Inspiratory Dyspnea Research Articles

CHARGE syndrome in a neonate

A female infant, aged 11 days, was admitted due to dyspnea for 11 days after birth, with the main clinical manifestations of inspiratory dyspnea, feeding difficulties, and unusual facies (micrognathia, high palatal arch, cleft palate, glossoptosis, and oblique mouth to the right), and the preliminary diagnosis was Pierre-Robin syndrome. There was no marked improvement after treatment such as ventilator-assisted ventilation, nutrition, and surgical ligation of patent ductus arteriosus. Whole-exome sequencing of the family showed a heterozygous mutation of c.3082A>G (p.Ile1028 Val) in the CHD7 gene, which was a pathogenic mutation of CHARGE syndrome. The neonate was ultimately diagnosed with CHARGE syndrome, and the family decided to withdraw treatment due to concerns about poor prognosis. This article reports a case of CHARGE syndrome caused by a mutation in the CHD7 gene and the multidisciplinary diagnosis and treatment of this disease, in order to provide help for early disease identification and guide clinical decision-making.

Effects of Inspiratory Muscle Training in People with Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis.

This study aimed to investigate the effects of inspiratory muscle training (IMT) on inspiratory muscle strength, dyspnea, and quality of life (QOL) in COPD patients. A comprehensive search was undertaken on the Web of Science, Scopus, Embase, Cochrane, and PubMed databases, encompassing data published up to 31 March 2024. A meta-analysis was subsequently conducted to quantify the standardized mean difference (SMD) and 95% confidence interval (CI) for the effects of IMT in COPD patients. Sixteen studies met the inclusion criteria. IMT significantly improved inspiratory muscle strength (SMD, 0.86, p < 0.00001), dyspnea (SMD = -0.50, p < 0.00001), and QOL (SMD = 0.48, p = 0.0006). Subgroup analysis showed that <60% maximal inspiratory muscle pressure (PImax) IMT (inspiratory muscle strength, SMD = 1.22, p = 0.005; dyspnea, SMD = -0.92, p < 0.0001), IMT conducted for ≤20 min (inspiratory muscle strength, SMD = 0.97, p = 0.008; dyspnea, SMD = -0.63, p = 0.007; QOL, SMD = 1.66, p = 0.007), and IMT conducted >3 times per week (inspiratory muscle strength, SMD = 1.06, p < 0.00001; dyspnea, SMD = -0.54, p < 0.00001; QOL, SMD = 0.48, p = 0.0009) had greater effects. This meta-analysis provides clinicians with evidence supporting the recommendation that COPD patients engage in IMT at <60% PImax for more than 3 times per week, with each session lasting no more than 20 min, to improve inspiratory muscle strength, dyspnea, and QOL.

Epiglottic retraction is useful in diagnosis of exercise-induced laryngeal obstruction

Background Exercise-induced laryngeal obstruction (EILO) is distinguished as upper airway obstruction accompanied by inspiratory dyspnoea and stridor during highly intensive exercises. Epiglottic retraction in the diagnosis of EILO has not been sufficiently explored. Aims/objectives We highlight the importance of epiglottic retraction in patients with EILO by evaluation by several diagnostic methods for EILO. Consideration of epiglottic retraction may be important for accurate diagnosis of EILO. Results Epiglottic retraction could be observed in three patients by laryngoscopy during heavy breathing and in two patients by continuous laryngoscopy during exercise. Stridor occurred by the forward prolapse of the arytenoids, but not by epiglottic retraction. In comparison with three athletes from other sports, lung volume was significantly greater in four swimmers although it was not different related to depending on the existence of epiglottic retraction. Conclusions and significance Laryngoscopy during heavy breathing is suggested to be useful to detect the epiglottic retraction, which might be overlooked if only continuous laryngoscopy during exercise is used. Epiglottic retraction was not rare in Japanese swimmers’ exercise-induced laryngeal obstruction in our cohort and it might be related to the greater lung volume.

Low-Temperature Plasma Radiofrequency Ablation for Congenital Epiglottic Cysts.

Objectives: Congenital epiglottic cysts are rare disorders of the larynx with symptoms such as laryngeal stridor and inspiratory dyspnea and are life-threatening in severe cases. This study aimed to investigate the usefulness of low-temperature plasma radiofrequency ablation for congenital epiglottic cysts and provide a reference for clinicians to develop treatment options. Methods: The clinical data of children (n = 7, 4 males and 3 females) with congenital epiglottic cysts, who were admitted to the Second Affiliated Hospital of Wenzhou Medical University and Yuying Children's Hospital from March 2018 to March 2023, were analyzed retrospectively. Following preoperative examinations, all patients underwent low-temperature plasma radiofrequency ablation under general anesthesia, and the curative effect was evaluated. Following surgery, regular patient follow-up examinations were conducted to monitor recurrence. Results: The age at the time of operation ranged from 1 day to 99 days, with an average of 37.57 ± 35.01 days. The surgical procedure was successfully completed in all the children; dyspnea disappeared and no surgical complications were observed. In addition, during the postoperative follow-up period of 6 months to 5 years, recurrence was not observed. Conclusions: Low-temperature plasma radiofrequency ablation is a safe and effective procedure for treating congenital epiglottic cysts and deserves clinical application and promotion.

Post traumatic disruption of the trachea: About three adolescents’ cases with literature review

Introduction: Tracheal lesions are rare but potentially serious and can cause significant morbidity and mortality. Early diagnosis is essential for optimal management. We report 3 cases of adolescents who were victims of external cervicothoracic trauma. All three patients presented with neck pain, inspiratory dyspnea, and polypnea with subcutaneous cervical emphysema in clinical examination. Nasofibroscopy showed normal appearance and mobility of the vocal cords. Cervical and thoracic CT scan with contrast enhancement was carried out in all our patients that showed tracheal breach in various localizations. The first patient underwent surgical exploration of the penetrating wound in the cervical area. The surgical exploration revealed no damage to the anterior and lateral faces of the trachea. In this case, a sagittal discontinuity on the posterior wall of the trachea was revealed using a rigid bronchoscope. All patients were admitted to the intensive care unit for monitoring and follow-up for 24 to 72 hours and received antibiotics and corticosteroids for 10 days. The patient's symptoms improved throughout the evolution. Conclusion: Early diagnosis is necessary to prevent complications. The gold standard for diagnosis is bronchoscopy. Conservative management is recently considered the best therapeutic choice which also allows the morbidity of surgical treatment to be avoided

양측성 성대 마비의 수술적 치료

Bilateral vocal fold paralysis (BVFP) is characterized by the complete or partial inability to move the vocal folds. BVFP presents with inspiratory dyspnea resulting from airway narrowing at the glottic level, where both vocal folds are positioned paramedian. Historically, iatrogenic damage to the recurrent laryngeal nerves has been identified as a common cause of BVFP. This condition is often critical, necessitating immediate treatment such as intubation for short-term relief, and potentially surgical procedures like tracheostomy to address the compromised airway. The primary objective in managing BVFP is to alleviate dyspnea in affected patients. Treatment options include tracheostomy, arytenoidectomy, laterofixation, and cordotomy, each with varying degrees of effectiveness in improving airway function, though voice quality may be negatively impacted or remain unchanged. The diversity in study methodologies, the absence of large-scale controlled randomized trials, and the challenge of distinguishing BVFP from posterior glottic stenosis hinder the ability to definitively determine the superiority of one treatment approach over another.

Sex differences of post-Covid patients undergoing outpatient pulmonary rehabilitation

BackgroundFollowing years of pandemic severe acute respiratory syndrome coronavirus 2 infections labelled Covid-19, long lasting impairment summarized as post-Covid syndrome (PCS) challenges worldwide healthcare. Patients benefit from rehabilitation programs, but sex specific aspects of improvement remain little understood. The aim of the study was to assess whether women and men differ in response to outpatient pulmonary rehabilitation for PCS.Methods263 (54.4% female) patients partaking in outpatient pulmonary rehabilitation (OPR) due to PCS between March 2020 and July 2022 were included in a prospective observational cohort study. Outcomes were assessed at baseline and before discharge from OPR and included six-minute walking distance (6MWD), 1-second forced expiratory volume (FEV1), diffusion capacity for carbon monoxide, maximal inspiratory pressure (MIP), dyspnea (medical research council scale), and post-Covid functional status scale (PCFS). Sexspecific changes in outcomes following OPR were assessed by linear mixed model and presented as mean differences (MD) with 95% confidence intervals. Linear regression was applied to test whether 6MWD correlates with PCFS and the minimal clinically important difference (MCID) in 6MWD regarding an improvement of at least one point in PCFS was computed with logistic regression.ResultsSignificant improvement throughout OPR was observed for all outcomes (all p < 0.0001). Despite less severe Covid-19 infections, PCFS scores remained higher in females after OPR (p = 0.004) and only 19.4% of women compared to 38.5% of men achieved remission of functional impairment. At baseline as well as after OPR, females showed higher symptom load compared to men in dyspnea (p = 0.0027) and scored lower in FEV1 (p = 0.009) and MIP (p = 0.0006) assessment. Performance in 6MWD was comparable between men and women. An increase of 35 m in 6MWD was computed as minimal clinically important difference to improve functional impairment.ConclusionBoth subjective symptoms such as fatigue and dyspnea and objective impairment in performance in pulmonary function were more frequently observed among women. Despite improvement throughout OPR in both women and men, the sex-gap in symptom load could not be closed as women less often achieved remission from functional impairment due to PCS. Intensified treatment of these symptoms should be considered in women undergoing rehabilitation for PCS.

Exercise – induced laryngeal obstruction (EILO) – challenge of sports medicine

Exercise induced laryngeal obstruction (EILO) is a paroxysmal paradoxical obstruction of the larynx during inspiration. This condition manifests as attacks of inspiratory dyspnea with stridor at the peak of physical exertion, when the respiratory rate is close to maximum. EILO primarily affects young athletes. This dysfunction requires differentiation from bronchial asthma, which also manifests itself as paroxysmal dyspnea. Endoscopic visualization of the larynx during a seizure provoked by intense exercise is necessary for EILO diagnosis. This condition may have a detrimental effect on the of professional athletes’ careers. Numerous therapeutic methods have been proposed for the treatment of EILO, from pulmonary rehabilitation, through injection of botulinum toxin into the muscles of the larynx, to surgical procedures widening the lumen of this organ. There is no evidence that inhalation is effective in the traatmant of this condition. A rational protocol for the management of a patient diagnosed with EILO is essential. Effective differentiation with bronchial asthma will help reduce the overuse of inhaled drugs by athletes.

Analysis of a Case of Airway Hemangioma in a 1-Month-Old Infant with Dyspnea – A Secondary Publication

Infantile hemangiomas are the most common benign tumors of infancy. However, hemangiomas located in the respiratory tract are rare and could cause life-threatening events due to airway obstruction. To date, the best recommended treatment for infantile hemangioma is oral propranolol as it exhibits faster effects with fewer adverse effects as compared to systemic corticosteroid therapy. In this study, we reported a case of a 1-month-old girl who was presented with respiratory symptoms and hemangioma on the scalp. The hemangioma extended from the right base of the skull to the thoracic inlet, causing inspiratory stridor and dyspnea. Treatment with oral propranolol was initiated and her symptoms regressed. Imaging showed regression of the hemangioma. This was a rare case of skin hemangioma found on the scalp, in which the hemangioma extended from the base of the skull to the subglottis, precipitating respiratory symptoms from airway obstruction. Based on this encounter, the presentation of skin hemangioma on the head, coupled with respiratory symptoms, necessitates the use of imaging studies, such as computed tomography, ultrasound, and magnetic resonance imaging to ascertain the extent of hemangioma.

LARYNGEAL PLASMACYTOMA IN KAHLERS DISEASE: A CASE REPORT

Multiple myeloma or Kahlers disease is a malignant hematological disorder due to a monoclonal plasma cell proliferation primarily invading the hematopoietic bone marrow. Extra-medullar involvement occurs in 18% of patients with multiple myeloma. Laryngeal Localization remains rare and has been described in a few cases after a literature review.We report the case of a 44-year-old woman who presented an inspiratory dyspnea caused by a laryngeal tumor. The pathological study and bone marrow examination confirmed the laryngeal localization of multiple myeloma. Treatment consisted of chemotherapy with good clinical outcomes over a 2-year follow-up period.

Clinical Insights of Lumpy Skin Disease in Cauvery Delta Region of Tamil Nadu

Lumpy Skin Disease (LSD) is a contagious and life-threatening affliction affecting both cattle and calves, marked by the emergence of nodules on the skin and various body areas. Notably, in calves, the impact extends beyond generalized lesions, leading to a frequent occurrence of respiratory distress. Secondary bacterial infection also often aggravates the condition. A total of 36 cases presented to Veterinary Clinical Complex, Veterinary College and Research Institute, Orathanadu during the period of April to June 2023 with the history of eruptive lesions all over the body showing signs of Lumpy skin disease with various clinical manifestations like nodular lesions all over the body, fever, nasal discharge, lymphadenopathy, inspiratory dyspnoea, along with diffused edematous swelling of all limbs and diarrhoea in calves. In Indigenous adult cattle, diffused edematous swelling of limbs either unilateral or bilateral along with brisket and jowl edema were observed. Mortality rate in calves less than 3 months is 75 %. In adult animal the mortality rate was high in Indigenous breeds compared to cross bred cattle. Animals were treated to combat secondary bacterial infections with antibiotics along with supportive like Syr. Lavitone H 3ml per.os daily as prophylactic therapy to combat fungal pneumonia. The cases with severe clinical manifestation were even treated with steroid Inj. Prednisolone @1mg/kg b.wt. Animal treated for 15 days, gradual recovery was noticed. Vector control need to be implemented to prevent the disease associated with economic losses.

Un inspirio insolito

The diagnosis of vocal cord dysfunction was eventually made in a 10-year-old boy with repeated self-limited episodes of inspiratory dyspnoea.

Rare Presentation: Primary Leiomyosarcoma of the Thyroid Gland

Leiomyosarcoma, an uncommon tumor, becomes even rarer when it emerges within the thyroid gland. Diagnosing it accurately is a challenging task due to its atypical location, diverse clinical and radiological presentations, its rarity, and overlapping differential diagnoses. However, immunohistochemistry studies can offer a precise identification. In this article, we present a compelling case of recurrent primary leiomyosarcoma of the thyroid gland in a 23-year-old man, revealed by inspiratory dyspnea caused by a voluminous cervical mass and ultimately confirmed as leiomyosarcoma through histopathological examination.

Infectious Acute Epiglotite: About 1 case in the Emergency Vital Service CHU- MOHAMED VI Marrakech

Acute infectious epiglottitis in adults is a rare but serious condition. For a long time, this condition was considered an illness of children between 2 and 6 years old. It can be seen in adults but remains misdiagnosed to this day, due to its misleading and polymorphic symptomatology in adults [1]. Inspiratory dyspnea associated with stridor is key signs to guide the diagnosis. Laryngoscopy and nasofibroscopy allow us to confirm the diagnosis [10]. Acute epiglottitis is an infectious and respiratory emergency that can be life-threatening due to obstruction of the upper airways [1]. It requires rapid treatment, which may even involve a tracheal approach. Naso or oro tracheal intubation and/or tracheotomy are emergency means used in severe acute epiglotitis. Antibiotic therapy also remains a therapeutic emergency and must be started early. We will report the observation of 1 case of a 46-year-old patient, admitted for acute inspiratory dyspnea of rapidly progressive onset, admitted to the Emergency vital Service of Chu Mohamed VI Marrakech.

Study of two Cases of Laryngeal Chondrosarcomas: Presentation, Management, And Outcomes

Laryngeal chondrosarcomas are rare malignant tumors arising in the cartilage of the larynx, posing diagnostic and therapeutic challenges. This study presents two cases treated at Ibn Sina University Hospital in Rabat, Morocco, emphasizing clinical presentations, diagnostic approaches, treatment strategies, and outcomes. Case 1 involved a 56-year-old chronic smoker presenting with inspiratory dyspnea, leading to total laryngectomy. Histopathology confirmed low-grade chondrosarcoma. Case 2 featured a 67-year-old chronic smoker with dysphonia, leading to total laryngectomy with adjuvant radiotherapy for a moderately differentiated chondrosarcoma. Imaging, endoscopy, and histopathology played crucial roles in diagnosis. The discussion outlines the rarity of laryngeal chondrosarcomas, their typical clinical manifestations, and the importance of imaging and histopathology in confirming the diagnosis. Surgical resection remains the mainstay of treatment, with considerations for partial surgery in specific cases. Radiotherapy is limited, while chemotherapy has no curative role. Prognosis correlates with histological grade and the completeness of surgical resection, with a five-year survival rate ranging from 79% to 90%. Recurrences and metastases are infrequent after complete surgery. In conclusion, a multidisciplinary approach involving oncologists, surgeons, and radiotherapists is crucial for tailored management, ensuring optimal outcomes and quality of life for laryngeal chondrosarcoma patients.

Prospective Study of 506 Dogs with Tick Paralysis: Investigating Measures of Severity and Clinical Signs as Predictors of Mortality and Assessing the Benefits of Different Therapeutics.

Survey data from 42 Australian eastern seaboard veterinary practices involving 506 cases are reported with regard to clinical signs, disease severity, mortality, use of pharmaceuticals, and recovery times. New measures of disease severity (visual analogue scales (VAS) and facial expressions) were tested alongside "gold standard" measures (neuromuscular junction (NMJ) scores). Univariable and multivariable logistic regression analyses were conducted to evaluate associations between variables. The VAS scores were progressive, prognostic (especially the respiratory scores) and correlated with the NMJ scores. The presence of inspiratory dyspnoea and crackles on the day of hospitalisation, progressing to expiratory dyspnoea and an expiratory wheeze 24 h later, were highly predictive of mortality. Altered facial features on hospital admission were also highly predictive of mortality. The previously used respiratory score (using various clinical signs) was not predictive of mortality. Older animals had a higher mortality rate, and no gender or breed susceptibility was found. The only pharmaceuticals that were positively associated with mortality were tick antiserum and, in severe cases, antibiotics. The use of many pharmaceutical products (acepromazine, atropine, steroids, antihistamines, antiemetics, diuretics, and S8 anti-anxiety and sedation drugs) had no effect on mortality. More drug classes were used with increasing clinical severity and specific factors (e.g., vomiting/retching, hydration) affected the period of hospitalisation. Geographic variation in respiratory signs and toxicity scores was evident, whereas mortality and disease severity were not different across regions.

Laryngeal Xanthogranulomatosis: A Case Report

Xanthogranulomatosis is an uncommon disease affecting non-Langerhans histiocytes. Laryngeal involvement is very rare. We describe the clinical case of an adult patient with disseminated xanthogranulomas affecting the supraglottic region of the larynx, leading to thickening and immobility of the epiglottis. The patient experienced inspiratory dyspnea on exertion. A transoral supraglottic epiglottectomy was performed, and a tracheostomy was subsequently required.

Retrospective review of airway obstruction in 19 infants with pharyngeal cysts

Objective:To discuss the clinical characteristic and treatment of laryngeal cysts in infants. Methods:The clinical data of 19 patients diagnosed with laryngeal cysts in Department of Otolaryngology, Sichuan Provincial Maternity and Child Health Care Hospital from November 2017 to April 2023 were retrospectively analyzed. Results:All of the 19 patients were diagnosed as laryngeal cysts, with clinical manifestations included respiratory distress, inspiratory dyspnea, difficulty in feeding and low and weak crying, etc. All of them were cured after surgical treatment. Conclusion:Misdiagnosis and missed diagnosis of laryngeal cysts are prone to occur in infants and young children. After diagnosis, patients should undergo early surgical treatment to remove airway obstruction and improve ventilation.

Reduced tidal volume-inflection point and elevated operating lung volumes during exercise in females with well-controlled asthma

IntroductionIndividuals with asthma breathe at higher operating lung volumes during exercise compared with healthy individuals, which contributes to increased exertional dyspnoea. In health, females are more likely to develop exertional...

The Therapeutic Role of Inspiratory Muscle Training in The Management of Asthma: A Narrative Review.

Asthma is a disorder of the airways characterized by chronic airway inflammation, hyperresponsiveness, and variable recurring airway obstruction. Treatment options for asthma include pharmacological strategies, while non-pharmacological strategies are limited. Established pharmacological approaches to treating asthma may cause unwanted side effects and do not always afford adequate protection against asthma, possibly due to an individual's variable response to medications. A potential non-pharmacological intervention that is most available and cost-effective is inspiratory muscle training (IMT), which is a technique targeted at increasing the strength and endurance of the diaphragm and accessory muscles of inspiration. Studies examining the impact of IMT on asthma have reported increases in inspiratory muscle strength, and a reduction in the perception of dyspnea and medication use. However, due to the limited number and discordant methods between studies more evidence is required to elucidate in asthmatics the efficacy of IMT on inspiratory muscle endurance, exercise capacity, asthma control, symptoms, quality of life, as well as adolescents with differing severities of asthma. Large randomized controlled trials would be a significant step forward in clarifying the effectiveness of IMT in asthmatics. While IMT may have favorable effects on inspiratory muscle strength, dyspnea and medication use, the current evidence that IMT is an effective treatment for asthma is inconclusive.