Degree Of Airway Obstruction Research Articles

Relationship between Serum Vitamin D Levels and Asthma Control in Adult Patients

Asthma is a heterogeneous disease characterized by respiratory symptoms that vary both over time and in intensity, along with limited expiratory airflow. This heterogeneity is related to the patient's genetic and environmental phenotype. Vitamin D levels can affect the severity of asthma and the success of asthma treatment. Vitamin D can also influence the effectiveness of glucocorticoid therapy as an anti-inflammatory. This study aimed to determine the relationship between serum vitamin D levels and asthma control, severity, obstruction, and exacerbation levels. This research was a descriptive cross-sectional study on asthma patients at Wahidin Sudirohusodo Hospital and its network for the period October–December 2023. Each research subject had a venous blood sample taken and then checked vitamin D levels at the Hasanuddin University Teaching Hospital Research Laboratory. This research involved 72 research subjects. Most of the research subjects were female (61.1%), aged <45 years (52.8%), worked as housewives (29.2%), had overweight BMI (33.3%), and had a history of atopy (59.7%). The degree of airway obstruction in the study subjects was mostly mild (66.7%) and the degree of severity was intermittent, persistent, and the degree of exacerbation in the same sample (33.3%). The results of the study showed a relationship between vitamin D levels and nutritional status, history of atopy, degree of asthma control using the ACT questionnaire, degree of stable asthma, and exacerbations where p<0.05. Also, it is found that a weakly positive connection (R: 0.2–0.4) between vitamin D levels and ACT, FEV1, FEV/FVC. There is a relationship between vitamin D levels and nutritional status, history of atopy, degree of asthma control using the ACT questionnaire, degree of stable asthma, and exacerbations. There was a relationship between vitamin D levels and the degree of obstruction assessed by spirometry in this study.

Degree of Airway Obstruction and Contributing Factors, Exploring Potential Mismatches and Pitfalls

BACKGROUND: The study investigates asthma, a chronic inflammatory respiratory condition that poses diagnostic challenges due to its variable symptoms, highlighting the importance of accurate documentation and interpretation. It aims to explore the demographic and clinical profiles of asthma patients, particularly focusing on the relationships among airway obstruction severity, spirometric measurements, atopic history, and family history to reveal the complex factors influencing asthma. AIMS: Employing a retrospective descriptive-analytic design, the research analyzes medical records of 107 patients treated at the Outpatient Installation of the Lung Polyclinic at Wlingi General Hospital in Blitar Regency from 2021 to 2022. The analysis incorporates descriptive statistics for demographic and clinical variables alongside Spearman correlation tests. METHOD: Results indicate a significant prevalence of smoking history among asthma patients, with 22.4% being active smokers and 52.3% passive smokers; however, no significant correlation with asthma control was found. Environmental risk factors such as dust and cold air were common but did not consistently correlate with asthma exacerbations. Spirometric analysis revealed a significant relationship between airway obstruction severity and parameters like FEV1, FVC, FEV1/FVC, PEF, FEF 25, FEF 50, and FEF 75, emphasizing the link between airflow obstruction and reduced lung function. Furthermore, no significant correlation was observed between stable asthma diagnosis and atopic or family history, suggesting that asthma control is influenced by various complex factors. CONCLUSION: Our research reveals critical pitfalls in the current understanding of asthma, advocating for a comprehensive evaluation of all contributing factors to enhance diagnostic accuracy and treatment efficacy. Recognizing these complexities is essential for improving asthma management and ensuring better health outcomes for patients.

Relationship between Respiratory Microbiome and Systemic Inflammatory Markers in COPD: A Pilot Study.

The respiratory microbiome may influence the development and progression of COPD by modulating local immune and inflammatory events. We aimed to investigate whether relative changes in respiratory bacterial abundance are also associated with systemic inflammation, and explore their relationship with the main clinical COPD phenotypes. Multiplex analysis of inflammatory markers and transcript eosinophil-related markers were analyzed on peripheral blood in a cohort of stable COPD patients (n = 72). Respiratory microbiome composition was analyzed by 16S rRNA microbial sequencing on spontaneous sputum. Spearman correlations were applied to test the relationship between the microbiome composition and systemic inflammation. The concentration of the plasma IL-8 showed an inverted correlation with the relative abundance of 17 bacterial genera in the whole COPD cohort. COPD patients categorized as eosinophilic showed positive relationships with blood eosinophil markers and inversely correlated with the degree of airway obstruction and the number of exacerbations during the previous year. COPD patients categorized as frequent exacerbators were enriched with the bacterial genera Pseudomonas which, in turn, was positively associated with the severity of airflow limitation and the prior year's exacerbation history. The associative relationships of the sputum microbiome with the severity of the disease emphasize the relevance of the interaction between the respiratory microbiota and systemic inflammation.

Life-threatening airway obstruction by Riedel's thyroiditis: a rare presentation and diagnostic dilemma.

Riedel's thyroiditis is the rarest form of thyroiditis, occasionally resulting in rapid thyroid enlargement and potential tracheal obstruction. Here, we detail the case of an 81-year-old woman with a medical history including Hodgkin lymphoma, Hashimoto's thyroiditis, and multinodular goiter. She presented to the emergency room with stridor, cervical swelling, and breathing difficulties for over 2 days. CT scans revealed substantial thyroid enlargement causing significant glottal and tracheal compression, to a minimum tracheal diameter of 7 mm. Due to the severity of the compressive symptoms, orotracheal intubation and mechanical ventilation were deemed necessary. Surprisingly, despite the initial suspicion of malignancy given the rapid growth in the elderly, subsequent cytological and histological evaluations indicated a benign form of invasive fibrous thyroiditis - Riedel's thyroiditis. Although surgical intervention was advised, the patient declined and opted for endobronchial treatment with a prosthetic stent and subsequent treatment with systemic glucocorticoids. Following successful treatment, she was discharged within a week and resumed normal activities without respiratory distress. This case is noteworthy for its rapid benign mass growth, rare emergent presentation, and the patient's advanced age. The rapid enlargement of the thyroid gland in elderly patients poses a diagnostic challenge, stemming from the higher occurrence of aggressive thyroid carcinomas. Despite the clinical presentation, a comprehensive diagnostic workup, including fine-needle aspiration and core-needle biopsy, is crucial for accurately distinguishing between benign and malignant causes of thyroid nodule enlargement. This case report illustrates diverse treatment options for Riedel's thyroiditis, and the importance of individualized treatment plans based on the degree of airway obstruction, patient preferences, and response to initial interventions. Clinicians should contemplate the inclusion of glucocorticoids in the therapeutic regimen for Riedel's thyroiditis, particularly in cases where surgical intervention is not feasible or declined by the patient.

Role of exhaled carbon monoxide in assessment of chronic obstructive airway disease severity

BackgroundChronic obstructive pulmonary disease (COPD) is a critical public health issue. Spirometric measurements are used to diagnose chronic obstructive lung disease, as per the guidelines of the GOLD initiative. Post-bronchodilator forced expiratory volume in 1 s (FEV1) is a predictor of mortality from COPD and helps to classify the disease’s severity. Smoking contributes to the high levels of exhaled CO. Evidence suggests that the exhaled CO level in COPD patients varies with degree of blockage and can be used to assess treatment response. Estimating the exhaled CO level can help assess airway inflammation and severity of airflow obstruction in individuals with COPD.AimEvaluate role of exhaled CO in assessment of severity of COPD.Materials and methodsThis cross-sectional study included 132 patients who visited the outpatient clinics or were admitted to the Chest Department, Kasr Alainy Hospital, Faculty of Medicine, Cairo University. The study participants were divided into three groups: group 1 nonsmoker healthy control, group 2 smoker non-COPD, and group 3 smoker COPD which further divided according to GOLD 2023 into mild, moderate, and severe COPD. The smoking status, exhaled CO, and spirometry test including FEV1/FVC and FEV1 were measured for each patient.ResultsExhaled CO was significantly increased in the smoker group (mean 9.69, SD 3.11) compared to the nonsmoker group (mean 2.19, SD 0.98) with p-value < 0.001. Exhaled CO was also statistically significantly higher in the smoker COPD group (mean 10.45, SD 3.03) compared to the smoker non-COPD group (mean 7.05, SD 1.56) with p-value < 0.001. Although exhaled CO was increased in the severe COPD group compared to the mild and moderate group, there is no statistically significant difference between them.ConclusionExhaled CO is a fast, sensitive, noninvasive, and well-established method test that can be used to identify smokers from nonsmokers with 98.9% sensitivity at 4.5 cutoff value. Also, exhaled CO levels in COPD patients vary with different degrees of airway obstruction.

Low levels of microRNA-21 in neutrophil-derived exosomes may contribute to airway smooth muscle hyperproliferation in horses with severe asthma.

Neutrophilic inflammation is associated with the degree of airway obstruction in severe equine asthma (SEA), but the contribution of these leukocytes to bronchial remodeling remains ill defined. Neutrophils could cause structural alterations of the airways by the release of exosomes, a type of cell-derived nanoparticles that can modify the biology of local and distant cells. Neutrophil-derived exosomes have been shown to increase airway smooth muscle (ASM) cell proliferation in humans and horses. Therefore, this study aimed to identify neutrophil exosomal microRNAs (miRs) implicated in the regulation of ASM biology in SEA. 6 horses with SEA and 6 healthy controls. The expression of selected miRs in exosomes from peripheral neutrophils was studied by quantitative PCR. The effects of miR-21 transfection in ASM cells were evaluated by gene expression analysis and proliferation studies. The miR-21 was downregulated in neutrophil exosomes from SEA horses, and it attenuated the proliferation of ASM cells stimulated with lipopolysaccharide. The lower level of miR-21 in neutrophil-derived exosomes could contribute to ASM hyperproliferation, which could, in turn, promote the thickening of the bronchial wall in SEA.

DEVELOPMENT AND EXPERIMENTAL REPLICATION OF THE MODEL OF PARTIAL TRACHEAL STENOSIS IN YOUNG SEXUALLY IMMATURE WHITE RATS

This work is devoted to the development of two models of experimental replication of stenosis in the upper part of the trachea with different degrees of compression of this organ in sexually immature (one-month-old) white Wistar rats. Considering the different degrees of laryngomalacia in newborns, we developed two models: with a lower (20%) and higher (30%) degree of airway obstruction. In the first version of modeling, this was achieved by applying the ligature at the level between 1 and 2, or 2 and 3 cartilaginous semi-rings of the trachea, in the second – by applying it directly to the 2 cartilaginous semi-ring of the trachea. Both models were performed to study the state of the organism in conditions of hypoxic hypoxia in laboratory animals.&#x0D; The developed modeling methods differ from each other not only in the place of application of the compressing ligature, but also in the mechanism of compression development. In the case of applying a ligature to the intercartilaginous ligaments (20% stenosis), soft tissues are compressed and both semi-rings of the trachea are brought together. In the second variant of modeling, the pathophysiological mechanism of stenosis consists not only in the compression of the cartilaginous semi-ring of the trachea, but also in the process of invagination of the dorsal, i.e., elastic part of the trachea into the lumen of this hollow organ. As a result, a more intense variant of tracheal stenosis in experimental animals is achieved. Another important component of the developed models is the possibility at different stages of the experiment to eliminate the compressive effect of the ligature on the trachea and to study the state of various organs and tissues of animals in the early or delayed post-hypoxic periods. This leads to a significant increase in the value or efficiency of conducting this kind of experiments, taking into account the fact that hypoxic and posthypoxic periods can be studied on the same experimental animal. Both exotracheal modeling methods are fundamentally different from the endotracheal variant of experimentally reproducing stenosis. With the latter, pathological structural and functional disorders of the cells of the mucous membrane, the connective apparatus of the trachea and smooth muscle elements, the development of inflammation, and the progression of irreversible changes in the cellular and organ structures of the trachea are observed. In addition, simulation of the specified variant of stenosis requires the use of expensive equipment – a laryngoscope and some other modern technologies. Both variants of exotracheal modeling of tracheal stenosis, proposed by us, are devoid of all these shortcomings. At the same time, they enable to achieve the same degree of stenosis of this organ in animals as with the endotracheal variant.

Study of Electrocardiographic Changes and Spirometry Findings in Chronic Obstructive Lung Disease

Introduction: Chronic Obstructive Pulmonary Disease is one of the top three causes of death worldwide and patients have to do pulmonary function test by spirometry to diagnose and to evaluate the severity. Electrocardiogram abnormalities have been found uniformly increasing with the severity by Global Initiative for Obstructive Lung Disease stages.&#x0D; Aims: To know the role of Electrocardiogram in the evaluation of severity of Chronic Obstructive Lung Disease.&#x0D; Methods: This was conducted in the department of Internal Medicine of Lumbini Medical College Teaching hospital from December 2021 to June 2022. The Chronic Obstructive Pulmonary Lung Disease was established with history, examination and spirometry along with Electrocardiogram.&#x0D; Results: Among 72 patients included 40 (55.56%) were in mild to moderate stage and 32 (44.44%) were in severe stage. The mean Force Expiratory Volume in one Second/Force Vital Capacity of severe stage was 38.59± 6.9 and 66.32±7.37 in mild to moderate stages. The electrocardiographic abnormalities like right atrial enlargement (P –pulmonale), right ventricular hypertrophy, complete right bundle branch block, low voltage in limbs, right axis deviation, sinus tachycardia and supraventricular tachycardia were seen in severe stage with statistical significance (p&lt;0.05). Whereas left axis deviation and premature atrial contraction were found in mild to moderate disease and was statistically not significant.Increased percentage of normal electrocardiogram was found in mild or moderate than severe stage with statistical significance. So it is inversely related with the severity of disease.&#x0D; Conclusion: The relationship between Electrocardiogram findings and degree of airway obstruction was found to be highly significant. So, Electrocardiogram can be used as a surrogate investigation to evaluate the severity of Chronic Obstructive Pulmonary Disease.

Profile of tracheotomy patients at Dr. Soetomo General Academic Hospital, Surabaya, Indonesia

Link of Video Abstract: https://youtu.be/YsAWA4NoiPw Background: The tracheotomy profile, including the degree of airway obstruction, underlying disease, following procedures, and complications, is important. The latest data regarding the profile of tracheotomy patients at ORL-HNS Dr. Soetomo General Academic Hospital has not been published yet. This research to describe the profile of tracheotomy patients at ORL-HNS Department Dr. Soetomo General Academic Hospital, Surabaya Methods: A retrospective descriptive study with total sampling covering tracheotomy patients in 2015-1019 at ORL-HNS Department Dr. Soetomo General Academic Hospital, Surabaya. Data were analyzed using SPSS version 23.0 for Windows. Result: There were 590 tracheotomy patients consisting of 452 men and 138 women, with the largest age group of 51-60 years with 167 patients (28.31%). Jackson 1 in 306 (51.86%), impending upper airway obstruction in 209 (35.42%), Jackson 2 in 38 (6.44%), Jackson 3 in 31 patients (5.25%), Jackson 4 in 3 patients (0.51%). The diagnosis includes tumors (87.29%), especially laryngeal carcinoma, then infection, neurological, trauma, and others. Procedures following tracheotomy are biopsies (11.19%), tumor surgery, and abscess incision and drainage. Complications were found in 65 patients (11.02%). Subcutaneous emphysema in 45 patients (7.63%), followed by bleeding and pneumothorax with subcutaneous emphysema (1.02%), 5 died (0.85%). Subcutaneous emphysema and bleeding in 2 patients (0.34%). Pneumothorax without subcutaneous emphysema in 1 patient (0.17%). Conclusions: There were more male tracheotomy patients than female. The age group of most patients was 51-60 years. The majority were Jackson 1, and most were diagnosed with tumors. A biopsy is the most following procedure in tracheotomy. Complications were found in 11.02% of tracheotomy patients; the most common is subcutaneous emphysema.

Detection of Small Airway Dysfunction in Asthmatic Patients by Spirometry and Impulse Oscillometry System

Background: There is no gold standard in diagnosing SAD. Indicators of SAD are considered: (a) a value <65% of predicted values of two of three measures, FEF25-75, FEF50 e FEF75 (FEF+); (b) a value of FEV3/FEV6 < LLN (FEV3/FEV6+); (c) an IOS value of R5-R20 >0.07 kPa·s·L−1 (R5-R20+). Aim and Objectives: The aim of the study was to ascertain, in asthmatic patients, whether spirometry and IOS indicators agree in detecting SAD. We also assessed the relationship between spirometry and IOS indicators and clinical features of asthma. Methods: We prospectively recruited adult asthmatic patients. Anthropometric and clinical characteristics were recorded. All patients performed spirometry and IOS tests. Results: We enrolled 301 asthmatic patients (179 females; mean age 50 ± 16 years) with normal to moderately severe degree of airway obstruction; 91% were non-smokers, 74% were atopic, 28% had an exacerbation in the previous year, and 18% had a poor asthma control by ACT. SAD was diagnosed in 62% of patients through FEF+, in 40% through FEV3/FEV6+ and in 41% through R5-R20+. κ values were 0.49 between FEF+ and FEV3/FEV6+, 0.20 between FEF+ and R5-R20+, 0.07 between FEV3/FEV6+ and R5-R20+. R5-R20+ but not FEF+ and FEV3/FEV6+ was significantly associated with ACT score (p < 0.05). Conclusions: Our study shows that in mild to moderately severe asthmatic patients, spirometry and IOS indicators are complementary in diagnosing SAD. Additionally, IOS indicator, but not spirometry ones, was related to asthma control.

An extract from the culture of a thermophilic &lt;i&gt;Staphylococcus aureus&lt;/i&gt; strain suppresses allergic inflammation in the airways &lt;i&gt;in vivo&lt;/i&gt; and degranulation of mast cells and basophils &lt;i&gt;in vitro&lt;/i&gt;

Aim. To study the anti-allergic effects of ruzam, an extract from the culture of a thermophilic Staphylococcus aureus strain, in an in vivo model of asthma and its influence on degranulation of mast cells and basophils in vitro.Materials and methods. Allergic asthma in guinea pigs was reproduced by two intraperitoneal injections of ovalbumin followed by a series of inhalations of this antigen for 1.5 months. Ruzam (6 μg / kg) or a reference drug (sodium cromoglycate, 3 mg / kg) was administered daily via a nebulizer during the last 6 days of immunization. One day after completion of inhalations with ovalbumin and compared drugs, changes in the airways were assessed using cytological, morphometric, and histologic methods. Rabbit blood basophils and rat peritoneal mast cells were used to determine the effect of ruzam on IgE-independent degranulation induced by the compound 48 / 80 in vitro. The effect of ruzam was compared with that of hydrocortisone hemisuccinate. Basophils from the blood of ovalbumin-sensitized guinea pigs were used to evaluate the effect of the drug on IgE-dependent degranulation induced by ovalbumin. Granules of mast cells and basophils were detected by alcian blue staining to calculate the degranulation index.Results. In the asthma model, ruzam reduced the degree of airway obstruction by increasing the bronchoalveolar lavage volume returned and suppressed neutrophilic and eosinophilic inflammation, while mobilizing other effector cells of the anti-pathogen immunity (lymphocytes and macrophages). Ruzam has proven to have a stronger anti-allergic effect than sodium cromoglycate by several parameters. At concentrations of 8.4–840 μg / ml, ruzam inhibited degranulation of mast cells and basophils, induced by the compound 48 / 80, equally to hydrocortisone hemisuccinate (10–3 M). At concentrations of 280 and 420 μg / ml, ruzam dose-dependently inhibited ovalbumin-induced degranulation of basophils in sensitized guinea pigs.Conclusion. The anti-allergic effect of ruzam was confirmed in test systems in vivo and in vitro. We speculate here that the TLR2 signaling pathway may be involved in biological and pharmacological effects of this drug.

Risk factors for difficult mask ventilation and difficult intubation among patients undergoing pharyngeal and laryngeal surgery

BackgroundThe prediction of difficult mask ventilation (DMV) and difficult intubation (DI) are key questions in anesthesia fields. DMV or DI related to pharyngeal and laryngeal diseases are a special kind of difficult airways. However, there is a lack of risk factors for prediction. MethodsThis study retrospectively collected data from patients who were admitted to the Eye & ENT Hospital of Fudan University from May 2014 to May 2018 and underwent laryngopharyngeal surgery under general anesthesia. ResultsA total of 126 patients were included. Twenty patients suffered from DMV. Preoperative laryngeal obstruction classification (OR = 7.46, 95% CI: 2.56–21.76, P < 0.001) and airway patency after sevoflurane inhalation (OR = 10.96, 95% CI: 2.70–44.43, p = 0.001) were independently associated with DMV. Seventy-six patients could be intubated at the first attempt. Preoperative laryngeal obstruction grade (OR = 0.28, 95% CI: 0.13–0.62, P = 0.002), neoplasm size (OR = 0.43, 95% CI: 0.22–0.82, P = 0.011), and airway patency after sevoflurane inhalation (OR = 0.14, 95% CI: 0.05–0.36, P < 0.001) were independently associated with first-attempt successful intubation. ConclusionAmong patients with pharyngeal and laryngeal diseases, the degree of laryngeal obstruction before the operation and the degree of airway obstruction after inhaling sevoflurane are the risk factors of DMV. The degree of laryngeal obstruction before the operation, airway obstruction after inhaling sevoflurane, and the neoplasm size are the risk factors of DI.

Wpływ zaburzeń składu ciała na jakość życia pacjentów z przewlekłą obturacyjną chorobą płuc

Introduction. COPD is a chronic inflammatory disease that constitutes a significant public health problem. It is characterized by not fully reversible, progressive limitation of airflow through the airways. In addition to the harmful pulmonary effects, COPD manifests itself with complications in other body systems, including body composition disorders, which adversely affects patients’ quality of life and prognosis. The objective of this study was to assess the quality of life of patients with COPD and to assess the factors that will affect its deterioration. Material and methods. The study included 37 patients of the University Hospital at the Jagiellonian University Medical College in Kraków at 8 Skawińska Street, who were diagnosed with COPD according to the GOLD guidelines. In the study group, a personal questionnaire was conducted, anthropometric data was collected, i.e. the Quetelet index was calculated, thigh circumference and skin folds were measured, and the subjective assessment of the quality of life was examined using the SGRQ-C questionnaire and the CAT Test. Results. Based on the analysis of the collected materials, it was shown that the average assessment of the quality of life in the study population was at a low level of 61.8 points on the SGRQ-C scale. There was a large variation in the assessment of HRQoL depending on the stage of the disease. The best result, amounting to 23.0 points, was achieved by patients in stage 1, and the worst – 81.6 points. – patients in stage 4 according to GOLD guidelines. Among the main determinants of the quality of life in the study group, in addition to the degree of airway obstruction, there were: high intensity of clinical symptoms, such as cough, shortness of breath or expectoration of secretions, low body weight and the number of comorbidities. Conclusions. It has been shown that the loss of fat-free body mass and systemic complications are factors that significantly reduce the quality of life, and patients with fewer comorbidities and with increased BMI score better on the SGRQ-C scale. It has been proven that the progression of the disease contributes to the exclusion of patients from active social life and causes many mental problems. It was established that patients with COPD should be covered by multidisciplinary care and a special training program in order to prevent or delay the onset of systemic complications, which significantly worsen the patients’ quality of life

Airwave oscillometry and spirometry in children with asthma or wheeze

Objective Lung function testing is used in diagnosing asthma and assessing asthma control. Spirometry is most commonly used, but younger children can find performing this test challenging. Non-volitional tests such as airwave oscillometry (AOS) may be helpful in that population. We compared the success of spirometry and AOS in assessing bronchodilator responsiveness in children. Methods AOS was conducted alongside routine lung function testing. Resistance at 5 Hz (R5), the difference between the resistance at 5 and 20 Hz (R5-20) and the area under the reactance curve (AX) were assessed. Patients between 5 and 16 years old attending clinic with wheeze or asthma were assessed. Patients performed AOS, followed by spirometry and were then given 400 µg salbutamol; the tests were repeated 15 minutes later. Results Lung function testing was performed in 47 children of whom 46 (98%) and 32 (68%) performed acceptable baseline oscillometry and spirometry, respectively (p < 0.001). Children unable to perform acceptable spirometry were younger (7.35, range: 5.4–10.3 years) than those who could (10.4, range: 5.5–16.9 years), p < 0.001. The baseline z-scores of AOS R5 correlated with FEV1 (r = 0.499, p = 0.004), FEF75 (r = 0.617, p < 0.001), and FEV1/FVC (r = 0.618, p < 0.001). There was a positive bronchodilator response assessed by spirometry (change in FEV1 ≥ 12%) in eight children which corresponded to a change in R5 of 36% (range: 30%–50%) and a change in X5 of 39% (range: 15%–54%). Conclusions Oscillometry is a useful adjunct to spirometry in assessing young asthmatic children’s lung function. The degree of airway obstruction, however, might affect the comparability of the results of the two techniques.

ENDOBRONCHIAL LIPOMA: SUCCESSFUL TREATMENT WITH ELECTROCAUTERY SNARING AND CRYOTHERAPY

ENDOBRONCHIAL LIPOMA: SUCCESSFUL TREATMENT WITH ELECTROCAUTERY SNARING AND CRYOTHERAPY

The affection of plasma exosomes on airway obstruction and endothelial function in OSA patients.

This study aimed to investigate the effects on airway obstruction and endothelial function by extracting and analyzing plasma exosomes with OSA patients. For this purpose, the clinical data and imaging data of 60 patients with OSA were retrospectively analyzed, who were admitted to the Central Hospital from Apr．2018 to Jul．2021．By using an electron microscope for the observation of exosomes, the degree of airway obstruction was compared by pulmonary function instrument, and HE staining was performed to analyze them. The results showed that the diameter of exosome particles was concentrated at 80.5 ~ 158.6 nm, the diameter of OSA exosomes was concentrated at about 121.9 nm, and the diameter of exosomes in the control group was concentrated at about 145.0 nm. Compared with the patients in the control group, the level of miRNA-33b-3p in the control group was significantly different (P < 0.05). The content of exosomal miRNA-33b-3p in OSA patients decreased significantly, and the corresponding airway obstruction increased. The results of HE staining showed that there were obvious atherosclerotic plaques in the arterial endothelium of the OSA group, and the atherosclerotic plaques were significantly reduced after miRNA-33b-3p injection (P < 0.05). In general, OSA patients can regulate airway obstruction and endothelial cell function by controlling the expression of Plasma exosomes and miRNA-33b-3p, resulting in increased airway obstruction and endothelial cell atherosclerosis.

Correlation of Rhinomanometry Measurement and True Lateral Radiography towards the Degree of Upper Airway Obstruction in Patients with Adenoid Hypertrophy

Background: Adenoid hypertrophy is one of the most common disorders in children which may lead to upper airway obstruction. Various modalities to measure airway obstruction in patients with adenoid hypertrophy, including true lateral radiographs, nasoendoscopy, and rhinomanometry are available; however, the results from different studies are still controversial. This study aimed to determine the relationship between the results of rhinomanometry and the true lateral radiographs to the degree of upper airway obstruction in patients with adenoid hypertrophy. Methods: This cross-sectional study included a total of 33 patients with adenoid hypertrophy aged 5-18 years using a purposive sampling technique. Patients diagnosed with adenoid hypertrophy were subjected to a true lateral examination using lateral neck radiographs to measure the degree of airway obstruction. Subsequently, an active anterior rhinomanometry was performed by measuring resistance and nasal airflow and then measuring the degree of airway obstruction. Data analysis was done using Chi-Square test. Results: The rhinomanometric nasal resistance in the inspiratory phase was 0.4159 ± 0.15201 Pa/cm3/s and 0.3694 ± 0.13717 Pa/cm3/s in the expiration phase. The results showed a significant relationship between the true lateral radiographs and both nasal inspiratory (p=0.005) and expiratory resistance (p=0.004). Similarly, the relationship between the true lateral radiographs and nasal airflow on both inspiratory and expiratory rhinomanometry was significant (p&lt;0.05). Conclusion: Rhinomanometric measurements can be used as an additional objective examination in assessing the degree of upper airway obstruction in patients with adenoid hypertrophy prior to surgery.

Increased Vascular Endothelial Growth Factor Serum Level and the Role of +936C/T Gene Polymorphism in Chronic Obstructive Pulmonary Disease.

Background and Objectives: Chronic obstructive pulmonary disease (COPD) represents a debilitating disease, with rising morbidity and mortality. Vascular endothelial growth factor (VEGF) plays a major role in angiogenesis, vascular permeability, and airway remodeling. The purpose of this study was to investigate the relationship between VEGF serum levels and VEGF +936 C/T gene polymorphism (rs3025039) with COPD, for the first time in a Romanian population. Materials and Methods: In total, 120 participants from Transylvania were included in this case-control study. Serum levels of VEGF were determined using an enzyme-linked immune-sorbent assay and rs3025039 was investigated by high molecular weight genomic deoxyribonucleic acid (DNA). Spirometric values, arterial blood gas analysis, and the Six Minute Walk Test (6MWT) outcome were also determined. Results: The serum level of VEGF was higher in the COPD group versus controls (p < 0.001), with a positive correlation with the 6MWT outcome. No significant difference was observed in the VEGF serum levels between VEGF +936C/T genotypes. There was no difference in the VEGF +936C/T genotype between COPD patients and healthy subjects (chi2 test p = 0.92, OR = 1.04, 95%CI = 0.41–2.62), but the presence of the T allele was significantly linked to the presence of COPD (chi2 test p = 0.02, OR = 2.36, 95%CI = 1.12–4.97). Conclusions: Higher VEGF serum levels were found in moderate and severe COPD and were positively correlated with the distance in the 6MWT. No significant difference was found between CC, CT, and TT genotypes of rs3025039 and the presence of COPD. The presence of the T allele was found to be linked to COPD and also to the degree of airway obstruction.

Inflammatory markers in exhaled breath condensate in bronchial asthma

Chronic respiratory diseases are among the most common non- infection diseases. In particular, it is bronchial asthma (BA), characterized by bronchial hyperreactivity and varying degrees of airway obstruction that is the cause of morbidity and mortality. The methods available for the information about the presence of inflammation in the airways, such as bronchoscopy and bronchial biopsy to be obtained have currently been invasive and difficult in everyday clinical practice, especially for children and seriously ill patients. In this regard, recently there has been an increase in the development of non-invasive methods for diagnosing the respiratory system, being comfortable and painless for trial subjects, especially children, also providing the inflammatory process control in the lungs, the severity assessment and monitoring the treatment process. The exhaled breath condensate (EBC) is of great attention, which is a source of various biomolecules, including nitric oxide (NO), leukotrienes, 8-isoprostane, prostaglandins, etc., being locally or systemically associated with disease processes in the body. Of particular interest is the presence of cytokines in EBC, namely the specific proteins produced by various cells of the body that play a key role in inflammatory processes in AD and provide cell communication (cytokine network). Thereby, it becomes possible for the severity and control level of childhood bronchial asthma using only the EBC analysis to be assessed. In addition, the non-invasiveness of this method allows it to be reused for monitoring lung diseases of even the smallest patients, including infants. Thus, the field of metabolite analysis in EBC has been developing and, in the near future, the given method is likely to be the most common for diagnosing the respiratory system diseases in both children and adults.

Quantification of airway conductance from noninvasive ventilatory drive in patients with sleep apnea.

Upper airway conductance, the ratio of inspiratory airflow to inspiratory effort, quantifies the degree of airway obstruction in hypopneas observed in sleep apnea. We evaluated the ratio of ventilation to noninvasive ventilatory drive as a surrogate of conductance. Furthermore, we developed and tested a refinement of noninvasive drive to incorporate the interactions of inspiratory flow, pressure, and drive to better estimate conductance. Hypopneas were compiled from existing polysomnography studies with esophageal catheterization in 18 patients with known or suspected sleep apnea, totaling 1,517 hypopneas during NREM sleep. For each hypopnea, reference standard conductance was calculated as the ratio of peak inspiratory flow to esophageal pressure change during inspiration. Ventilatory drive was calculated using the algorithm developed by Terrill et al. and then mathematically modified according to the presence or absence of flow limitation to noninvasively estimate esophageal pressure. The ratio of ventilation to ventilatory drive and the ratio of peak inspiratory flow to estimated esophageal pressure were each compared with the reference standard for all hypopneas and for median values from individual patients. Hypopnea ventilation to drive ratios were of limited correlation with the reference standard (R2 = 0.17, individual hypopneas; R2 = 0.03, median patient values). Modification of drive to estimated pressure yielded estimated conductance, which strongly correlated with reference standard conductance (R2 = 0.49, individual hypopneas; R2 = 0.77, median patient values). We conclude that the severity of airway obstruction during hypopneas may be estimated from noninvasive drive by accounting for mechanical effects of flow on pressure. NEW & NOTEWORTHY Classification of hypopneas as obstructive (decreased upper airway conductance) or central (decreased inspiratory flow commensurate with decreased effort) is complicated by the requirement of invasive methods, such as esophageal manometry. Here, we demonstrate that using a few esophageal pressure measurements to account for the interactions between inspiratory flow, pressure, and noninvasive ventilatory drive allows estimation of upper airway conductance. Further studies may use these findings to quantify airway obstruction completely noninvasively.