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Anaesthetic Management of Early-Onset Scoliosis
Published in Alaaeldin (Alaa) Azmi Ahmad, Aakash Agarwal, Early-Onset Scoliosis, 2021
Damarla Haritha, Souvik Maitra
Respiratory System: The deformity of the chest wall leads to a restrictive kind of lung disease due to limitation of the movement of the rib cage upon inspiration and compression of the lung tissue; however mixed or obstructive lung disease may be present in 46% of the patients [10,11]. Altered respiratory mechanics and reduced lung volume leads to restrictive lung disease, and airway narrowing leads to obstructive lung diseases in some cases [12]. Total lung capacity (TLC) is reduced whereas residual volume (RV) usually remains within normal limit, hence RV/TLC ratio is increased [13]. The forced vital capacity (FVC) and forced expiratory volume in the first-second (FEV1) both are reduced so that the ratio of FEV1 /FVC almost remains normal [14]. The reduction in the vital capacity represents the inability to cough and clear lung secretions effectively, leading to frequent lower respiratory tract infections [15]. The limitation of expansion of lung tissue leads to a decrease in respiratory compliance and, when combined with stretching of the intercostal muscles, leads to increase in work of breathing, resulting in decreased tidal volume and increased respiratory rate. The inspiratory capacity is maximally affected, while the functional residual capacity (FRC) is not that severely affected. In severe cases, as the curve progresses, an increase in residual volume may develop due to inadequate expiration as a result of muscle dysfunction.
Effect of Neutrophils on Airway Smooth Muscle Responsiveness
Published in Devendra K. Agrawal, Robert G. Townley, Inflammatory Cells and Mediators in Bronchial Asthma, 2020
Neutrophils are an important feature of the pathology of chronic bronchitis, yet airway hyperreactivity is not invariably increased above that found in the normal population.75,76There does seem to be a relation between the rate of decline in FEV1 (forced expiratory volume in 1 s) and the presence of heightened airway reactivity, but this may mean only that those persons with airway hyperreactivity are at great risk for cigarette-induced airway disease.77,78 Likewise, there is an increased incidence of airway hyperreactivity and atopy in the inflammatory airway disease cystic fibrosis. The role, in any, that neutrophils might play in these disorders will only be eludicated when a more fundamental understanding of how neutrophils might affect nonspecific airway reactivity (NSR) is achieved. Animal models of chronic bronchitis may provide some insight. However, dogs chronically exposed to SO2 develop clinical and pathological evidence of chronic bronchitis while exhibiting a decrease in histamine responsiveness, despite the presence of neutrophils.79
Disorders of the respiratory system
Published in Judy Bothamley, Maureen Boyle, Medical Conditions Affecting Pregnancy and Childbirth, 2020
Pulmonary function is considered to be the most important feature when planning pregnancy, and a full cardiac pulmonary assessment should be made. It is considered that women who have moderate to good lung function defined at FEV1 (Forced Expiratory Volume in 1 second) from 50–70% tolerate pregnancy well41. However, women with pulmonary hypertension, cor pulmonale and poor lung function (FEV1 < 30–40%) should be advised against pregnancy. Implications of the danger of pregnancy and their predicted shortened life-expectancy and period of parenthood should be discussed3,43.
Wearable device for sedentary behavior change in chronic obstructive pulmonary disease is feasible and acceptable
Published in Canadian Journal of Respiratory, Critical Care, and Sleep Medicine, 2023
Wade Michaelchuk, Tracey JF Colella, Roger S. Goldstein, Dina Brooks
The study was approved by the Research Ethics Boards at West Park Healthcare Center (#20-003-WP) and University of Toronto (#40112). Individuals with COPD were recruited from West Park Healthcare Center from October 2020 to November 2021. Previous research participants who had provided consent to be approached about research were contacted by telephone to ascertain interest in study participation. The study coordinator then followed up with potential participants using a scripted overview to assess eligibility for study inclusion. Eligibility requirements were: 1) a spirometrically confirmed physician diagnosis of COPD (post bronchodilator forced expiratory volume in 1 second/forced vital capacity [FEV1/FVC] ratio <0.7), 2) no acute exacerbation within the prior six weeks and 3) able to provide informed consent in English. Informed consent was provided by all participants prior to the study commencing. Demographic and clinical data were retrieved from the participants’ medical records and lung function data were collected in a manner consistent with American Thoracic Society/European Respiratory Society (ATS/ERS) guidelines.19
Role of RAGE and its ligand HMGB1 in the development of COPD
Published in Postgraduate Medicine, 2022
Lin Chen, Xuejiao Sun, Xiaoning Zhong
Chronic Obstructive Pulmonary Disease (COPD) is projected to become the third leading cause of death worldwide by 2030 [1]. Smoking is the main risk factor, but only 20–25% of smokers eventually develop COPD [2].Interestingly, up to 25% of COPD patients have never smoked [1]. Environmental exposure and genetics also play an important role in COPD pathogenesis [1,3]. COPD is characterized by a progressive and irreversible airflow limitation [1]. Common COPD symptoms include dyspnea, cough and/or sputum production. Post-bronchodilator ratio of forced expiratory volume in the first second to forced vital capacity (FEV1/FVC) < 70% is required for a diagnosis of COPD. The small airway diseases (increased bronchial hypersecretion, narrowing and disappearance of small airways, persistent chronic airway inflammation, etc.) and the parenchymal destruction play a role in the pathogenesis of COPD and cause chronic airflow limitation [4]. To date, long-acting inhaled bronchodilators and anti-inflammatory therapies have been the mainstay of COPD therapy, but can’t stop COPD progression, so far, any therapeutic approach of COPD can’t significantly decrease mortality rate [5]. This may reflect the fact that there is still a poor understanding of the underlying disease mechanisms and new molecular targets are urgently needed to deal with this challenge.
Challenges in uncontrolled asthma in pediatrics: important considerations for the clinician
Published in Expert Review of Clinical Immunology, 2022
Beatrice Andrenacci, Giuliana Ferrante, Giulia Roberto, Giorgio Piacentini, Stefania La Grutta, Gian Luigi Marseglia, Amelia Licari
Spirometry is a noninvasive, informative tool in asthma diagnosis. The hallmark of asthma is variable airflow obstruction and bronchial hyperreactivity. In obstructive airway disease, the forced expiratory volume in the 1st second/forced vital capacity ratio (FEV1/FVC) is typically reduced. However, FEV1/FVC should not be considered alone, because it cannot convey whether one or both components are within normal limits or not. When spirometry shows reduced values, a bronchodilator test should be performed to assess reversibility; an increase in FEV1 of ≥12% is considered significant according to ERS/ ATS standards [105]. However, in children, the sensitivity and specificity of this cutoff are under debate [91]. However, it should be pointed out that GINA documents still recommend symptom-based asthma management versus spirometry-based management [14].