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Lymphangioleiomyomatosis (LAM) is a rare, cystic lung disease with progressive pulmonary function loss caused by progressively proliferating LAM cells. The degree of airway obstruction has not been well investigated within the pathogenesis of LAM.Using a combination of ex vivo computed tomography (CT), microCT and histology, the site and nature of airway obstruction in LAM explant lungs was compared with matched control lungs (n=5 each). The total number of airways per generation, total airway counts, terminal bronchioles number and surface density were compared in LAM versus control.Ex vivo CT analysis demonstrated a reduced number of airways from generation 7 on (p<0.0001) in LAM compared with control, whereas whole-lung microCT analysis confirmed the three- to four-fold reduction in the number of airways. Specimen microCT analysis further demonstrated a four-fold decrease in the number of terminal bronchioles (p=0.0079) and a decreased surface density (p=0.0079). Serial microCT and histology images directly showed the loss of functional airways by collapse of airways on the cysts and filling of the airway by exudate.LAM lungs show a three- to four-fold decrease in the number of (small) airways, caused by cystic destruction which is the likely culprit for the progressive loss of pulmonary function.
Upper airway obstruction can lead to growth retardation by unclear mechanisms. We explored the effect of upper airway obstruction in juvenile rats on whole-body energy balance, growth plate metabolism, and growth. We show that after seven weeks, obstructed animals' ventilation during room air breathing increased, and animals grew less due to abnormal growth plate metabolism. Increased caloric intake in upper airway-obstructed animals did not meet increased energy expenditure associated with increased work of breathing. Decreased whole-body energy balance induced hindrance of bone elongation following obstruction removal, and array pathways regulating growth plate development and marrow adiposity. This is the first study to show that rapidly growing animals cannot consume enough calories to maintain their energy homeostasis, leading to an impediment in growth in the effort to save energy.
A significant proportion of lung cancer patients suffer from malignant airway obstruction (MAO). Palliative external beam radiotherapy (EBRT) is often used to control the symptoms caused by MAO. In this study, we report the effect of palliative EBRT on lung cancer with MAO and analyze the factors that influence it.
Foreign body airway obstruction (FBAO) is a relatively common emergency and a potential cause of sudden death both in children and older people; bystander immediate action will determine the victim's outcome. Although many school children's basic life support (BLS) training programs have been implemented in recent years, references to specific training on FBAO are lacking. Therefore, the aim was to assess FBAO-solving knowledge acquisition in 10-13-year-old school children. A quasi-experimental non-controlled simulation study was carried out on 564 ten-to-thirteen-year-old children from 5 schools in Galicia (Spain). Participants received a 60-min training led by their physical education teachers (5 min theory, 15 min demonstration by the teacher, and 30 min hands-on training) on how to help to solve an FBAO event. After the training session, the school children's skills were assessed in a standardized adult's progressive FBAO simulation scenario. The assessment was carried out by proficient researchers utilizing a comprehensive checklist specifically designed to address the variables involved in resolving a FBAO event according with current international guidelines. The assessment of school children's acquired knowledge during the simulated mild FBAO revealed that 62.2% of participants successfully identified the event and promptly encouraged the simulated patient to cough actively. When the obstruction progressed, its severity was recognized by 86.2% and back blows were administered, followed by abdominal thrusts by 90.4%. When the simulated victim became unconscious, 77.1% of children identified the situation and immediately called the emergency medical service and 81.1% initiated chest compressions. No significant differences in performance were detected according to participants' age. Conclusion: A brief focused training contributes to prepare 10-13-year-old school children to perform the recommended FBAO steps in a standardized simulated patient. We consider that FBAO should be included in BLS training programs for school children. What is Known: • Kids Save Lives strategy states that school children should learn basic life support (BLS) skills because of their potential role as first responders. • This BLS training does not include content for resolving a foreign body airway obstruction (FBAO). What is New: • Following a 60-min theoretical-practical training led by physical education teachers, 10-13-year-old school children are able to solve a simulated FBAO situation. • The inclusion of FBAO content in BLS training in schools should be considered.
Airway obstruction (AO) in asthma is driven by airway smooth muscle (ASM) contraction. AO can be induced extrinsically by direct stimulation of ASM with contractile agonists as histamine, or by indirect provocation with antigens as ovalbumin, while the airway tone is dependent on intrinsic mechanisms. The association of the ASM phenotypes involved in different types of AO and airway tone in guinea pigs was evaluated.
(1) Background: To detect early airway obstruction in an adult primary care setting. (2) Methods: Seventeen general practitioners (GP) were involved. A total of 912 patients consulting their GPs over 40 years were recruited: 583 of them (323M) agreed to perform/undergo all the procedures: respiratory questionnaire, mMRC questionnaire, and spirometry. We identified four subgroups: physician COPD patients; physician asthma patients; asthma-COPD overlap syndrome patients; and no respiratory diagnosis subjects, on the basis of physician diagnosis. For screening purposes, an FEV1/FVC < 70% was considered a marker of airway obstruction (AO). (3) Results: Prevalence rates of COPD, A, and ACOS were 12.5%, 7.8%, and 3.6%, respectively. In the overall sample 16.3% showed airway obstruction: 26% mild, 56% moderate, 17% severe, and 1% very severe. In obstructed subjects, those reporting neither respiratory symptoms nor a physician’s respiratory diagnosis were 60% level I; 43% level II; 44% level III; and none level IV. Wheezing (p < 0.001), sputum (p = 0.01), older age (p < 0.0001), and male gender (p = 0.002) were the best predictors of airway obstruction. (4) Conclusions: A high prevalence of AO was found. In AO we found a high prevalence of subjects without respiratory symptoms or respiratory chronic diagnosis. Airway obstruction was predicted by the presence of wheezing, sputum, older age, and male gender.
COPD influences cardiac function and morphology. Changes of the electrical heart axes have been largely attributed to a supposed increased right heart load in the past, whereas a potential involvement of the left heart has not been sufficiently addressed. It is not known to which extent these alterations are due to changes in lung function parameters. We therefore quantified the relationship between airway obstruction, lung hyperinflation, several echo- and electrocardiographic parameters on the orientation of the electrocardiographic (ECG) P, QRS and T wave axis in COPD.
Chronic obstructive lung disease determines morbidity and mortality of patients with cystic fibrosis (CF). CF airways are characterized by a nonresolving neutrophilic inflammation. After pathogen contact or prolonged activation, neutrophils release DNA fibres decorated with antimicrobial proteins, forming neutrophil extracellular traps (NETs). NETs have been described to act in a beneficial way for innate host defense by bactericidal, fungicidal, and virucidal actions. On the other hand, excessive NET formation has been linked to the pathogenesis of autoinflammatory and autoimmune disease conditions. We quantified free DNA structures characteristic of NETs in airway fluids of CF patients and a mouse model with CF-like lung disease. Free DNA levels correlated with airflow obstruction, fungal colonization, and CXC chemokine levels in CF patients and CF-like mice. When viewed in combination, our results demonstrate that neutrophilic inflammation in CF airways is associated with abundant free DNA characteristic for NETosis, and suggest that free DNA may be implicated in lung function decline in patients with CF.
Loss of a patent airway is a significant cause of prehospital death. Endotracheal intubation is the gold standard of care but has a high rate of failure and complications, making development of new devices vital. We previously showed that tracheal tissue has a unique spectral profile which could be utilized to confirm correct airway device placement. Therefore, the goals of this study were twofold: 1- to develop an airway obstruction model and 2- use that model to assess how airway compromise affects tissue reflectance. Female swine were anesthetized, intubated, and instrumented. Pigs were allowed to breathe spontaneously and underwent either slow- or rapid-onset obstruction until a real-time pulse oximeter reading of ≤50%. At baseline, 25%, 50%, 75%, and 100% obstruction, a fiber-optic reflection probe was inserted into the trachea and esophagus to capture reflectance spectra. Both slow- and rapid-onset obstruction significantly decreased arterial oxygen concentration (sO2 ) and increased partial pressure of CO2 (pCO2 ). The presence of the tracheal-defining spectral profile was confirmed and remained consistent despite changes in sO2 and pCO2 . This study validated a model of slow- and rapid-airway obstruction that results in significant hypoxia and hypercapnia. This is valuable for future testing of airway device components that may improve airway management. Additionally, our data support the ability of spectral reflectance to differentiate between tracheal and esophageal tissues in the presence of a clinical condition that decreases oxygen saturation.
We developed a technique to determine the site of upper airway obstruction in patients with idiopathic obstructive sleep apnea (OSA). This technique is based on the analysis of inspiratory airflow pressures at various levels of the pharyngeal airway during sleep. Pharyngeal pressure was measured by a moveable Millar catheter pressure transducer. The catheter's position in the airway was localized radiographically. Ten patients with OSA were tested: five patients were found to have upper airway obstruction at the level of the soft palate, and five had upper airway obstruction at the base of the tongue. We concluded that measuring airway pressures at multiple sites along the airway is useful in localizing the site of obstruction in patients with OSA, and may have important implications in terms of the patient's response to surgical treatment.
Ischemic heart disease (IHD) and chronic airway disease (COPD and Asthma) are major epidemics accounting for significant mortality and morbidity. The combination presents many diagnostic challenges. Clinical symptoms and signs frequently overlap. There is a need for airway evaluation in these patients to plan appropriate management.
Conventional scoring of sleep provides little information about the process of transitioning between vigilance-states. We used the state space technique to explore whether rats with chronic upper airway obstruction (UAO) have abnormal sleep/wake states, faster movements between states, or abnormal transitions between states.
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