Assessment of upper airway obstruction by measuring peak oral and nasal inspiratory flow

2015 ◽  
Vol 129 (5) ◽  
pp. 473-477 ◽  
Author(s):  
S Bathala ◽  
R Eccles
Keyword(s):  
Airway Obstruction ◽  
Phase Ii ◽  
Flow Rate ◽  
Upper Airway ◽  
Inspiratory Flow ◽  
Upper Airway Obstruction ◽  
University Hospital ◽  
Inspiratory Flow Rate ◽  
Efficacy Measures ◽  
Study Participants

AbstractObjective:We wanted to access upper airway obstruction in patients undergoing tonsillectomy by measuring peak oral and nasal inspiratory airflow.Methods:We recruited study participants from a cohort of patients on the waiting list for tonsillectomy, with or without adenoidectomy, at University Hospital of Wales, Cardiff, UK. Fifty patients enrolled on phase I of the study and underwent pre-operative measurement of the rate of peak oral and nasal inspiratory flow; 25 of these patients returned after one month for phase II of the study and underwent post-operative measurement of the rate of both peak oral and nasal inspiratory flow.Results:Of the 25 participants who completed phase II of the study, 17 (68 per cent) showed an increase in post-operative peak oral inspiratory flow rate by an average of 45 per cent, while 18 (72 per cent) showed an increase in post-operative peak nasal inspiratory flow rate by an average of 22 per cent.Conclusion:Both peak oral and nasal inspiratory flow rate measurements may be useful measures of oral and nasal obstruction. Further larger studies are needed to develop these measurements as screening and efficacy measures for adenotonsillectomy to relieve upper airway obstruction.

Mouth and nose resistance in newborn kittens and puppies

1981 ◽  
Vol 51 (3) ◽  
pp. 641-645 ◽  
Author(s):  
J. P. Mortola ◽  
J. T. Fisher
Keyword(s):  
Mechanical Properties ◽  
Airway Obstruction ◽  
Flow Rate ◽  
Muscle Tone ◽  
Upper Airway ◽  
Upper Airway Obstruction ◽  
Upper Airways ◽  
Airway Patency ◽  
The Difference ◽  
Adult Cats

Newborn mammals, including infants, have difficulties in mouth breathing when the nasal passages are occluded. In this study we examined the possibility that differences in the passive mechanical properties of the upper airways could fully explain this behavior. Steady inspiratory flows through the upper airways in anesthetized supine newborn kittens and puppies resulted in upper airway obstruction, even at flows less than those occurring during resting breathing, suggesting that in the unanesthetized condition muscle tone plays an important role in maintaining upper airway patency. Mouth (Rm) and nose (Rn) resistances have been measured during steady expiratory flows with nostrils closed and mouth passively open or nostrils open and mouth closed. In all the newborns, Rn was substantially smaller than Rm. In contrast, the Rn/Rm in adult dogs is greater than unity. In adult cats Rn/Rm is above or below unity depending upon the flow rate, but the ratio is always larger than in newborn kittens. The difference between newborns and adults is entirely due to the small Rn of the newborn, as Rm is not greater in the newborn than in the adult. We conclude that the obligatory nose breathing behavior of newborns is not fully explained by the passive mechanical properties of the upper airways.

Accelerometry of Adductor Pollicis Muscle Predicts Recovery of Respiratory Function from Meeting Abstracts

2003 ◽  
Vol 98 (6) ◽  
pp. 1333-1337 ◽  
Author(s):  
Matthias Eikermann ◽  
Harald Groeben ◽  
Johannes Hüsing ◽  
Jürgen Peters
Keyword(s):  
Airway Obstruction ◽  
Neuromuscular Blockade ◽  
Forced Vital Capacity ◽  
Respiratory Function ◽  
Vital Capacity ◽  
Upper Airway ◽  
Inspiratory Flow ◽  
Upper Airway Obstruction ◽  
Residual Paralysis ◽  
Adductor Pollicis Muscle

Background Residual paralysis increases the risk of pulmonary complications but is difficult to detect. To test the hypothesis that accelerometry predicts effects of residual paralysis on pulmonary and upper airway function, the authors related tests of pulmonary and pharyngeal function to accelerometry of adductor pollicis muscle in 12 partially paralyzed volunteers. Methods Rocuronium (0.01 mg/kg + 2-10 microg x kg-1 x min-1) was administered to maintain train-of-four (TOF) ratios (assessed every 15 s) of approximately 0.5 and 0.8 over a period of more than 5 min. The authors evaluated pharyngeal and facial muscle functions during steady state relaxation and performed spirometric measurements every 5 min until recovery. Upper airway obstruction was defined as a mean ratio of expiratory and inspiratory flow at 50% of vital capacity of greater than 1. The TOF ratio associated with "acceptable" pulmonary recovery (forced vital capacity and forced inspiratory volume in 1 s of > or =90% of baseline) was calculated using a linear regression model. Results At peak blockade (TOF ratio 0.5 +/- 0.16), forced inspiratory flow was impaired (53 +/- 19%) to a greater degree than forced expiratory flow (75 +/- 20%) with a mean ratio of expiratory and inspiratory flow at 50% of vital capacity of 1.18 +/- 0.6. Upper airway obstruction, observed in 8 of 12 volunteers, paralleled an impaired ability to swallow reported by 10 of 12 volunteers. In contrast, all volunteers except one could sustain a head lift for more than 5 s. The authors calculated that a mean TOF ratio of 0.56 (95% confidence interval, 0.22-0.71) predicts "acceptable" recovery of forced vital capacity, whereas forced inspiratory volume in 1 s was impaired until a TOF ratio of 0.95 (0.82-1.18) was reached. A 100% recovery of TOF ratio predicts an acceptable recovery of forced vital capacity, forced inspiratory volume in 1 s, and mean ratio of expiratory and inspiratory flow at 50% of vital capacity in 93%, 73%, and 88% of measurements (calculated negative predictive values), respectively. Conclusion Impaired inspiratory flow and upper airway obstruction frequently occur during minimal neuromuscular blockade (TOF ratio 0.8), and extubation may put the patient at risk. Although a TOF ratio of unity predicts a high probability of adequate recovery from neuromuscular blockade, respiratory function can still be impaired.

Analysis of Inspiratory Flow Shapes in Patients With Partial Upper-Airway Obstruction During Sleep

CHEST Journal ◽  
2001 ◽  
Vol 119 (1) ◽  
pp. 37-44 ◽  
Author(s):  
Tero Aittokallio ◽  
Tarja Saaresranta ◽  
Päivi Polo-Kantola ◽  
Olli Nevalainen ◽  
Olli Polo
Keyword(s):  
Airway Obstruction ◽  
Upper Airway ◽  
Inspiratory Flow ◽  
Upper Airway Obstruction ◽  
Partial Upper Airway Obstruction

Assessment of Changes in Upper Airway Obstruction by Automatic Identification of Inspiratory Flow Limitation During Sleep

2009 ◽  
Vol 56 (8) ◽  
pp. 2006-2015 ◽  
Author(s):  
Christian Morgenstern ◽  
Matthias Schwaibold ◽  
Winfried J. Randerath ◽  
Armin Bolz ◽  
Raimon Jane
Keyword(s):  
Airway Obstruction ◽  
Upper Airway ◽  
Inspiratory Flow ◽  
Upper Airway Obstruction ◽  
Automatic Identification ◽  
Flow Limitation

Upper airway obstruction assessment: Peak inspiratory flow and clinical COPD Questionnaire

2018 ◽  
Vol 43 (5) ◽  
pp. 1303-1311
Author(s):  
J. Sanchez-Guerrero ◽  
J. Guerlain ◽  
S. Samaha ◽  
A. Burgess ◽  
J. Lacau St Guily ◽  
...  
Keyword(s):  
Airway Obstruction ◽  
Upper Airway ◽  
Inspiratory Flow ◽  
Upper Airway Obstruction ◽  
Peak Inspiratory Flow

Inspiratory Flow Volume Loops and the Diagnosis of Upper Airway Obstruction

2008 ◽  
Vol 15 (5) ◽  
pp. 274-282 ◽  
Author(s):  
Carl R. Pavel ◽  
Michael J. Morris ◽  
Karin L. Nicholson ◽  
Jackie A. Hayes
Keyword(s):  
Airway Obstruction ◽  
Upper Airway ◽  
Inspiratory Flow ◽  
Upper Airway Obstruction ◽  
Flow Volume

scholarly journals The effect of leptin replacement on sleep-disordered breathing in the leptin-deficient ob/ob mouse

2016 ◽  
Vol 120 (1) ◽  
pp. 78-86 ◽  
Author(s):  
H. Pho ◽  
A. B. Hernandez ◽  
R. S. Arias ◽  
E. B. Leitner ◽  
S. Van Kooten ◽  
...  
Keyword(s):  
Airway Obstruction ◽  
Duty Cycle ◽  
Rem Sleep ◽  
Minute Ventilation ◽  
Upper Airway ◽  
Neuromuscular Control ◽  
Inspiratory Flow ◽  
Upper Airway Obstruction ◽  
Airflow Limitation ◽  
Breathing Patterns

Obese leptin-deficient ( ob/ob) mice demonstrate defects in upper airway structural and neuromuscular control. We hypothesized that these defects predispose to upper airway obstruction during sleep, and improve with leptin administration. High-fidelity polysomnographic recordings were conducted to characterize sleep and breathing patterns in conscious, unrestrained ob/ob mice (23 wk, 67.2 ± 4.1 g, n = 13). In a parallel-arm crossover study, we compared responses to subcutaneous leptin (1 μg/h) vs. vehicle on respiratory parameters during NREM and REM sleep. Upper airway obstruction was defined by the presence of inspiratory airflow limitation (IFL), as characterized by an early inspiratory plateau in airflow at a maximum level (V̇imax) with increasing effort. The severity of upper airway obstruction (V̇imax) was assessed along with minute ventilation (V̇e), tidal volume (VT), respiratory rate (RR), inspiratory duty cycle, and mean inspiratory flow at each time point. IFL occurred more frequently in REM sleep (37.6 ± 0.2% vs. 1.1 ± 0.0% in NREM sleep, P < 0.001), and leptin did not alter its frequency. V̇imax (3.7 ± 1.1 vs. 2.7 ± 0.8 ml/s, P < 0.001) and V̇e increased (55.4 ± 22.0 vs. 39.8 ± 16.4 ml/min, P < 0.001) with leptin vs. vehicle administration. The increase in V̇e was due to a significant increase in VT (0.20 ± 0.06 vs. 0.16 ± 0.05 ml, P < 0.01) rather than RR. Increases in V̇e were attributable to increases in mean inspiratory flow (2.5 ± 0.8 vs. 1.8 ± 0.6 ml/s, P < 0.001) rather than inspiratory duty cycle. Similar increases in V̇e and its components were observed in non-flow-limited breaths during NREM and REM sleep. These responses suggest that leptin stabilized pharyngeal patency and increased drive to both the upper airway and diaphragm during sleep.

scholarly journals ADVANCEMENTS IN DRY POWDER INHALER

2017 ◽  
Vol 10 (2) ◽  
pp. 8 ◽  
Author(s):  
Ganga Srinivasan ◽  
Advait Shetty
Keyword(s):  
Flow Rate ◽  
Large Fraction ◽  
Dry Powder Inhaler ◽  
Upper Airway ◽  
Inspiratory Flow ◽  
Systemic Absorption ◽  
Chronic Obstructive ◽  
Inspiratory Flow Rate ◽  
Dry Powder ◽  
Related Factors

The dry powder inhaler (DPI) has become widely known as a very attractive platform for drug delivery. DPIs are being used for the treatment of asthma and chronic obstructive pulmonary disease by many patients. There are over 20 devices presently in the DPI market. DPIs are preferred over nebulizers and pressurized metered dose inhalers. However, some of the challenges of DPI are dependence on inspiratory flow (unsuitable for young children, elderly people), systemic absorption due to deposition of drug in deep lung (unsuitable for local diseases treatment), and increase in upper airway deposition of a large fraction of coarse particles. Hence, there is a need to address these unmet issues. The interpatient variation can be minimized by developing devices independent of patient’s inspiratory flow rate or active based powder mechanism. This article reviews DPI devices currently available, advantages of newly developed devices, and formulation technologies. The platform technologies are developed to improve aerosolization and dispersion from the device and decrease the patient related factors. The DPI delivery system has been expanded to treatment of non-respiratory diseases such as migraine and diabetes. The development of innovative DPI device and formulation technologies for delivering therapeutic proteins such as insulin has been accelerated to overcome the problems associated with conventional insulin therapy.Keywords: Dry powder inhaler, Inspiratory flow rate, Insulin, Platform technologies.

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