Risk Factors For Airway Obstruction Research Articles

Occupational risk factors for airway obstruction in a population-based study in Northern Europe.

Airway obstruction is a key feature of asthma and chronic obstructive pulmonary diseases (COPD). Smoking habits and workplace exposures to vapors, gas, dusts, and fumes (VGDF) could cause or exacerbate airway obstruction. The aim of this study is to evaluate the risk of airway obstruction due to smoking and workplace exposure, and their interaction, in a large population-based study. In this cross-sectional study, a sample (n = 6153) of the Swedish population aged between 24 and 76 years underwent a questionnaire, clinical examination, blood test, and spirometry to gather information on airway obstruction classified by Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria or American Thoracic Society (ATS)/European Respiratory Society (ERS) criteria, risk factors, and confounders. Occupational exposures to VGDF wererated according to a specific job-exposure matrix. Adjusted logistic regression models were used to evaluate risk factors for airway obstruction in smokers and nonsmokers. In total, 9.8% had airway obstruction by GOLD criteria and 10.3% by ATS/ERS. Smokers with a high likelihood of exposure to VGDF had a higher risk of airway obstruction than those not exposed (odds ratio [OR]: 1.74, 95% confidence interval [CI]: 1.15-2.65 by GOLD; OR: 1.58, 95% CI: 1.06-2.37 by ATS/ERS) especially those >50 years of age. In smokers highly exposed to VGDF, risk estimates were higher than in the whole population, and the interaction between high exposure to VGDF and smoking further increased the risk of airway obstruction. This study suggests a possible role for interaction between cigarette smoking and VGDF exposure on the risk of airway obstruction.

Pre-operative preparation to anesthesia in children

The objective: the article is devoted to specific parameters of pre-operative preparation for anesthesia in children above 1 month old which is significantly different from adult practice. Special attention is paid to ensuring the psychological comfort of the child, collecting history and physical examination, which allows to assess the physical status of the patient, concomitant diseases and risk factors of airway obstruction during anesthesia. The article presents basic principles of anesthesia risk assessment in children and modern scales used for this purpose. It describes possible complications of anesthesia due to concurrent hereditary pathology in the child. Special parts of the article are devoted to pre-operative starvation, the problem of choice of premedication, specific pre-operative management in case of acute respiratory infections and acute surgical diseases of the abdomen.

Predictors of New Airway Obstruction – An 11 Year’s Population-Based Follow-Up Study

In the present study we aimed to investigate the incidence and predictors of spirometry based airway obstruction in a representative population-based sample. Altogether 3,863 subjects, 1,651 males and 2,212 females aged ≥30 years had normal spirometry in year 2000. Fifty-three percent of them were never and 23% current smokers. A re-spirometry was performed 11 years later. Several characteristics, such as level of education, use of alcohol, physical activity, diet using Alternate healthy eating (AHEI) index, body mass index, circumwaist, sensitive C reactive protein (CRP) and cotinine of the laboratory values and co-morbidities including asthma, allergic rhinitis, sleep apnoea and chronic bronchitis, as potential risk factors for airway obstruction were evaluated. Using forced expiratory volume in one second/ forced vital capacity below the lower limit of normal, we observed 124 new cases of airway obstruction showing a cumulative 11-year incidence of 3.2% and corresponding to an incidence rate of 5.6/1,000 per year (PY). The incidence rate was higher in men than in women (6.3/1,000 PY vs. 5.0/1,000 PY, respectively). The strongest risk factors were current smoking (Odds ratio [OR] 2.5) and previously diagnosed asthma (OR 2.1). Sensitive CRP associated with the increased risk and high AHEI index with the decreased risk of airway obstruction. Using the similar study approach our findings on the incidence of airway obstruction are in line with the previously published figures in Europe. We were able to confirm the recent findings on the protective effect of healthy diet.

The prevalence of airway obstruction among Japanese HIV-positive male patients compared with general population; a case–control study of single center analysis

Previous studies have suggested that human immunodeficiency virus (HIV) infection and/or the airway colonization of Pneumocystis jirovecii (Pcj) impact on the progression of airway obstruction, such as chronic obstructive pulmonary disease (COPD). This study was aimed to evaluate the relationship between HIV infection, airway colonization of Pcj and airway obstruction in Japanese male patients. Case-control study of 49 HIV-positive and 257 HIV-negative men were enrolled in this study. Airway obstruction was determined by spirometry. Cigarette smoking was determined by a self report. Laboratory data were obtained from medical records. Among HIV positive patients, the airway colonization of Pcj was evaluated by induced sputum using the real time polymerase chain reaction method. Forty-eight out of 49 (97.9%) HIV-positive patients received antiretroviral therapy, and their median CD4 cell counts were 491/μL (79-935). The prevalence of airway obstruction as determined by spirometry was 10.2% (5/49) in HIV-positive subjects and 2.4% (5/208) in HIV-negative subjects (p = 0.024). Compared with the control group, HIV-positive patients were significantly younger (median age 44 vs 40, p = 0.019). After adjusting for age, pack-years of smoking, HIV infection was an independent risk factor for airway obstruction (OR; 10.93, 95%CI 1.99-60.1, p = 0.006). None of patient was detected the airway colonization of Pcj. HIV infection was an independent risk factor for airway obstruction regardless of airway colonization of Pcj. Health-care providers should be aware of the increased likelihood of airway obstruction among HIV-positive patients.

The European Respiratory Society spirometry tent: a unique form of screening for airway obstruction

In order to raise public awareness of the importance of early detection of airway obstruction and to enable many people who had not been tested previously to have their lung function measured, the European Lung Foundation and the European Respiratory Society (ERS) organised a spirometry testing tent during the annual ERS Congresses in 2004-2009. Spirometry was performed during the ERS Congresses in volunteers; all participants answered a simple, brief questionnaire on their descriptive characteristics, smoking and asthma. Portable spirometers were freely provided by the manufacturer. Nurses and doctors from pulmonary departments of local hospitals/universities gave their service for free. Lower limit of normal (LLN) and Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria for diagnosing and grading airway obstruction were used. Of 12,448 participants in six congress cities, 10,395 (83.5%) performed acceptable spirometry (mean age 51.0 ± 18.4 yrs; 25.5% smokers; 5.5% asthmatic). Airway obstruction was present in 12.4% of investigated subjects according to LLN criteria and 20.3% according to GOLD criteria. Through multinomial logistic regression analysis, age, smoking habits and asthma were significant risk factors for airway obstruction. Relative risk ratio and 95% confidence interval for LLN stage I, for example, was 2.9 (2.0-4.1) for the youngest age (≤ 19 yrs), 1.9 (1.2-3.0) for the oldest age (≥ 80 yrs), 2.4 (2.0-2.9) for current smokers and 2.8 (2.2-3.6) for reported asthma diagnosis. In addition to being a useful advocacy tool, the spirometry tent represents an unusual occasion for early detection of airway obstruction in large numbers of city residents with an important public health perspective.

Live Fish Impaction in Hypopharynx in an Elderly Patient

Successful removal of a live fish impacted in the hypopharynx of a 65-year-old male is reported to emphasize the importance of the speed with which it has to be recognized and intervened. The present report also highlights the altered sensory perception in the oral cavity of elderly people as a potential risk factor for airway obstruction due to a foreign body. Moreover, the possibility of a foreign body has to be suspected, if an elderly patient without any cardiorespiratory illness presents with an acute onset of progressive respiratory distress.

Nursing Dysphagia Screening for Acute Stroke Patients in the Emergency Department

The harmful effects of dysphagia, difficulty swallowing, after a stroke are becoming more prominently recognized as significant contributors to morbidity and mortality in the stroke population. Dysphagia has been found to be clinically present in 42% to 67% of patients within the first 3 days of stroke onset, and almost 50% of these patients experience aspiration. Approximately one third of stroke patients with dysphagia develop pneumonia requiring treatment.1 Dysphagia has also been identified as a risk factor for airway obstruction, dehydration, and malnutrition.

Sensibilización y asma ocupacional en los avicultores

A high prevalence of asthma has been reported in poultry farmers. Our aim was to determine air contaminants in poultry confinement buildings and the prevalence of occupational asthma in these workers. Spanish poultry farmers who participated in the European Study Prevalence and Risk Factors for Airway Obstruction in Farmers, who worked inside confinement buildings, were enrolled in a cross-sectional study that included the measurement of air contaminants (ammonia, total dust, endotoxin and microorganisms), symptoms, skin testing with common and poultry-related allergens, and a specific bronchial challenge. The Spearman correlation coefficient was used to assess the correlation between air contaminants. 14/15 poultry farmers participated in the study (response index: 93.3%). Concentrations of air contaminants in the confinement buildings [median (interquartile range)] were: 7.5 (5-20) ppm for ammonia, 2.6 (1.8-4.6) mg/m3 for total dust, 137.1 (58.6-243.9) ng/m3 for endotoxin and 7,600 (907-27,750) colony-forming units/m3 * 103 for bacteria. Endotoxin correlated with bacterial concentration (r = 0.69, p < 0.01). 5/14 poultry farmers reported wheezing and/or asthma within the last year (35.7%), and in 2 of them spirometry demonstrated current asthma (14.3%). Specific bronchial provocation confirmed the diagnosis of occupational asthma in one subject with current asthma sensitized to the storage mite Lepidoglyphos destructor (7.1%). One third of poultry farmers working inside confinement buildings reported wheezing, that is partly attributable to occupational asthma caused by storage mites.

Chronic bronchitis in farmers.

Chronic bronchitis was studied in relation to work time and years of exposure in farming, as well as to production type, dusty occupation outside farming, and the combination of work exposure and smoking, in a population of farmers. In 1989 a representative cohort of 10,792 farmers and spouses was selected from a government register and invited to participate in a cross-sectional study in 1991. The total response rate was 80%. There were 33% part-time farmers, and among the men 32% of the full-time and 42% of the part-time farmers had worked in dusty occupations outside farming. Bronchitis symptoms were recorded on a self-administered questionnaire, spirometric data were obtained, and internal reference equations were calculated for forced expiratory volume in 1 s (FEV1.0). The exposure factors of importance for chronic bronchitis were full-time farming versus part-time farming, livestock production types (poultry, dairy, swine, horse and combinations), and occupational dust exposure outside agriculture. The combinations of the work exposure factors were significant and showed a 2- to 3-fold increase in risk for chronic bronchitis. Combinations with smoking showed up to a 6-fold increase in risk. Over the age of 50 years, chronic bronchitis was a risk factor for airway obstruction defined as the standardized residuals for FEV1.0 less than -2 for both nonsmokers (OR 2.8, 95% CI 1.1-6.8) and smokers (OR 8.5, 95% CI 5.1-14.3). Work exposure factors in farming and other dusty occupations enhance the risk for chronic bronchitis from 2- to 3-fold for farmers. In combination with smoking the risk increases to up to 6-fold.

Alcohol consumption and airway obstruction.

To clarify the basis of the reported association between alcohol and pulmonary disease, the relationship between intake of alcohol and pulmonary function was examined in 2,539 community-dwelling adult participants in an ongoing longitudinal study of risk factors for airway obstruction. Forced expiratory volume in 1 s, expressed as a percentage of forced vital capacity, was used as the indicator of airway obstruction, and forced vital capacity expressed as a percentage of the predicted value was used as an index of restriction. Although crude (unadjusted) mean values of the ratio of forced expiratory volume in 1 s to forced vital capacity were significantly lower for heavy than for light drinkers, the difference disappeared when adjustment was made for numerous confounding factors (including such recognized risk factors for pulmonary disease as cigarette smoking, low socioeconomic status, male sex, and age). There was also no evidence of an association between consumption of alcohol and airway restriction. Although these findings do not rule out a possible effect of alcohol on pulmonary disease, its impact, if any, is probably the result of interaction with other factors associated with alcoholism, if not derived primarily from those other factors.