Database : MEDLINE
Search on : Airway and Obstruction [Words]
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[PMID]: 29523819
[Au] Autor:Li HY; Lee LA; Kezirian EJ; Nakayama M
[Ad] Address:Department of Otorhinolaryngology - Head and Neck Surgery, Sleep Center, Linkou-Chang Gung Memorial Hospital, Taoyuan City, 33305, Taiwan R.O.C.. hyli38@cgmh.org.tw.
[Ti] Title:Suspension Palatoplasty for Obstructive Sleep Apnea- A Preliminary Study.
[So] Source:Sci Rep;8(1):4224, 2018 Mar 09.
[Is] ISSN:2045-2322
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:Suspension palatoplasty, a new surgical technique to treat obstructive sleep apnea (OSA), has been developed to correct the retropalatal obstruction in patients with small tonsils (grade I/II) and anterior-posterior palatal (A-P) obstruction. The objecteive of this preliminary study was to investigate the effectiveness and change in retropalatal airway dimensions after suspension palatoplasty. This retrospective case series study included 25 consecutive male adults with OSA. Unique technical features of suspension palatoplasty are exposure of pterygomandibular raphe and suspension of palatopharyngeus muscle to the raphe. Six months after suspension palatoplasty, apnea-hyponea index significantly reduced from 39.8 to 15.1 (effect size = 1.6). None experienced postoperative bleeding and velopharyngeal insufficiency 1 month following surgery. Subjective snoring severity (visual analogue scale) and daytime sleepiness (the Epworth Sleepiness Scale) significantly improved (8.7 vs 2.0 and 10.2 vs 4.9, respectively). A-P dimension of the retropalatal airspace widened significantly on perioperative endoscopy (23.0 units vs 184.6 unites) as well as posterior air space in cephalometry (7.6 mm vs 10.2 mm). Our preliminary findings show that suspension palatoplasty seems to be an effective OSA surgery in the specific patient population with minimal complications, however, further studies including a large number of patients are required to confirm the findings.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180310
[Lr] Last revision date:180310
[St] Status:In-Data-Review
[do] DOI:10.1038/s41598-018-22710-1

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[PMID]: 29446293
[Au] Autor:Beygel EA; Katamanova EV; Shayakhmetov SF; Ushakova OV; Pavlenko NA; Kuks AN; Voronin DA
[Ti] Title:[The impact of the long-term exposure of industrial aerosols on clinical and functional indices of the broncho-pulmonary system in aluminum smelter workers].
[So] Source:Gig Sanit;95(12):1160-3, 2016.
[Is] ISSN:0016-9900
[Cp] Country of publication:Russia (Federation)
[La] Language:rus
[Ab] Abstract:It was found that the appearance of respiratory diseases among workers was established to be associated with the impact of aerosols with the complex chemical composition, exceeding corresponding MAC. Among respiratory diseases in workers there were detected predominantly chronic non-obstructive bronchitis - 59.15%, and chronic obstructive pulmonary disease (COPD) - in 35.2% of cases. In the analysis of spirometric indices of examined patients the vast majority (76.3%) of them showed disturbances of the bronchial patency of mild to moderate degree of the pronouncement. As a result of the implementation offlexible bronchoscopy there was established the presence of a diffuse lesion of bronchi with a predominance of subatrophic and atrophic processes in the mucosa. It was found that under the increase of the concentration of HF in the air of industrial premises the probability of bronchial obstruction and deterioration of the tracheobronchial patency in aluminum smelter workers was established to elevate.
[Mh] MeSH terms primary: Air Pollutants, Occupational
Aluminum
Bronchitis, Chronic
Chemical Industry
Occupational Diseases
Pulmonary Disease, Chronic Obstructive
[Mh] MeSH terms secundary: Aerosols/adverse effects
Aerosols/analysis
Aerosols/chemistry
Air Pollutants, Occupational/analysis
Air Pollutants, Occupational/toxicity
Aluminum/analysis
Aluminum/chemistry
Bronchitis, Chronic/epidemiology
Bronchitis, Chronic/etiology
Bronchitis, Chronic/prevention & control
Chemical Industry/methods
Chemical Industry/standards
Humans
Male
Middle Aged
Occupational Diseases/epidemiology
Occupational Diseases/etiology
Occupational Diseases/prevention & control
Occupational Exposure/adverse effects
Occupational Exposure/analysis
Occupational Exposure/prevention & control
Pulmonary Disease, Chronic Obstructive/epidemiology
Pulmonary Disease, Chronic Obstructive/etiology
Pulmonary Disease, Chronic Obstructive/prevention & control
Siberia/epidemiology
Time
[Pt] Publication type:JOURNAL ARTICLE
[Nm] Name of substance:0 (Aerosols); 0 (Air Pollutants, Occupational); CPD4NFA903 (Aluminum)
[Em] Entry month:1803
[Cu] Class update date: 180309
[Lr] Last revision date:180309
[Js] Journal subset:IM
[Da] Date of entry for processing:180216
[St] Status:MEDLINE

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[PMID]: 29446284
[Au] Autor:Kudaeva IV; Dyakovich OA; Beygel EA; Masnavieva LB; Naumova OV; Budarina LA
[Ti] Title:[Clinical, biochemical and allergological indices characterizing occupational diseases of the bronchial and pulmonary system in employees at aluminium production].
[So] Source:Gig Sanit;95(12):1142-5, 2016.
[Is] ISSN:0016-9900
[Cp] Country of publication:Russia (Federation)
[La] Language:rus
[Ab] Abstract:There are many harmful factors that possess a damaging impact on the body of employees at aluminum production. It leads to the development of bronchial asthma (BA), chronic nonobstructive bronchitis (CNB) and chronic obstructive pulmonary disease (COPD). The pathogenesis of these disorders, as well as sensitizing effect offluorine in the aluminum production is not fully understood. The purpose of this work was to study the characteristics of laboratory indices in patients with occupational diseases of the respiratory system. In workers of aluminum production with the diagnosis of occupational diseases of respiratory system (15 patients with a diagnosis of asthma, 30 CNB cases, 20 COPD patients) we evaluated the content of total protein, total cholesterol, high density lipoprotein cholesterol (HDLC), total calcium, phosphorus, ceruloplasmin, hematological indices and performed emigration of leukocytes braking test (TTEEL). Clinical and biochemical profile ofpersons with occupational asthma was characterized by a low level of total calcium and ceruloplasmin, a high concentration of phosphorus in the blood serum and inhibition of leukocyte emigration in the test with sodium fluoride. For aluminum production CNB workers characteristic active proatherogenic process was pronounced by a decrease in the HDLC level and an increase in atherogenic index; higher hematocrit value and concentration of erythrocytes, and more than 50% of cases of sensitization to the presence of sodium fluoride. COPD cases had occupational lower average concentration of hemoglobin in the erythrocyte, total protein in serum, as well as polymorphic variant response to sodium fluoride in the form of a depression and activation of leucocytes emigration.
[Mh] MeSH terms primary: Air Pollutants, Occupational
Aluminum
Asthma, Occupational
Chemical Industry
Pulmonary Disease, Chronic Obstructive
[Mh] MeSH terms secundary: Air Pollutants, Occupational/analysis
Air Pollutants, Occupational/toxicity
Aluminum/analysis
Aluminum/toxicity
Asthma, Occupational/blood
Asthma, Occupational/diagnosis
Asthma, Occupational/epidemiology
Biomarkers/analysis
Chemical Industry/methods
Chemical Industry/standards
Humans
Male
Middle Aged
Occupational Exposure/adverse effects
Occupational Exposure/analysis
Occupational Exposure/prevention & control
Occupational Health/statistics & numerical data
Pulmonary Disease, Chronic Obstructive/blood
Pulmonary Disease, Chronic Obstructive/diagnosis
Pulmonary Disease, Chronic Obstructive/epidemiology
Pulmonary Disease, Chronic Obstructive/etiology
Respiratory Hypersensitivity/blood
Respiratory Hypersensitivity/chemically induced
Respiratory Hypersensitivity/diagnosis
Siberia/epidemiology
[Pt] Publication type:JOURNAL ARTICLE
[Nm] Name of substance:0 (Air Pollutants, Occupational); 0 (Biomarkers); CPD4NFA903 (Aluminum)
[Em] Entry month:1803
[Cu] Class update date: 180309
[Lr] Last revision date:180309
[Js] Journal subset:IM
[Da] Date of entry for processing:180216
[St] Status:MEDLINE

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[PMID]: 28452711
[Au] Autor:Scott JR; Sowerby LJ; Rotenberg BW
[Ad] Address:Department of Otolaryngology-Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
[Ti] Title:Office-based rhinologic surgery: A modern experience with operative techniques under local anesthetic.
[So] Source:Am J Rhinol Allergy;31(2):135-138, 2017 Mar 01.
[Is] ISSN:1945-8932
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:BACKGROUND: Office-based rhinologic procedures have become popularized in recent years with the advent of several minimally invasive techniques. There is a paucity of literature, however, that supports more robust in-clinic procedures, e.g., true endoscopic sinus surgery (ESS). There is a high volume of this work being done at our center, and the objective of this article was to review the safety and tolerability of in-clinic surgeries. METHODS: A retrospective chart review was conducted. All the adult patients who underwent in-clinic sinonasal procedures and surgery with a minimum of 3 months of follow-up were included. Information regarding intra- and postoperative complications and revision procedures were recorded. For the ESS procedures, the indication, sinuses operated on, and type of revision were also collected. RESULTS: A total of 315 patients met the inclusion criteria. There were 166 turbinoplasties, 118 ESS, 35 septoplasties, 34 rhinoplasties, and 4 septorhinoplasties performed. For the ESS procedures, 74 (62.7%) were bilateral, and experience was had operating in all paranasal sinuses. All ESS work involved opening diseased ostia and was more than just polypectomies. The mean follow-up for the ESS cases was 13.4 months (range, 12-65 months). Complication rates and tolerability measures were comparable with those of other reported in-office sinonasal procedures performed with the patient under local anesthetic. CONCLUSION: Office-based rhinologic surgery was safe and well tolerated by the patients. The need for revision ESS in our series was low when considering the extent of surgery that was performed. An in-clinic procedure may avoid a general anesthetic in the operating room for appropriately selected patients.
[Mh] MeSH terms primary: Anesthetics, Local/therapeutic use
Endoscopy
Nasal Obstruction/epidemiology
Pain/prevention & control
Paranasal Sinuses/surgery
Postoperative Complications/prevention & control
Rhinoplasty
[Mh] MeSH terms secundary: Adult
Aged
Aged, 80 and over
Animals
Canada/epidemiology
Female
Follow-Up Studies
Hospitalization
Humans
Male
Middle Aged
Minimally Invasive Surgical Procedures
Nasal Obstruction/surgery
Pain/etiology
Treatment Outcome
Young Adult
[Pt] Publication type:JOURNAL ARTICLE
[Nm] Name of substance:0 (Anesthetics, Local)
[Em] Entry month:1803
[Cu] Class update date: 180309
[Lr] Last revision date:180309
[Js] Journal subset:IM
[Da] Date of entry for processing:170429
[St] Status:MEDLINE
[do] DOI:10.2500/ajra.2017.31.4414

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[PMID]: 29520643
[Au] Autor:Calandrelli R; Pilato F; Massimi L; Panfili M; D'Apolito G; Gaudino S; Colosimo C
[Ad] Address:Polo scienze delle immagini, di laboratorio ed infettivologiche, Area diagnostica per immagini, Fondazione Policlinico Universitario Agostino Gemelli, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1-00168, Rome, Italy. rosalinda.calandrelli@policlinicogemelli.it.
[Ti] Title:Quantitative evaluation of facial hypoplasia and airway obstruction in infants with syndromic craniosynostosis: relationship with skull base and splanchnocranium sutural pattern.
[So] Source:Neuroradiology;, 2018 Mar 08.
[Is] ISSN:1432-1920
[Cp] Country of publication:Germany
[La] Language:eng
[Ab] Abstract:PURPOSE: Craniosynostostic syndromes are due to multisuture synostoses and affect the entire craniofacial skeleton. This study analyzed the facial complex and airways to quantify the relationship between insufficient facial growth, airways obstruction, and the sutural pattern of the splanchnocranium and cranial fossae. METHODS: Preoperative high-resolution CT images in 19 infants with syndromic craniosynostosis were quantitatively analyzed. Because all children showed involvement of minor sutures/synchondroses coursing in the posterior cranial fossa, they were divided into three groups according to the synostotic involvement of "minor" sutures/synchondroses coursing in anterior (ACF) and middle (MCF) cranial fossae: group 1 (ACF), group 2 (MCF), and group 3 (ACF-MCF). Analysis of the facial complex and airway was performed. Each group was compared with age-matched healthy subjects. RESULTS: Premature closure of skull base synchondroses of ACF and MCF was found only in groups MCF and ACF-MCF. Group MCF showed synostosis in the posterior branch of the coronal ring and reduced anterior hemifossae lengths while group ACF-MCF showed synostosis in the anterior branch of the coronal ring and reduced middle hemifossae lengths. No group showed reduced maxillary or mandibular volumes but group MCF showed synostosis of the zygomaticomaxillary sutures and maxillary retrusion. All groups showed reduced airway volume but group 2 had a higher degree of airway hypoplasia. CONCLUSION: The skull base synostotic process drives the changes in facial complex growth and airway obstruction. Premature closure of synchondroses/sutures in the posterior branch of the coronal ring causes insufficient facial growth, maxillary retrusion, and more severe airway reduction.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180309
[Lr] Last revision date:180309
[St] Status:Publisher
[do] DOI:10.1007/s00234-018-2005-5

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[PMID]: 29519693
[Au] Autor:Keshishyan S; Mohan A; Ahmed S; Dhillon SS; Patil M; Harris K
[Ad] Address:Pulmonary Critical Care and Sleep Division, Department of Medicine, Westchester Medical Center, Valhalla, NY, USA.
[Ti] Title:Airway Obstruction Caused by Iron Pill Aspiration: An Interventional Pulmonology Approach to Prevent Surgery.
[So] Source:Heart Lung Circ;, 2017 Oct 08.
[Is] ISSN:1444-2892
[Cp] Country of publication:Australia
[La] Language:eng
[Ab] Abstract:Iron Pill Aspiration (IPA) is a challenging medical condition that requires prompt management to prevent detrimental outcomes. One of the most serious complications of IPA is airway inflammation which commonly leads to severe obstruction. Airway complications may require surgical intervention including the resection of the affected lung. Prompt recognition and management of IPA can reduce the risk of airway complications and may prevent the need of a surgical intervention. Bronchoscopic management entails the use of flexible and rigid bronchoscopes along with balloon bronchoplasty, ablation of the inflammatory tissue causing obstruction and airway stenting. In this report, we describe a case of severe airway obstruction secondary to iron pill aspiration with favourable outcome following bronchoscopic multimodalities intervention including temporary airway stenting.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180309
[Lr] Last revision date:180309
[St] Status:Publisher

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[PMID]: 29519647
[Au] Autor:Guthrie AJ; Chai RL
[Ad] Address:Department of Otolaryngology, The New York Eye and Ear Infirmary of Mount Sinai, New York, NY, United States. Electronic address: aguthrie@nyee.edu.
[Ti] Title:Transoral robotic surgery for the treatment of laryngeal chondrosarcoma: A case report.
[So] Source:Am J Otolaryngol;, 2018 Mar 01.
[Is] ISSN:1532-818X
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:IMPORTANCE: Transoral robotic surgery has revolutionized the practice of head and neck surgery over the past decade, with indications now expanding to include laryngeal pathology. Although laryngeal chondrosarcoma is a rare entity, trends in otolaryngology literature suggest that it can frequently be managed with conservative approaches. We hope to inspire other head and neck surgeons to consider transoral robotic surgery for the treatment of such tumors so that outcomes data can be collected and studied. OBSERVATION: An 87-year-old male presented with a left-sided supraglottic mass that was found incidentally on imaging performed for an unrelated reason. Flexible fiberoptic laryngoscopy revealed a cystic-appearing supraglottic mass with near complete obstruction of the glottis airway. Internal review of the imaging demonstrated a 3.5 by 2.3 by 2.8 cm centrally hypodense lesion with a rim of calcification in the left paraglottic space, with resultant narrowing of the laryngeal airway. INTERVENTION: The patient underwent awake tracheostomy and transoral robotic subtotal resection of the mass using the Da Vinci surgical system (Intuitive Surgical Inc., Sunnyvale, CA, USA). The vocal folds, ventricular mucosa, and arytenoid cartilage were grossly preserved. Final pathology revealed a low-grade cartilaginous neoplasm consistent with low-grade chondrosarcoma. CONCLUSIONS AND RELEVANCE: Chondrosarcoma of the larynx is a rare entity that accounts for roughly 1% of laryngeal neoplasms. Recent trends in otolaryngology literature and practice suggest that low-grade chondrosarcomas can be effectively treated with organ-preserving, conservative surgery. Transoral robotic surgery offers numerous advantages over both open and endoscopic approaches. To our knowledge, this is the first report in the literature describing the successful use of transoral robotic surgery for the resection of a laryngeal chondrosarcoma.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180309
[Lr] Last revision date:180309
[St] Status:Publisher

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[PMID]: 29518425
[Au] Autor:Lazarinis N; Bood J; Gomez C; Kolmert J; Lantz AS; Gyllfors P; Davis A; Wheelock CE; Dahlén SE; Dahlén B
[Ad] Address:Division of Respiratory Medicine and Allergy, Department of Medicine, Karolinska University Hospital Huddinge, Stockholm, Sweden. Electronic address: nikolaos.lazarinis@ki.se.
[Ti] Title:Leukotriene E induces airflow obstruction and mast cell activation via the CysLT receptor.
[So] Source:J Allergy Clin Immunol;, 2018 Mar 05.
[Is] ISSN:1097-6825
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:BACKGROUND: Leukotriene E (LTE ) is the final active metabolite among the cysteinyl leukotrienes (CysLTs). Animal studies have identified a distinct LTE receptor, suggesting that current CysLT receptor antagonists may provide incomplete inhibition of CysLT responses. OBJECTIVE: We tested this hypothesis by assessing the influence of the CysLT antagonist montelukast on responses induced by inhalation of LTE in asthmatic subjects. METHODS: Fourteen subjects with mild intermittent asthma and two subjects with aspirin exacerbated respiratory disease (AERD) received montelukast 20 mg bid and placebo for 5-7 days in a randomized, double blind, crossover study (NCT01841164). The provocative dose of LTE causing 20% fall in FEV (PD ) was determined at the end of each treatment period by a rising dose challenge. Measurements included lipid mediators in urine and sputum cells 4 hours post LTE challenge. RESULTS: Montelukast completely blocked the LTE induced bronchoconstriction. Despite tolerating at least 10 times higher dose of LTE after montelukast, there was no difference in the percentage of eosinophils in sputum. The urinary excretion of all major lipid mediators increased after the LTE inhalation. Montelukast blocked the release of the mast cell product prostaglandin (PG) D , as well as the release of PGF , and thromboxane, but not the increased excretion of PGE and its metabolites nor isoprostanes. CONCLUSION: Leukotriene E induces airflow obstruction and mast cell activation via the CysLT receptor. CLINICAL IMPLICATIONS: Clinically available leukotriene antagonists protect against the airway obstruction and the pro-inflammatory effects of the terminal cysteinyl-leukotriene LTE
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180308
[Lr] Last revision date:180308
[St] Status:Publisher

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Clinical Trials Registry
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[PMID]: 29400693
[Au] Autor:Dunican EM; Elicker BM; Gierada DS; Nagle SK; Schiebler ML; Newell JD; Raymond WW; Lachowicz-Scroggins ME; Di Maio S; Hoffman EA; Castro M; Fain SB; Jarjour NN; Israel E; Levy BD; Erzurum SC; Wenzel SE; Meyers DA; Bleecker ER; Phillips BR; Mauger DT; Gordon ED; Woodruff PG; Peters MC; Fahy JV; National Heart Lung and Blood Institute (NHLBI) Severe Asthma Research Program (SARP)
[Ad] Address:Division of Pulmonary and Critical Care Medicine, Department of Medicine and Cardiovascular Research Institute, and.
[Ti] Title:Mucus plugs in patients with asthma linked to eosinophilia and airflow obstruction.
[So] Source:J Clin Invest;128(3):997-1009, 2018 Mar 01.
[Is] ISSN:1558-8238
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:BACKGROUND: The link between mucus plugs and airflow obstruction has not been established in chronic severe asthma, and the role of eosinophils and their products in mucus plug formation is unknown. METHODS: In clinical studies, we developed and applied a bronchopulmonary segment-based scoring system to quantify mucus plugs on multidetector computed tomography (MDCT) lung scans from 146 subjects with asthma and 22 controls, and analyzed relationships among mucus plug scores, forced expiratory volume in 1 second (FEV1), and airway eosinophils. Additionally, we used airway mucus gel models to explore whether oxidants generated by eosinophil peroxidase (EPO) oxidize cysteine thiol groups to promote mucus plug formation. RESULTS: Mucus plugs occurred in at least 1 of 20 lung segments in 58% of subjects with asthma and in only 4.5% of controls, and the plugs in subjects with asthma persisted in the same segment for years. A high mucus score (plugs in ≥ 4 segments) occurred in 67% of subjects with asthma with FEV1 of less than 60% of predicted volume, 19% with FEV1 of 60%-80%, and 6% with FEV1 greater than 80% (P < 0.001) and was associated with marked increases in sputum eosinophils and EPO. EPO catalyzed oxidation of thiocyanate and bromide by H2O2 to generate oxidants that crosslink cysteine thiol groups and stiffen thiolated hydrogels. CONCLUSION: Mucus plugs are a plausible mechanism of chronic airflow obstruction in severe asthma, and EPO-generated oxidants may mediate mucus plug formation. We propose an approach for quantifying airway mucus plugging using MDCT lung scans and suggest that treating mucus plugs may improve airflow in chronic severe asthma. TRIAL REGISTRATION: Clinicaltrials.gov NCT01718197, NCT01606826, NCT01750411, NCT01761058, NCT01761630, NCT01759186, NCT01716494, and NCT01760915. FUNDING: NIH grants P01 HL107201, R01 HL080414, U10 HL109146, U10 HL109164, U10 HL109172, U10 HL109086, U10 HL109250, U10 HL109168, U10 HL109257, U10 HL109152, and P01 HL107202 and National Center for Advancing Translational Sciences grants UL1TR0000427, UL1TR000448, and KL2TR000428.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1802
[Cu] Class update date: 180309
[Lr] Last revision date:180309
[Cl] Clinical Trial:ClinicalTrial
[St] Status:In-Data-Review

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[PMID]: 29197547
[Au] Autor:Gelb AF; Yamamoto A; Verbeken EK; Schein MJ; Moridzadeh R; Tran D; Fraser C; Barbers R; Elatre W; Koss MN; Glassy EF; Nadel JA
[Ad] Address:Pulmonary Division, Department of Medicine, Lakewood Regional Medical Center (LRMC), Lakewood, CA; Geffen School of Medicine at UCLA Medical Center, Los Angeles, CA. Electronic address: afgelb@msn.com.
[Ti] Title:Further Studies of Unsuspected Emphysema in Nonsmoking Patients With Asthma With Persistent Expiratory Airflow Obstruction.
[So] Source:Chest;153(3):618-629, 2018 Mar.
[Is] ISSN:1931-3543
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:BACKGROUND: Previously, we and other investigators have described reversible loss of lung elastic recoil in patients with acute and persistent, moderate-to-severe, chronic, treated asthma who never smoked, and its adverse effect on maximal expiratory airflow. In four consecutive autopsies, we reported the pathophysiologic mechanism(s) has been unsuspected mild, diffuse, middle and upper lobe centrilobular emphysema. METHODS: We performed prospective studies (5 to 22 years) in 25 patients (12 female) with chronic asthma, age 55 ± 15 years, who never smoked, with persistent moderate-to-severe expiratory obstruction. Studies included measuring blood eosinophils, IgE, total exhaled nitric oxide (NO), central airway NO flux, peripheral airway/alveolar NO concentration, impulse oscillometry, heliox curves, lung elastic recoil, and high-resolution thin-section (1 mm) lung CT imaging at full inspiration with voxel quantification. RESULTS: In 25 patients with stable asthma with varying type 2 phenotype, after 270 µg of aerosolized albuterol sulfate had been administered with a metered dose inhaler with space chamber, FVC was 3.1 ± 1.0 L (83% ± 13% predicted) (mean ± SD), FEV was 1.8 ± 0.6 L (59% ± 11%), the FEV /FVC ratio was 59% ± 10%, and the ratio of single-breath diffusing capacity of the lung for carbon monoxide to alveolar volume was 4.8 ± 1.1 mL/min/mm Hg/L (120% ± 26%). All 25 patients with asthma had loss of static lung elastic recoil pressure, which contributed equally to decreased intrinsic airway conductance in limiting expiratory airflow. Lung CT scanning detected none or mild emphysema. In all four autopsied asthmatic lungs previously reported and one unreported explanted lung, microscopy revealed unsuspected mild, diffuse centrilobular emphysema in the upper and middle lung fields, and asthma-related remodeling in airways. In eight cases, during asthma remission, there were increases in measured static lung elastic recoil pressure-calculated intrinsic airway conductance, and measured maximal expiratory airflow at effort-independent lung volumes. CONCLUSIONS: As documented now in five cases, unsuspected microscopic mild centrilobular emphysema is the sentinel cause of loss of lung elastic recoil. This contributes significantly to expiratory airflow obstruction in never-smoking patients with asthma, with normal diffusing capacity and near-normal lung CT scan results. TRIAL REGISTRY: Protocol No. 20070934 and Study No. 1090472, Western Institutional Review Board, Olympia, WA; ClinicalTrials.gov; No. NCT00576069; URL: www.clinicaltrials.gov.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1712
[Cu] Class update date: 180309
[Lr] Last revision date:180309
[Cl] Clinical Trial:ClinicalTrial
[St] Status:In-Data-Review


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