the clinical manifestations and patients’ outcome. ResultsThere were 14 generalized hypoplasia (29.2%), 10 funnel type (20.8%), 15 segmental type (31.3%), and 9 isolated bronchial stenosis cases (18.7%). Among 48 cases of CTBS, 32 patients (66.7%) had various CV anomalies including atrial septal defect (n=9), pulmonary artery sling (n=7), ventricular septal defect (n=7), patent ductus arteriosus (n=6), tetralogy of Fallot (n=3), peripheral pulmonary stenosis (n=3), etc. No significant difference existed in the incidence and types of comorbid CV anomalies among 4 types of CTBS, except that funnel type had significantly higher comorbidity of pulmonary artery sling (50%, p<0.01). ConclusionPatients with CTBS had high incidence of various associated CV anomalies. Isolated bronchial stenosis had similar high comorbidity of CV anomalies as did the 3 classical categories of congenital tracheal stenosis. The higher comorbidity of pulmonary artery sling in patients with funnel CTBS might be related to its gradual caudal narrowing of the trachea.

Bronchoscopic Curative Therapy

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Imaging Findings of Pneumothorax Caused by Bronchial Cartilage Hypoplasia in a Dog

A 10-year-old, castrated poodle dog presented with a cough for 2 weeks, and the cough initially developed since very young age. On radiographs, pneumothorax was noticed by characteristics of radiolucent area without pulmonary markings along the thoracic wall and diaphragm, retracted lung lobes from the thoracic wall and severely decreased volume of the left cranial lung lobe with disconnected bronchus. Computed tomography (CT) findings identified several pulmonary air-filled cysts and collapsed lung with abnormal shape and non-tapered end of bronchus, bronchioles at the accessory lobe and left cranial lobe. Also, pneumothorax, pneumomediastinum and subcutaneous emphysema were found. Imaging diagnosis was the spontaneous pneumothorax caused by ruptured emphysematous bullae associated with congenital bronchial cartilage abnormality or bronchial tree malformation. On surgery, hypoplasia of the left cranial lobe, right middle lobe, and accessory lobe with a bulla where air was leaking was identified. The accessory lobe was partially resected and bronchial cartilage hypoplasia was confirmed by histopathologic examination.

Developmental Expression and Glucocorticoid Control of the Leptin Receptor in Fetal Ovine Lung.

The effects of endogenous and synthetic glucocorticoids on fetal lung maturation are well-established, although the role of leptin in lung development before birth is unclear. This study examined mRNA and protein levels of the signalling long-form leptin receptor (Ob-Rb) in fetal ovine lungs towards term, and after experimental manipulation of glucocorticoid levels in utero by fetal cortisol infusion or maternal dexamethasone treatment. In fetal ovine lungs, Ob-Rb protein was localised to bronchiolar epithelium, bronchial cartilage, vascular endothelium, alveolar macrophages and type II pneumocytes. Pulmonary Ob-Rb mRNA abundance increased between 100 (0.69 fractional gestational age) and 144 days (0.99) of gestation, and by 2–4-fold in response to fetal cortisol infusion and maternal dexamethasone treatment. In contrast, pulmonary Ob-Rb protein levels decreased near term and were halved by glucocorticoid treatment, without any significant change in phosphorylated signal transducer and activator of transcription-3 (pSTAT3) at Ser727, total STAT3 or the pulmonary pSTAT3:STAT3 ratio. Leptin mRNA was undetectable in fetal ovine lungs at the gestational ages studied. These findings demonstrate differential control of pulmonary Ob-Rb transcript abundance and protein translation, and/or post-translational processing, by glucocorticoids in utero. Localisation of Ob-Rb in the fetal ovine lungs, including alveolar type II pneumocytes, suggests a role for leptin signalling in the control of lung growth and maturation before birth.

Histology and Scanning Electron Microscopy of the Lower Respiratory Tract in the Adult Red Fox (Vulpes vulpes)

MOUSSA, E. A. & HASSAN, S. A. Histology and scanning electron microscopy of the lower respiratory tract in the adult red fox(Vulpes vulpes). Int. J. Morphol., 33(1):267-274, 2015.SUMMARY: The study was conducted on a total of three adult healthy freshly killed red foxes of both sexes weighing about 4-6 kg collected from Abou Rawwash, Giza, Egypt. The wall of trachea and bronchi formed of mucosa, submucosa and adventitia. Themucosa formed of pseudostratified columnar epithelium and lamina propria. The respiratory epithelium composed of tall columnarciliated, goblet cells, basal cells, and neuroendocrine cells. Goblet cells account for about 20 to 30% of cells in the more proximal. Basalcells are relatively small triangular cells whose bases are attached to the basement membrane. The primary bronchiole is lined by simplecolumnar nonciliated to cuboidal epithelium containing some bronchiolar exocrine cells and some goblet cells. Neuroendocrine cellsconstitute about 4 to 5% of bronchial epithelial cells, attached at their bases to the basement membrane and have tapering apic es. The laminapropria consists principally of a network of capillaries, a meshwork of connective tissue fibers continuous with the basement membrane.The submucosa formed of connective tissue elements and blood vessels and devoid of Tracheobronchial glands in red fox. The adventitiacontain tracheal cartilage and muscle in trachea and bronchial cartilages and muscles in bronchi. Tracheal muscle is transverse bundlesattached to the outer perichondrium. In the bronchi, muscle is organized in transverse bundles close to the epithelium adjacent to the laminapropria and longitudinal bundles close to the cartilages. Alveoli are demarcated by septa composed of a continuous layer of epi thelial cellsoverlying a thin interstitium. The epithelial cells consist principally of type I and type II pneumocytes. SEM revealed that, the mucosalsurface of both trachea and bronchi was completely covered by cilia. There were few glandular openings or goblet cell.KEY WORDS: Scanning; Fox; Respiratory; Histology.

Williams-Campbell syndrome-a rare entity of congenital bronchiectasis: A case report in adult

Williams-Campbell syndrome is a rare entity of congenital bronchiectasis due to developmental arrest in the tracheobronchial tree, in which extensive loss of bronchial cartilage is associated with diffuse cystic bronchiectasis; may be unilateral or bilateral. Clinical manifestations start from infancy with subsequent recurrent pulmonary infection leading to respiratory failure. Patients may survive into late adulthood and require lung transplantation. We report such a rare case diagnosed on the basis of clinico-radiological presentation and histopathological examination of the pneumonectomy specimen. A 40 years patient was presented with severe breathlessness and had history of recurrent episode of productive cough with low grade fever since childhood for which he was admitted in hospital and treated symptomatically. Chest roentgenogram revealed right hyperlucent lung, deviation of trachea towards left; while the left lung showed multiple scattered large thin walled cysts along with elevation of left dome of diaphragm. High resolution computed tomography revealed multiple cystic thin walled airways in the left hemithorax, suggestive of bronchiectasis with collapse of left lung and compensatory hyperinflation of right lung along with herniation of right upper lobe to the left.

Functional anatomy of the syrinx of the chukar partridge (Galliformes: Alectoris chukar) as a model for phonation research.

The phonation process of vertebrates is influenced by the material characteristics of the participating structures, ranging from molecular to macroscopic dimensions. Good animal models for phonation research are still lacking. Due to easy availability and relatively simple structure, the syrinx of birds might serve as a good animal model for this purpose. Our aim was therefore to determine structural features of the syrinx and obtain insights into its mucus layer characteristics. Epithelium and glands were analyzed using histological, histochemical, and immunohistochemical methods and conclusions were drawn on the use of the syrinx as a model for phonation research by comparing the epithelium and its mucus characteristics to human laryngeal secretions. Ten adult partridges were analyzed. The tympanum of the syrinx developed from the last two tracheal cartilages, whereas the caudal part of the syrinx was formed from eight pieces of bronchial cartilages. The tracheal and bronchial epithelia and the pessulus of the syrinx were lined by pseudo-stratified columnar epithelium in which goblet cells and intraepithelial glands were localized. Collagen fibers were distributed in the lamina propria of all parts of the syringeal mucosa. Elastic fibers in the membranes of the syrinx showed evident distribution. All glandular epithelial cells and goblet cells were positive for neutral, acidic and carboxylated mucins were dominant in particular. Epithelium and glands revealed positive reactivity with antibodies to the mucins MUC1, MUC2, and MUC5AC. Of these, MUC2 and MUC5AC were dominant. The syrinx of partridge can serve as a good ex vivo model for phonation research.

Wt1-expressing progenitors contribute to multiple tissues in the developing lung

Lungs develop from paired endodermal outgrowths surrounded by a mesodermal mesenchyme. Part of this mesenchyme arises from epithelial-mesenchymal transition of the mesothelium that lines the pulmonary buds. Previous studies have shown that this mesothelium-derived mesenchyme contributes to the smooth muscle of the pulmonary vessels, but its significance for lung morphogenesis and its developmental fate are still little known. We have studied this issue using the transgenic mouse model mWt1/IRES/GFP-Cre (Wt1cre) crossed with the Rosa26R-EYFP reporter mouse. In the developing lungs, Wt1, the Wilms' tumor suppressor gene, is specifically expressed in the embryonic mesothelium. In the embryos obtained from the crossbreeding, the Wt1-expressing cell lineage produces the yellow fluorescent protein (YFP), allowing for colocalization with differentiation markers. Wt1cre-YFP cells were very abundant from the origin of the lung buds to postnatal stages, contributing significantly to pulmonary endothelial and smooth muscle cells, bronchial musculature, tracheal and bronchial cartilage, as well as CD34⁺ fibroblast-like interstitial cells. Thus Wt1cre-YFP mesenchymal cells show the very same differentiation potential as the splanchnopleural mesenchyme surrounding the lung buds. FSP1⁺ fibroblast-like cells were always YFP⁻; they expressed the common leukocyte antigen CD45 and were apparently recruited from circulating progenitors. We have also found defects in pulmonary development in Wt1-/- embryos, which showed abnormally fused lung lobes, round-shaped and reduced pleural cavities, and diaphragmatic hernia. Our results suggest a novel role for the embryonic mesothelium-derived cells in lung morphogenesis and involve the Wilms' tumor suppressor gene in the development of this organ.

Prevalence of tracheobronchomalacia and excessive dynamic airway collapse in bronchial asthma of different severity

BackgroundTracheobronchomalacia (TBM) is a pathologic condition in which softening of tracheal and bronchial cartilage causes the dynamic narrowing of transverse or sagittal diameters of tracheobronchial lumen; an excessive dynamic airway collapse (EDAC) may also be associated, with a substantial invagination of the posterior membrane of trachebronchial tree.The aim of this study was to assess the prevalence of both TBM and EDAC in a population of asthmatics with different degrees of disease severity compared to a reference group of subjects without any bronchial obstruction.MethodsA cohort of 202 asthmatics was investigated by means of a dynamic flexible videobronchoscopy: 74 mild persistent (MPA - age 18–68 ys; 35 males; mean FEV1 = 88.6% pred. ± 8.3 sd); 63 moderate (MA - age 21–71 ys; 30 males; mean FEV1 = 71.3% pred. ± 9.1 sd), 65 severe asthmatics (SA - age 33–70 ys; 25 males; mean FEV1 = 48.5% pred. ± 7.6 sd), and 62 non obstructed subjects (NO - age 18–71 ys; 38 males; mean FEV1 98.6% pred. ± 2.7 sd). TBM and EDAC were classified according to FEMOS classification.ResultsTBM and EDAC were observed in only 1/62 subjects (both 1.61%) of NO group, while their prevalence was 2.70% and 6.75% in MPA group; 7.93% and 19.04% in MA group; 18.46% and 69.23% in SA group, respectively. The crude prevalence of thyroid disorders in the population was 12.9%. In particular, the prevalence of thyroid disorders was significantly higher in females than in men, but 54-fold higher in females than in men in the presence of EDAC.Conclusions1) The prevalence of both TBM and EDAC is directly related to age, gender (females), and asthma severity; 2) EDAC is much more frequent than TBM in all asthma patients; 3) both tracheal abnormalities proved to be more represented in asthmatics with thyroid disorders, and particularly in female asthmatics with EDAC.

Prevalence of tracheobronchomalacia and excessive dynamic airway collapse in bronchial asthma of different severity

Background: Tracheobronchomalacia (TBM) is a pathologic condition in which softening of tracheal and bronchial cartilage causes the dynamic narrowing of transverse or sagittal diameters of tracheobronchial lumen; an excessive dynamic airway collapse (EDAC) may also be associated, with a substantial invagination of the posterior membrane of trachebronchial tree. The aim of this study was to assess the prevalence of both TBM and EDAC in a population of asthmatics with different degrees of disease severity compared to a reference group of subjects without any bronchial obstruction. Methods: A cohort of 202 asthmatics was investigated by means of a dynamic flexible videobronchoscopy: 74 mild persistent (MPA - age 18–68 ys; 35 males; mean FEV1 = 88.6% pred. ± 8.3 sd); 63 moderate (MA - age 21–71 ys; 30 males; mean FEV1 = 71.3% pred. ± 9.1 sd), 65 severe asthmatics (SA - age 33–70 ys; 25 males; mean FEV1 = 48.5% pred. ± 7.6 sd), and 62 non obstructed subjects (NO - age 18–71 ys; 38 males; mean FEV1 98.6% pred. ± 2.7 sd). TBM and EDAC were classified according to FEMOS classification. Results: TBM and EDAC were observed in only 1/62 subjects (both 1.61%) of NO group, while their prevalence was 2.70% and 6.75% in MPA group; 7.93% and 19.04% in MA group; 18.46% and 69.23% in SA group, respectively. The crude prevalence of thyroid disorders in the population was 12.9%. In particular, the prevalence of thyroid disorders was significantly higher in females than in men, but 54-fold higher in females than in men in the presence of EDAC. Conclusions: 1) The prevalence of both TBM and EDAC is directly related to age, gender (females), and asthma severity; 2) EDAC is much more frequent than TBM in all asthma patients; 3) both tracheal abnormalities proved to be more represented in asthmatics with thyroid disorders, and particularly in female asthmatics with EDAC.