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Diagnostic tests in respiratory medicine
Published in Vibeke Backer, Peter G. Gibson, Ian D. Pavord, The Asthmas, 2023
Vibeke Backer, Peter G. Gibson, Ian D. Pavord
The three most common causes of chronic cough are upper airway cough syndrome, asthma and GERD, but there are often multiple causes. Furthermore, acute viral cough is the costliest healthcare problem. Acute cough is defined as more than 3 weeks of symptoms; subacute is indicated by 3–8 weeks of symptoms and longer than 8 weeks is defined as a chronic cough. Chronic cough can be triggered and arise anywhere in the bronchial tree.
Pulmonary Tuberculosis
Published in Lloyd N. Friedman, Martin Dedicoat, Peter D. O. Davies, Clinical Tuberculosis, 2020
Charles S. Dela Cruz, Barbara Seaworth, Graham Bothamley
Bronchiectasis was originally defined as the production of more than a cupful of purulent sputum daily, usually with finger clubbing to indicate chronic sepsis. A radiological definition correlating with the pathological finding of dilated bronchial tubes was achieved by lipoidal bronchography.68 As high-resolution CT scanning with 1–3 mm sections became more widespread, a radiological definition of an airway greater than the accompanying pulmonary artery became the standard,69 usually with bronchial wall thickening, air-fluid levels or mucus impaction, loss of definition of blood vessels due to peri-bronchial fibrosis and evidence of infection.70 Most CT scans were performed for minor hemoptysis or a persistent cough. Transitory bronchiectasis in pneumonia and atelectasis occurs, so that a single CT scan may over-estimate the presence of bronchiectasis. The cause of bronchiectasis appears to be obstruction of the airway such that infected mucus cannot be expectorated, leading to a cycle of chronic inflammation. The relative contribution of TB to bronchiectasis varies according to its local incidence.71
Adhesion Molecule Antagonists in Animal Models of Asthma
Published in Bruce S. Bochner, Adhesion Molecules in Allergic Disease, 2020
Asthma is a common chronic disease causing narrowing of the bronchial tree; it is characterized by acute episodes of bronchial constriction and increased mucus production, linked to an underlying airways hypersensitivity (1–4). With the recent recognition that asthma is a disease with a significant inflammatory component (1,2), inhaled steroids have become the treatment of choice (3). However, although symptoms in many patients are well controlled with inhaled steroids and β-agonists, there remains a significant role for novel anti-inflammatories in the treatment of asthma in certain patient populations (1–5). Basic research has begun to focus on the mechanisms of infiltration and activation within the lung of eosinophils and mononuclear leukocytes, which contribute to and characterize the underlying inflammatory state. Because adhesion molecules play key roles in this process, much attention has focused on their role in leukocyte recruitment and activation in vivo. Here we review some of the key publications that document the critical role of adhesion molecules in animal models of allergic airways disease.
Pediatric bronchoscopy: recent advances and clinical challenges
Published in Expert Review of Respiratory Medicine, 2021
P Goussard, P Pohunek, E Eber, F Midulla, G Di Mattia, M Merven, JT Janson
Symptoms of FBA can be very variable from immediate serious asphyxia to mild coughing. There may even be no symptoms at all, and the foreign body (FB) is only detected after some late symptoms develop, such as pneumonia. The severity of symptoms is determined by the size of a foreign body and its location in the tracheo-bronchial tree. Mostly the acute clinical symptoms are coughing, variable dyspnea, stridor, localized wheezing. On examination, there may be unilateral decrease of air entry on auscultation, localized wheezing, localized or unilateral hyperinflation on chest X-ray. The prognosis of an FBA depends on the size and nature of the aspirated FB, its location, and the time from FBA to extraction. Some urgent lay interventions have been described, such as Heimlich maneuver with chest compression or tapping the back in prone position in infants. This may help for acute relief; however never can fully replace an endoscopy.
Fluoroscopy guided percutaneous biopsy in combination with bronchoscopy and endobronchial ultrasound in the diagnosis of suspicious lung lesions – the triple approach
Published in European Clinical Respiratory Journal, 2020
Jatinder Singh Sidhu, Geir Salte, Ida Skovgaard Christiansen, Therese Marie Henriette Naur, Asbjørn Høegholm, Paul Frost Clementsen, Uffe Bodtger
Bronchoscopy and EBUS-TBNA were performed under conscious sedation by the administration of midazolam and fentanyl intravenously in an ambulatory setting. Bronchoscopy was performed in all patients, since the surgeons demand an inspection of the bronchial tree in all patients who may be potential candidates for surgery. The patients received additional oxygen during the procedures. Oxygen saturation and pulse were monitored. The bronchoscopy was only supplemented with EBUS-TBNA if indicated according to the European Guidelines [1] (for example abnormal hilar or mediastinal lymph nodes/centrally located lung tumor). Bronchoscopy was performed with an Olympus BF-1T180 (Olympus XBF-UC40P; Olympus Medical Systems Europe Ltd., Hamburg, Germany), and EBUS-TBNA was performed with a flexible ultrasound bronchoscope (Olympus XBF-UC40P; Olympus Medical Systems Europe Ltd., Hamburg, Germany) using a 22-G Olympus NA-200C needle with biopsy sampling according to guidelines [13].
Current challenges in managing comorbid heart failure and COPD
Published in Expert Review of Cardiovascular Therapy, 2018
J. Alberto Neder, Alcides Rocha, Maria Clara N. Alencar, Flavio Arbex, Danilo C. Berton, Mayron F. Oliveira, Priscila A. Sperandio, Luiz E. Nery, Denis E. O’Donnell
A patient with COPD usually shows a complex combination of airway disease (chronic bronchitis) and alveolar-capillary destruction (emphysema). Chronic bronchitis diminishes the total cross-sectional area of the bronchial tree, which increases the airway resistance. Emphysema decreases the elastic forces that drive air out of the lungs; moreover, loss of alveolar attachments makes the non-cartilaginous, intra-parenchymal small airways (<2 mm) easily collapsible as the lungs empty [17]. Thus, both chronic bronchitis and emphysema contribute to airflow limitation and a slow rate of lung emptying [18]. Consequently, the expiratory time becomes insufficient to allow full exhalation, meaning that a fraction of the inspired air is trapped within the lungs (lung hyperinflation) [19]. Those abnormalities are best appreciated after a forced expiration but, as the disease progresses, they can be present even at the end of a normal, relaxed expiration [20]. The lungs also become less-efficient gas exchangers due to an increased mismatch between ventilation and perfusion and/or loss of alveolar-capillary membrane [20].