Presence Of Airway Obstruction Research Articles

Clinical implications of airway obstruction with normal or low FEV1 in childhood and adolescence

BackgroundAirway obstruction is defined by spirometry as a low forced expiratory volume in 1 s (FEV1) to forced vital capacity (FVC) ratio. This impaired ratio may originate from a low...

Associations between vitamin A and K intake and lung function in the general US population: evidence from NHANES 2007-2012.

While nutrition's critical role in enhancing respiratory health is acknowledged, the specific impacts of vitamins A and K on lung function remain largely unexplored. The study aimed to evaluate the relationships between vitamins A and K intake and lung function. The cross-sectional study focused on adults aged 20-79 with utilizing data from US National Health and Nutrition Examination Survey (NHANES) 2007-2012. Lung function was assessed by measuring forced expiratory volume (FEV1), forced vital capacity (FVC), and the ratio of these two values (FEV1/FVC). Regression model was performed to determine the associations between intake of vitamins A and K and outcomes. Data of 10,034 participants (representing 142,965,892 adults in the US) were analyzed. After adjusting for relevant confounders, multivariable analysis revealed 1 μg/day increase of vitamin A intake was significantly associated with 0.03 ml increased FEV1 (p = 0.004) and 0.04 ml increased forced vital capacity (FVC) (p < 0.001). In addition, 1 μg/day increase in vitamin K intake was significantly associated with 0.11 ml increased FEV1 (p = 0.022). Neither vitamin A and K intake was associated with FEV1/FVC or presence of airway obstruction. In relatively healthy population of the US, greater vitamin A or K intake was independently associated with better lung function assessed by spirometry. Benefits of such vitamins for pulmonary health should be confirmed in future randomized controlled trials.

Approach to selecting mucoactive medications to treat cough in children

Cough is the most common symptom of acute respiratory infections in children. Rational approaches to the therapy of cough should be based on the diagnosis and analysis of cough features. In accordance with sputum quality and quantity, a dry (unproductive, minimally productive) and wet (productive) cough is distinguished. The cough can be acute (up to 4 weeks), subacute, chronic, recurrent in duration. Cough assessment should involve considering the following characteristics: rhythm, timbre, nature, intensity, time of onset, duration, frequency, body position while coughing, impact of cough on the patient’s condition and sleep; presence of airway obstruction, etc. All presentations of cough can change during the development of the disease, which must be considered in the diagnosis and therapy. These characteristics of cough help the therapist select a rational therapy. Particular attention is paid to the therapy of wet cough, which is based on the stimulation of mucociliary clearance, restoration of the drainage function of the lungs; improvement of sputum elimination, thinning and removal of viscous bronchial secretion from the respiratory tract; prevention of mucostasis. The article discusses the pharmacokinetics and mechanism of action for Ambroxol in terms of its indications for OTC drug delivery, clinical data on the use of ambroxol in children. The primary mechanism of action for Ambroxol involves stimulation of surfactant synthesis, a complex mechanism that is not yet fully understood, but which provides Ambroxol with effective mucokinetic and secretion-stimulating properties, thus contributing to mucus clearance, which facilitates expectoration and productive cough.

Chinese experts consensus statement: diagnosis and treatment of cystic fibrosis (2023)

Chinese experts consensus statement: diagnosis and treatment of cystic fibrosis (2023)

Lung Function Impairment Is Related to Subclinical Atherosclerosis Only in Active Smokers

Background: Although an association between lung function and subclinical atherosclerosis has been reported, it remains unclear whether this association is only driven by tobacco smoking. We aimed to assess this in a population with at least one cardiovascular risk factor. Methods: We recruited 6209 subjects aged between 45 and 70 years with at least one cardiovascular risk factor (excluding diabetes mellitus) participating in the ILERVAS project 2015–2018. Lung function was determined by spirometry. Subclinical atherosclerosis was assessed with the ankle–brachial index (ABI) and the presence of carotid and femoral plaques measured by ultrasound. Results: A total of 5927 subjects were included: 49% male, median (p25–p75) age 57 years (52–62). Plaques were found in 4337 (73.2%) of the subjects. The patients with atherosclerosis showed worse lung function: median forced expiratory volume in one second (FEV1) 95% and forced vital capacity (FVC) 94% in the patients with plaques vs. 99% and 98% in the other patients (p &lt; 0.001). Adjusted models stratified by smoking status showed that being in the lower quartiles of FEV1 % was associated with carotid and femoral plaques (OR 1.599, p = 0.005; and OR 1.654, p = 0.006), whereas FVC % was inversely associated with carotid plaques (OR 0.967, p = 0.041). A pathological ABI was associated with worse FEV1 (OR 1.971, p = 0.038) and the presence of airway obstruction (OR 1.658, p = 0.015). However, these differences were restricted to current smokers. Conclusions: Lung function impairment was correlated with subclinical atherosclerosis only in current smokers. This highlights the unique role of smoking-related vascular and pulmonary dysfunction in early stages of pulmonary and cardiovascular afflictions.

Accuracy of the COPD diagnostic questionnaire as a screening tool in primary care

BackgroundThe COPD Diagnostic Questionnaire (CDQ) was developed to identify people who would benefit from spirometry testing to confirm Chronic Obstructive Pulmonary Disease (COPD). The aim of this study was to determine the usefulness of a cut-off score of 16.5 on the CDQ in identifying those at increased risk of obstruction, in a mixed population of people ‘at risk’ of COPD and those with an ‘existing’ COPD diagnosis.MethodsPeople ‘at risk’ of COPD (aged > 40 years, current/ex-smoker) and those with ‘existing’ COPD were identified from four general practices and invited to participate. Participants completed the CDQ and those with a CDQ score ≥ 16.5 were categorised as having intermediate to increased likelihood of airflow obstruction. Pre and post-bronchodilator spirometry determined the presence of airway obstruction (FEV1/FVC ratio < 0.7). Sensitivity, specificity and accuracy of the CDQ was determined compared to spirometry as the gold standard.ResultsOne hundred forty-one participants attended an initial assessment (‘at risk’ = 111 (79%), ‘existing’ COPD = 30 (21%)). A cut-off score of 16.5 corresponded to a sensitivity of 81%, specificity of 36% and accuracy of 50%, in the entire mixed population. The area under the ROC curve was 0.59 ± 0.50 indicating low diagnostic accuracy of the CDQ. Similar results were found in the ‘existing’ COPD group alone.ConclusionWhilst a cut-off score of 16.5 on the CDQ may result in a large number of false positives, clinicians may still wish to use the CDQ to refine who receives spirometry due to its high sensitivity.Trial registrationANZCTR, ACTRN12619001127190. Registered 12 August 2019 – Retrospectively registered, http://www.ANZCTR.org.au/ACTRN12619001127190.aspx

Baseline Spirometry as a Predictor of Positive Methacholine Challenge Testing for Exertional Dyspnea.

There are several tests recommended by the American Thoracic Society (ATS) to evaluate for airway hyper-responsiveness (AHR), one of which is methacholine challenge testing (MCT). Few studies have examined the correlation of baseline spirometry to predict AHR in MCT, especially in the younger, relatively healthy military population under clinical evaluation for symptoms of exertional dyspnea. The study aim was to retrospectively correlate baseline spirometry values with MCT responsiveness. This study is a retrospective review of all MCT performed at Brooke Army Medical Center/Wilford Hall Medical Center over a 12-y period; all completed studies were obtained from electronic databases. The following parameters were analyzed from the studies: baseline FEV1, FVC, FEV1/FVC, mid-expiratory flow (FEV25-75%), FEV25-75%/FVC. Studies were categorized based on baseline obstruction, restriction, FEF25-75% lower limit of normal, and response to bronchodilator testing (if completed); these values were compared based on methacholine reactivity and severity. Methacholine challenge studies (n = 1,933) were reviewed and categorized into reactive (n = 577) and nonreactive (n = 1,356) as determined by ATS guidelines. The mean baseline FEV1 (% predicted) with MCT reactivity was 88.0 ± 13.0% versus no MCT reactivity was 92.7 ± 13.0% (P < .001). The mean baseline FVC (% predicted) was 93.1 ± 13.7% versus 95.3 ± 13.5% (P < .001). The mean baseline FEV25-75% (% predicted) was 80.0 ± 22.1% versus 89.0 ± 23.4% (P < .001). Based on partition analysis, methacholine reactivity was most prevalent with baseline obstruction, n = 115 (43%), and in the absence of obstruction, when the FEF25-75% (% predicted) was below 0.70, n = 111 (40%). The negative predictive value with normal spirometry was 73%. The analysis of baseline spirometry prior to MCT proved useful in the evaluation of exertional dyspnea in a military population. The presence of airways obstruction (FEV1/FVC < lower limit of the normal range) followed by a reduction in FEV25-75% < 70% predicted showed a positive correlation with underlying AHR. In patients with exertional dyspnea and normal baseline spirometry, the use of the FEF25-75% may be a useful surrogate measurement to predict reactivity during MCT and consideration for additional testing or treatment.

Rationale and Clinical Use of Bronchodilators in Adults with Bronchiectasis.

Currently, there is much controversy surrounding the therapeutic approach to pulmonary function abnormalities in patients with bronchiectasis and, consequently, whether and when to use bronchodilators in these patients. National and international guidelines on the treatment of bronchiectasis in adults do not recommend the routine use of bronchodilators because there is no evidence that a significant response to a bronchodilator or the presence or hyperresponsiveness of the airway are good predictors of future effective clinical response. However, some guidelines recommend them in the presence of airway obstruction and/or special conditions, which vary according to the guideline in question, although there are no recommendations on optimal dosing and bronchodilator treatment combined with or without inhaled corticosteroids. Nonetheless, in contrast with guideline recommendations, bronchodilators are overused in real-world patients with bronchiectasis even in the absence of airway obstruction, as demonstrated by analysis of national and international registries. This overuse can be explained by the awareness of the existence of a solid pharmacological rationale that supports the use of bronchodilators in the presence of chronic airway obstruction independent of its aetiology. We performed a systematic review of the literature and were able to verify that there are no randomised controlled trials (apart from a small study with methodological limitations and a very recent trial involving a not-very-large number of patients), or any long-term observational studies on the short- or long-term effect of bronchodilators in patients with bronchiectasis. Therefore, we believe that it is essential and even urgent to evaluate the effects of bronchodilators in these patients with appropriately designed studies.

Reference value for expiratory time constant calculated from the maximal expiratory flow-volume curve

BackgroundThe expiratory time constant (RCEXP), which is defined as the product of airway resistance and lung compliance, enable us to assess the mechanical properties of the respiratory system in mechanically ventilated patients. Although RCEXP could also be applied to spontaneously breathing patients, little is known about RCEXP calculated from the maximal expiratory flow-volume (MEFV) curve. The aim of our study was to determine the reference value for RCEXP, as well as to investigate the association between RCEXP and other respiratory function parameters, including the forced expiratory volume in 1 s (FEV1)/ forced vital capacity (FVC) ratio, maximal mid-expiratory flow rate (MMF), maximal expiratory flow at 50 and 25% of FVC (MEF50 and MEF25, respectively), ratio of MEF50 to MEF25 (MEF50/MEF25).MethodsSpirometric parameters were extracted from the records of patients aged 15 years or older who underwent pulmonary function testing as a routine preoperative examination before non-cardiac surgery at the University of Tokyo Hospital. RCEXP was calculated in each patient from the slope of the descending limb of the MEFV curve using two points corresponding to MEF50 and MEF25. Airway obstruction was defined as an FEV1/FVC and FEV1 below the statistically lower limit of normal.ResultsWe retrospectively analyzed 777 spirometry records, and 62 patients were deemed to have airway obstruction according to Japanese spirometric reference values. The cut-off value for RCEXP was 0.601 s with an area under the receiver operating characteristic curve of 0.934 (95% confidence interval = 0.898–0.970). RCEXP was strongly associated with FEV1/FVC, and was moderately associated with MMF and MEF50. However, RCEXP was less associated with MEF25 and MEF50/MEF25.ConclusionsOur findings suggest that an RCEXP of longer than approximately 0.6 s can be linked to the presence of airway obstruction. Application of the concept of RCEXP to spontaneously breathing subjects was feasible, using our simple calculation method.

The impact of indoor air quality on respiratory health of older people living in nursing homes: spirometric and exhaled breath condensate assessments

In the Portuguese Geriatric Study of the Health Effects of Indoor Air Quality in Senior Nursing Homes, we aimed to evaluate the impact of indoor air contaminants on the respiratory symptoms and biomarkers in a sample of elderly living in nursing homes.A total of 269 elderly answered a health questionnaire, performed a spirometry and 150 out of these collected an exhaled breath condensate sample for pH and nitrites analysis. The study included the evaluation of indoor chemical and microbiological contaminants.The median age of the participants was 84 (78–87) years and 70.6% were women. The spirometric data indicated the presence of airway obstruction in 14.5% of the sample. Median concentrations of air pollutants did not exceed the existing standards, although increased peak values were observed. In the multivariable analysis, each increment of 100 µg/m3 of total volatile organic compounds was associated with the odds of respiratory infection in the previous three months (=1.05; 95% CI: 1.00–1.09). PM2.5 concentrations were inversely associated with pH values (= −0.04, 95%: −0.06 to −0.01, for each increment of 10 µg/m3). Additionally, a direct and an inverse association were found between total bacteria and FEV1/FVC and FVC, respectively.

Diagnostic accuracy of capnovolumetry for the identification of airway obstruction \u2013 results of a diagnostic study in ambulatory care

BackgroundOne of the known weaknesses of spirometry is its dependence on patients’ cooperation, which can only partially be alleviated by educational efforts. Therefore, procedures less dependent on cooperation might be of value in clinical practice. We investigated the diagnostic accuracy of ultrasound-based capnovolumetry for the identification of airway obstruction.MethodsConsecutive patients from a pulmonary outpatient clinic were included in the diagnostic study. As reference standard, the presence of airway obstruction was evaluated via spirometry and bodyplethysmography. Capnovolumetry was performed as index test with an ultrasound spirometer providing a surrogate measure of exhaled carbon dioxide. Receiver operating characteristic (ROC) analysis was performed using the ratio of slopes of expiratory phases 3 and 2 (s3/s2) ≥ 0.10 as primary capnovolumetric parameter for the recognition of airway obstruction. Logistic regression was performed as secondary analysis to identify further useful capnovolumetric parameters. The diagnostic potential of capnovolumetry to identify more severe degrees of airway obstruction was evaluated additionally.ResultsOf 1400 patients recruited, 1287 patients were included into the analysis. Airway obstruction was present in 29% of patients. The area under the ROC-curve (AUC) of s3/s2 was 0.678 (95% CI 0.645, 0.710); sensitivity of s3/s2 ≥ 0.10 was 47.7 (95% CI 42.7, 52.8)%, specificity 79.0 (95% CI 76.3, 81.6)%. When combining this parameter with three other parameters derived from regression analysis (ratio area/volume phase 3, slope phase 3, volume phase 2), an AUC of 0.772 (95% CI 0.743, 0.801) was obtained. For severe airway obstruction (FEV1 ≤ 50% predicted) sensitivity of s3/s2 ≥ 0.10 was 75.9 (95% CI 67.1, 83.0)%, specificity 75.8 (95% CI 73.3, 78.1)%; for very severe airway obstruction (FEV1 ≤ 30% predicted) sensitivity was 86.7 (95% CI 70.3, 94.7)%, specificity 72.8 (95% CI 70.3, 75.2)%. Sensitivities increased and specificities decreased considerably when the combined capnovolumetric score was used as index test.ConclusionsCapnovolumetry by way of an ultrasound spirometer had a statistically significant albeit moderate potential for the recognition of airway obstruction in a heterogeneous population of patients typically found in clinical practice. Diagnostic accuracy of the capnovolumetric device increased with the severity of airway obstruction.Trial registrationThe study is registered under DRKS00013935 at German Clinical Trials Register (DRKS).

102 Association Between Patients' Characteristics and Peri-Intubation Adverse Events in the Emergency Department

To evaluate patient characteristics and their association with adverse events in emergency department (ED) intubations. Twenty-two academic emergency departments in the United States recorded 5,071 ED intubations in the National Emergency Airway Registry (NEAR) using a Web-based tool, StudyTRAX in 2016 (additional data on about 7,500 ED intubations for 2017 are expected in late April 2018). Only emergency departments who met the 90% compliance requirements were included in the study. We discuss associations between patient characteristics and adverse events. The rates of certain adverse events noted in prior studies of intubation have changed. Esophageal intubations were a significant adverse event in past registry data. Overall adverse event rates in this review were found in 13% of intubations. The most common adverse events were hypoxia (8%) and hypotension (4%). Several patient characteristics were noted to have a significant association with adverse events. The highest rates of any adverse events were found in patients in the following categories: morbid obesity (22.13%), presence of airway obstruction (20.79%), and predicted difficult airway (18.17%). Hypoxia was found most commonly in patients with predicted difficult airway (15.8%) and with morbid obesity (14.9%). Hypotension was seen predominantly in patients over 75 years of age (7%) and in the morbidly obese (5.5%). Interestingly, predicted difficult airway and thin body habitus appeared to be equally associated with hypotension (4.4%). This registry data shows hypoxia and hypotension to be the most common adverse events in ED intubations. The patient characteristics linked to the highest rates of any adverse events were found to be morbid obesity, presence of airway obstruction and predicted difficult airway. Further research in this area may help elucidate the most appropriate way to decrease the occurrence of adverse events.

Respiratory waveform variation can prevent pulsus paradoxus measurement by sphygmomanometry

Background: Pulsus paradoxus (PP) represents increased fluctuation of systolic pressure during the respiratory cycle. PP increases in pathologic conditions, including asthma and other obstructive airways diseases. Respiratory waveform variation (RWV) represents arterial-waveform baseline variability resulting from intra-pleural pressure changes during the respiratory cycle in the presence of airway obstruction. It is not known whether RWV influences manual PP measurement using a sphygmomanometer and stethoscope. Methods: We performed an observational study in six healthy adults. Participants performed tidal-breathing through a breathing apparatus with pre-determined inspiratory (0–45.6 cm H2O) and expiratory (0–24.4 cm H2O) resistance levels for a total of 23 data sets per participant. PP was measured from continuous radial artery pressure recordings as the absolute difference between maximum and minimum systolic pressure levels during a complete respiratory cycle. Results: In this study, PP values measured without applied airway resistance exceeded 10 mmHg, the traditional definition of PP, in five of the six participants. Manual measurement of PP would not be possible at greater RWV because the maximum diastolic pressure exceeded minimum systolic pressure during RWV. Conclusions: PP in normal adults may exceed 10 mmHg, and RWV may be of sufficient magnitude to preclude manual PP measurement.

Airway Obstruction in Sleep Apnea Patients.

Obstructive sleep apnea (OSA) is a condition of breathing pathology occurring during sleep, characterized by repeated episodes of upper airway obstruction. The aim of the study was to determine the occurrence of airway obstruction in smoking males with OSA in whom lung function tests had not been performed before. One hundred and four current smokers selected from 1241 patients were enrolled for the research. The subjects included in the study smoked minimum 20 cigarettes a day for at least 10years. The diagnosis of OSA was confirmed by polysomnography (PSG) in the Sleep Laboratory and subjects were assigned to one of three groups, depending on the severity of OSA. The control group consisted of 30 age-matched male smokers in whom OSA was not confirmed in PSG. Patients from the study and control group scored ≥11points in the Epworth Sleepiness Scale. Spirometry, impulse oscillometry, and body plethysmography were used to assess pulmonary function. Airflow limitation in subjects of the control group and OSA patients was confirmed. There were no significant differences in the incidence of bronchial obstruction between the control and study groups, and among the patients of various OSA severity. We conclude that the severity of OSA in smokers does not associate with the presence of airway obstruction. However, the increased peripheral respiratory resistance found in oscillometry did relate to a longer smoking time in OSA patients.

Late presenting nasal deformities after nasal continuous positive airway pressure injury: 33-year experience

This study was designed to characterize the resultant nasal deformities seen in adolescent and adult patients who sustained nasal continuous positive airway pressure (nCPAP) injuries during their NICU admission. Data from patients who sustained nCPAP injury in the NICU and seen for plastic surgery evaluation at one institution over the past 33 years was collected. Exclusion criteria were patients with additional nasal trauma after nCPAP injury. A retrospective review was performed, including demographics, time of initial injury, surgical timing, associated medical history, nasal function and photographs. Deformities were characterized according to aesthetic nasal subunit location and secondary nasal deformities. Outcome measures included the need and type of surgical correction, presence of airway obstruction, and surgical complications. 11 patients were included; the average age was 13.9±4.6 years. The average gestational age was 26.5±1.6 weeks. All of the nasal deformities included the inferior third of nose. The nasal soft triangle and columella were the most common subunits affected. Three patients had combined deformities with involvement of at least two nasal subunits. All injuries resulted in secondary nasal deformities, including nostril asymmetry, columellar asymmetry, nasal tip deviation, lack of projection and nasal airway obstruction. All patients required at least two operative interventions for treatment. Mean age of initial reconstruction was 7.2 years. Despite surgical intervention, secondary deformities and nasal airway obstruction was still present. Late presenting nCPAP injury deformities most commonly affect the lower third of the nose and can result in a myriad of secondary nasal deformities. The nasal soft triangle and columella were the most commonly involved subunits. Secondary deformities involved the nasal aesthetic subunits adjacent to the primarily affected areas, resulting in asymmetry as well as nasal airway obstruction. Most patients required staged open nasal reconstruction with composite grafts.

(822) - Impact of Demographics on Airway Obstruction on Spirometry Among Patients With Lung Transplantation

To study the impact of demographic variables on airway obstruction at various time points among patients with LT. We reviewed all spirometry tests done among patients with LT over the last 20 years (1993-2012). Data was available for analysis among 930 patients (mean age 53.5±12.5 years, range 18-81 years) who underwent 20,032 spirometries during this period. Airway obstruction was diagnosed when ratio of FEV1 to forced vital capacity (FVC) was below the lower limit of normal. We compared the prevalence of airway obstruction based upon patient’s age, gender, ethnicity (Caucasians/non-Caucasians) and body mass index (BMI>30 kg/m2). Comparisons were done using independent t-test and Fisher exact test as appropriate. Airway obstruction was common (n=8661, 43.2%). Patients with BMI>30 kg/m2 (odd ratio, 95% CI: 1.14, 1.06-1.23; P<0.001), Caucasians (1.49, 1.34-1.67; P<0.001) and females (1.19, 1.13-1.27; P<0.001) were all more likely to have airway obstruction. On the other hand, it was less likely to be seen among patients older than 65 years (0.89, 0.83-0.97; P=0.008). The ‘protective effect’ of age>65 years was seen up to 18 months post-transplantation (0.54, 0.47-0.63; P<0.001) after which the likelihood of airway obstruction was similar in both groups. In contrast, increased risk of airway obstruction among patients with BMI>30 was seen up to 18 months (1.38, 1.23-1.54; P<0.001) after which it did not have an association up till 5 years post-transplantation. Caucasians had an increased likelihood of having airway obstruction at anytime post-transplantation although the risk was higher in the initial 18 months (2.23-1.86-2.74; P<0.001). Gender did not have an impact on presence of airway obstruction up till 2 years post transplant after which it was significantly more common among females (1.28, 1.17-1.4; P<0.001). Demographic variables appear to have profound effects on the likelihood of finding airway obstruction after LT. Patients with BMI>30 kg/m2, females and Caucasians appear to have an increase risk of airway obstruction during different post-transplantation periods. Older patients appeared less likely to have airway obstruction in the early post-transplantation period. Although this may reflect lower incidence of acute cellular rejection among older patients, further studies are needed to evaluate this finding.

Opening interrupter technique in pre-school children with chronic respiratory diseases: a perspective case-control study in the diagnosis of airway hyperesponsiveness

Background: Optimal treatment for pediatric respiratory diseases is strictly related to follow-up evaluations of lung function. The aim of our study was to show the efficacy of the Opening Interrupter Technique in diagnosing the presence of airway obstruction in pre-school children. Materials and methods: Our study was a prospective case–control study, evaluating 82 patients affected by asthma and/or cystic fibrosis (CF) and 50 healthy pre-school children, as control group. All patients were 3- to 5-years old and they were followed by our Pediatric Department, University of Catania, Italy, from February 2011 to June 2012. Measurements of respiratory resistance (o-Rint) by the opening interrupter technique were made with the MasterScreen PFT device, Jaeger GmbH, Würzburg, Germany, during quiet breathing. The presence of airway obstruction was detected as a value of o-Rint higher than two standard deviations (SD) compared with the theoretical data. Results: We found higher values of o-Rint in asthmatic patients than in the control group, with a high statistical difference (p < 0.0001). The same results were found when we compared patients with CF and the control group (p < 0.0001). Nevertheless, we did not find any significant statistical difference between respiratory resistances measured in asthmatic and patients with CF (p > 0.05). There was a significant inverse correlation between o-Rint and height only in asthmatic and patients with CF, but not in healthy controls (p < 0.05). Conclusions: In our study, the opening interrupter technique was efficient in detecting the presence of obstruction in chronic patients affected by asthma and CF.

I have taken my umbrella, so of course it does not rain

Spirometry is used worldwide to diagnose respiratory disease, and it is a validated measure to assess airway obstruction. Irreversible airway obstruction is the defining feature of chronic obstructive pulmonary disease...

Unrecognised ventricular dysfunction in COPD

While both chronic congestive heart failure (CHF) and chronic obstructive pulmonary disease (COPD) impose a substantial disease burden and share aetiological and epidemiological associations, they have largely been studied separately. The aim of our study was to assess the prevalence and the prognostic implications of the coexistence of left ventricular dysfunction in COPD patients and airway obstruction in CHF patients. We used a prospective cohort study including stable ≥ 60-yr-old patients with echocardiographically confirmed CHF (n=201) and stable ≥ 60-yr-old patients with clinically and spirometry-confirmed COPD (n=218). All CHF patients underwent routine spirometry, and all COPD patients underwent routine echocardiographic assessment and B-type natriuretic peptide (BNP) measurement. Patients were followed for 2 yrs. The prevalence of airway obstruction among CHF patients was 37.3% and the prevalence of ventricular dysfunction among COPD patients was 17%. The presence of ventricular dysfunction in patients with COPD tended to increase the risk of mortality during follow-up (hazard ratio 2.34, 95% CI 0.99-5.54; p=0.053). The presence of airway obstruction in patients with CHF did not influence survival. CHF and COPD frequently coexist, and ventricular dysfunction worsens survival in patients with COPD. Considering the high prevalence and the prognostic implications of ventricular dysfunction, routine assessment with either BNP or echocardiogram should be considered in COPD patients.

Die Obstruktionen der oberen Atemwege und ihre Bedeutung für das Schlucken bei Neugeborenen

Oral feeding in infants requires highly integrated sucking, swallowing, and respiratory sequencing controlled by the neurologic system. Rapid neuromuscular coordination of oral, pharyngeal, and esophageal phases of swallowing must be coordinated with respiration in the swallowing process. When obstruction is present in the upper airway secondary to anatomic or physiologic anomalies, disruption to the oral feeding process may occur. The infant will likely be unable to coordinate sucking and swallowing with breathing in an advantageous sequence. Inefficient feeding and difficulty with airway protection during swallowing may have serious implications regarding the infant's respiratory health as well as ability to gain weight adequately. A stable and patent airway is always the first priority in the management of the infant with upper-airway obstruction. Evaluation of the infant's potential for oral feeding may occur simultaneously with the initial evaluation of the degree of airway obstruction or it may occur following medical or surgical intervention for the airway obstruction. The evaluation process and management options for oral feeding will depend upon the method used to establish a patent airway. Clinical assessment by the speech-language pathologist includes a thorough assessment of oral sensory and motor mechanics, recognition of clinical signs and symptoms of swallowing dysfunction, and consideration of referral for instrumental assessment to obtain objective information regarding airway protection and swallowing function. A variety of medical and feeding interventions may be used to help support oral feeding to whatever extent is safe and efficient. Infants with significant oral feeding problems in the presence of airway obstruction may require a period of supplemental tube feeding and non-nutritive oral stimulation.