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Case 19
Published in Andrew Solomon, Julia Anstey, Liora Wittner, Priti Dutta, Clinical Cases, 2021
Andrew Solomon, Julia Anstey, Liora Wittner, Priti Dutta
Spirometry is an important tool both for diagnosis but also for the monitoring of disease progression. Although the level of airway obstruction does not correlate well with the extent of the patient's disability, it helps to guide treatment and estimate prognosis.
Bronchoscopy
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Marcus D. Jarboe, James D. Geiger
Airway obstruction can occur while removing a foreign body at the level of the cords. If obstruction occurs, precluding ventilation, use the bronchoscope to push the foreign body back into the trachea and if necessary, further down into the mainstem bronchus.
The immune and lymphatic systems, infection and sepsis
Published in Peate Ian, Dutton Helen, Acute Nursing Care, 2020
Michelle Treacy, Caroline Smales, Helen Dutton
Airway patency can be compromised due to rapidly swelling deep tissues of the mucus membranes and lips known as angioedema. Swelling of the tongue associated with oropharyngeal and laryngeal oedema may also threaten the airway. The patient’s ability to swallow their own saliva should be assessed, and the development of a hoarse voice indicates partial airway obstruction. High-pitched inspiratory noise or stridor is caused by upper airway obstruction and should be immediately recognised and dealt with by summoning urgent help via the peri-arrest or cardiac arrest call systems. Under the direction of the medical team, intramuscular adrenaline and other pharmacology agents should be urgently administered. Worsening signs of airway obstruction include: Swelling of tongue and lips.Hoarseness.Oropharyngeal swelling.
Features of post-obstructive pneumonia in advanced lung cancer patients, a large retrospective cohort
Published in Infectious Diseases, 2023
Marco Moretti, Shauni Wellekens, Silke Dirkx, Karolien Vekens, Johan Van Laethem, Bart Ilsen, Eef Vanderhelst
The most common cause of central airway obstruction is the extension of a tumour into the airway. Bronchogenic carcinomas account for the vast majority; however, oesophageal and thyroid cancers may also be implicated [1,2]. Post-obstructive pneumonia (POP) may occur in patients with airway obstruction. It is defined as an infection of the lung parenchyma distal to a partial or complete bronchial obstruction [3–5]. However, a standardised definition of POP is lacking, and conflicting results are reported in the literature [4–6]. A two-year prospective monocentric study found an incidence of POP among patients diagnosed with community-acquired pneumonia (CAP) of 5.4% [4]. The same study identified a substantial difference in disease presentation between patients affected by POP in comparison to CAP. Fever, sputum production and leukocytosis were less prominent features in patients affected by POP, in contrast to the higher rate of haemoptysis. Furthermore, POP was associated with significantly less favourable outcomes; 16% of patients with POP developed a cavitating lesion and a 30-day mortality up to 40% was reported [4]. In an expert-opinion review, Rolston et al. make a distinction between POP in patients with CAP and POP in patients with advanced lung cancer. The prevalence of POP in the setting of advanced lung cancer may be as high as 40-55% with a more symptomatic clinical presentation [5].
A computational model of upper airway respiratory function with muscular coupling
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2022
Olusegun J. Ilegbusi, Don Nadun S. Kuruppumullage, Matthew Schiefer, Kingman P. Strohl
The model predicts a decrease in the pharyngeal luminal opening from the standing position to the supine position, which results in a reduction in the pressure in the laryngopharynx. This results in an increase in the resistance to the airflow which correlates with the relevant anatomical changes and outcomes relevant to patients with obstructive sleep apnea. We have also assessed the dimensional variations in the upper airway in three different longitudinal sections along the airway namely the tongue level, the epiglottis level, and the larynx level. Out of these three, in this formulation, the epiglottis section exhibits the smallest opening in all three cases considered. This result suggests a possible new location for airway obstruction, which may be examined for its impact on clinical treatment. In the supine position, the narrowing of the airway results in the higher-pressure differential between the internal pressure and the external pressure imposed by the weight of the surrounding tissues, which makes the upper airway behave like a collapsible vessel.
Assessment and treatment of airflow obstruction in patients with chronic obstructive pulmonary disorder: a guide for the clinician
Published in Expert Review of Respiratory Medicine, 2021
The pivotal pharmacological treatment is represented by bronchodilators, long- and ultra-long-acting beta-2 selective adrenergic agonists (LABA or u-LABA) and long- and ultra-long-acting muscarinic receptor antagonists, so-called anticholinergic drugs (LAMA or u-LAMA), topically administered by inhalation as a fine or ultrafine aerosol by different-pressurized metered dispensers (pMDI) or as fine or ultrafine dry powders by different devices (DPI). Primarily, they may induce bronchodilation and/or decrease the bronchomotor tone allowing a reduction of operative lung volumes. Bronchodilators, however, can also improve the mucociliary clearance in different way and indirectly might exert even an anti-inflammatory action, by decreasing the mechanical stress due to dynamic hyperinflation and repeated small airway closure and reopening during tidal breathing [51]. All these mechanisms can exert a favorable effect on various determinants of airway obstruction and its consequences [52].