scholarly journals Upper airway obstruction in patients with endothoracic goiter enlargement: no relationship between flow-volume loops and radiological tests

2010 ◽  
Vol 163 (4) ◽  
pp. 665-669 ◽  
Author(s):  
M Albareda ◽  
J Viguera ◽  
C Santiveri ◽  
P Lozano ◽  
A Mestrón ◽  
...  
Keyword(s):  
Airway Obstruction ◽  
Vital Capacity ◽  
Visual Analysis ◽  
Upper Airway ◽  
Forced Expiratory Volume ◽  
Upper Airway Obstruction ◽  
Flow Volume ◽  
Flow Parameters ◽  
Forced Expiratory Flow ◽  
Expiratory Flow

BackgroundIn about 16–85% of subjects with goiter, upper airway obstruction (UAO) is observed. This percentage is higher in patients affected by goiter with endothoracic enlargement. UAO is an indication for surgery. Visual analysis of flow-volume loops (FVL) are the best indicators for UAO, although various studies using clinical and radiological parameters have observed no correlation.ObjectiveTo evaluate the presence of UAO in patients with endothoracic goiter enlargement and the relationship between the FVL with the observed symptoms and the measurements obtained by computed tomography (CT).SubjectsSubjects with endothoracic goiter enlargement participated in the study.Designi) Symptom questionnaire (dysphagia, dyspnea, cough, oppression, dysphonia, and worsened symptoms when prone); ii) analysis: TSH and free thyroxine; iii) cervical ultrasound; iv) cervical-thoracic CT (measurements of area and diameter in the area of maximum stenosis and at 2 cm from the carina); v) chest radiography and vi) forced spirometry: visual analysis of FVL morphology and the maximum forced expiratory volume in 1 s (FEV1), forced expiratory flow at 50% vital capacity/forced inspiratory flow at 50% vital capacity and FEV1/peak expiratory flow parameters.ResultsFifty subjects participated in the study: 11 men/39 women, median age 73.8 years (43.76–88.43). UAO was diagnosed in 13 cases (26%, confidence interval: 14.6–40.3%) and 27 subjects (54%) presented symptoms suggesting goiter compression. No clinical or radiological variables showed the presence of UAO.ConclusionsThe frequency of UAO in subjects affected by goiter with endothoracic enlargement was lower than that described for goiter patients, and there were no clinical or radiological indicators to establish its presence.

Effects of aerosol methacholine and histamine on airways and lung parenchyma in healthy humans

1993 ◽  
Vol 74 (6) ◽  
pp. 2681-2686 ◽  
Author(s):  
R. Pellegrino ◽  
B. Violante ◽  
E. Crimi ◽  
V. Brusasco
Keyword(s):  
Vital Capacity ◽  
Transpulmonary Pressure ◽  
Lung Parenchyma ◽  
Forced Expiratory Volume ◽  
Flow Volume ◽  
Tissue Properties ◽  
Bronchodilator Effect ◽  
Healthy Humans ◽  
Forced Expiratory Flow ◽  
Expiratory Flow

To investigate whether histamine (His) and methacholine (MCh) have different effects on airways and lung parenchyma, 11 healthy subjects were given aerosol MCh until a response plateau was obtained and then two doses of His. At the plateau, forced expiratory volume in 1 s and forced expiratory flow at 40% of vital capacity from partial flow-volume curves were reduced by 19 +/- 3 (SE) and 80 +/- 4%, respectively. Aerosol His decreased forced expiratory volume in 1 s by an additional 12 +/- 1% but left partial forced expiratory flow unchanged. The bronchodilator effect of deep inhalation, as inferred from the ratio of forced expiratory flow from maximal to that from partial flow-volume curves, increased after MCh and plateaued but decreased after His. Quasi-static transpulmonary pressure-volume area determined in seven subjects was unchanged after MCh but was increased by 57 +/- 10% after His. We conclude that adding His after the response to MCh plateaued does not increase the maximal degree of bronchoconstriction but may increase parenchymal hysteresis, thus blunting the bronchodilator effect of deep inhalation. These results suggest that His and MCh have similar effects on airway smooth muscle but different effects on lung tissue properties.

Upper airway obstruction

2020 ◽  
pp. 4040-4048
Author(s):  
James H. Hull ◽  
Matthew Hind
Keyword(s):  
Airway Obstruction ◽  
Tracheal Stenosis ◽  
Upper Airway ◽  
Normal Function ◽  
Forced Expiratory Volume ◽  
Upper Airway Obstruction ◽  
Smoke Inhalation ◽  
Medical Emergency ◽  
Retropharyngeal Abscess ◽  
High Index Of Suspicion

The upper airway is anatomically defined by the carina inferiorly and pharynx superiorly, with pathology predominately arising from the trachea and larynx. Obstruction of the upper airway may arise because of a fixed structural pathology such as tracheal stenosis or malignancy, but can arise following loss of normal function (e.g. inappropriate vocal cord adduction). A high index of suspicion is required to make the diagnosis because the clinical features of upper airway obstruction can mimic other respiratory conditions. Calculation of the ratio of forced expiratory volume in one second to peak expiratory flow (Empey index) may identify patients with unsuspected upper airway obstruction. Acute upper airway obstruction is a medical emergency and usually caused by aspiration, oedema (allergic, hereditary, and acquired angio-oedema, smoke inhalation), or infection (croup, epiglottitis, quinsy, retropharyngeal abscess). Non-acute causes of upper airway obstruction include malignancy, tracheal stenosis, tracheal compression, dynamic large airway collapse, and laryngeal dysfunction.

scholarly journals The Value of Spirometry in Subglottic Stenosis

2019 ◽  
Vol 98 (2) ◽  
pp. 98-101 ◽  
Author(s):  
Alhelali Abdullah ◽  
A. Alrabiah ◽  
Sayed S. Habib ◽  
Y. Aljathlany ◽  
A. Aljasser ◽  
...  
Keyword(s):  
Upper Airway ◽  
Forced Expiratory Volume ◽  
Endoscopic Examination ◽  
Subglottic Stenosis ◽  
King Saud University ◽  
Medical City ◽  
Forced Expiratory Flow ◽  
Surgery Outcomes ◽  
Expiratory Flow ◽  
Grade 3

The diagnosis of subglottic stenosis (SGS) is usually made by clinical assessment and definitively by a direct endoscopic examination. This study aimed to evaluate different spirometric values in relation to anatomical grading and severity of subglottic stenosis cases of upper airway obstruction. Cases of SGS that underwent dilatational procedures endoscopically at the otolaryngology department of the King Saud University Medical City, Riyadh, Saudi Arabia, from June 2015 to October 2017 were collected. Pulmonary function test (PFT) pre- and postoperative parameters and the grades of subglottic stenosis were extracted. We compared different spirometric values to the severity of SGS and compared the pre- and postoperative results for each patient. There were 19 cases with a valid PFT study within 7 days preoperatively in addition to a documented intraoperative grading according to the Myer-Cotton grading system; 7 (36.8%) were grade 1, 8 (42.1%) were grade 2, and 4 (21.1%) were grade 3. The actual preoperative ratio of forced expiratory volume (FEV1) in 1 second to peak expiratory flow (PEF) for all 19 patients ranged from 7.34 to 21.40 mL/L/min. We found a significant improvement in all spirometric parameters postdilatation including PEF ( P < .001), FEV1 ( P < .001), FEV1/PEF ( P = .001), forced expiratory flow (FEF) from 25%, 50%, and 75% of vital capacity, respectively, FEF25 ( P < .001), FEF50 ( P = .001), FEF75 ( P = .048), and maximum mid-expiratory flow ( P = .002). We did not find any correlation between the severity of stenosis and spirometric values. This study revealed that spirometry is a useful marker in following up patients with subglottic stenosis and is also a good indicator to determine postairway surgery outcomes. However, these markers do not correlate with anatomical grading and the severity of subglottic stenosis.

Improvement of upper airway obstruction after 131I-treatment of multinodular nontoxic goiter evaluated by flow volume loop curves

1996 ◽  
Vol 19 (2) ◽  
pp. 71-75 ◽  
Author(s):  
Birte Nygaard ◽  
U. Søes-Petersen ◽  
P. F. Høilund-Carlsen ◽  
A. Veje ◽  
P. E. Holst ◽  
...  
Keyword(s):  
Airway Obstruction ◽  
Upper Airway ◽  
Upper Airway Obstruction ◽  
Flow Volume ◽  
Nontoxic Goiter ◽  
131I Treatment ◽  
Flow Volume Loop

Relationship of ventilatory capacity to hyperbaric exposure in divers

1984 ◽  
Vol 56 (6) ◽  
pp. 1655-1658 ◽  
Author(s):  
I. S. Davey ◽  
J. E. Cotes ◽  
J. W. Reed
Keyword(s):  
Flow Rate ◽  
Vital Capacity ◽  
Positive Association ◽  
Forced Expiratory Volume ◽  
Elastic Tissue ◽  
Significant Positive Association ◽  
Cross Sectional ◽  
Maximal Depth ◽  
Forced Expiratory Flow ◽  
Expiratory Flow

The results of divers' annual medical examinations were used to assess the effects of diving exposure independent of age, stature, and smoking on forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1). Cross-sectional analysis of records for 858 men showed a significant positive association between the maximal depth that subjects had experienced and FVC but not FEV1. There was a significant negative association for FEV1/FVC%, and this index was also positively correlated with years of diving exposure. Among a subsample of 81 men the forced expiratory flow rate at low lung volume was reduced relative to that of control subjects similarly assessed; the extent of the reduction from the reference value was significantly correlated with the diving exposure. Longitudinal analysis of results for 255 men over a minimum of 5 yr showed that the change in FVC per annum (positive or negative) was correlated with the change in maximal depth; there were no similar associations for FEV1 or FEV1/FVC%. Thus diving exposure affects the vital capacity and the forced expiratory flow rate at small lung volumes. The latter is evidence for narrowing of airways that might be secondary to diving-induced loss of lung elastic tissue; this hypothesis merits further investigation.

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 &gt; 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.

An assessment of forced expiratory volumes and flow rates in the detection of early ventilatory impairment in RN submariners

1985 ◽  
Vol 71 (3) ◽  
pp. 167-170
Author(s):  
R. Herrmann ◽  
G. M. Clifford ◽  
D. J. Smith ◽  
Caroline S. M. Searing
Keyword(s):  
Forced Vital Capacity ◽  
Vital Capacity ◽  
Linear Regression Analysis ◽  
Smoking Habit ◽  
Multiple Linear Regression Analysis ◽  
Forced Expiratory Volume ◽  
Single Breath ◽  
Forced Expiratory Flow ◽  
Expiratory Flow ◽  
Highly Correlated

AbstractA prospective study of an early diagnostic test of small airway dysfunction, the forced expiratory flow between 75 and 85% of the forced vital capacity, was carried out in 230 RN submariners. All the subjects were male caucasians, of whom 105 were smokers and 125 non-smokers. Measurements were performed using a single breath wedge spirometer (Vitalograph®) and forced vital capacity (FVC), forced expiratory volume in one second (FEV1), ratio of the FEV1 to the FVC (FEV1/FVC%) and the forced expiratory flow between 75 and 85% of the forced vital capacity (FEF75–85) obtained from the tracings in accordance with the recommendations of the American Thoracic Society. Multiple linear regression analysis of these four measurements together with height, age and smoking habit showed age to be the most significant factor for FEF75–85, followed by height Height was the most significant factor for FVC and FEV1 followed by age. Age was the only significant factor for FEV1/FVC%. FEF75-85 was highly correlated with FEV1/FVC% (r = 0.72) and to a lesser extent with FEV1 and FVC (r = 0.70 and 0.37 respectively). In the presence of age and height no significant effect of smoking habit on FEF75–85 could be demonstrated. However when the FEV1/FYC%, age and smoking habit were examined, there was found to be a significantly greater decrease in FEV1/FYC% with age in the smokers. It would appear that in this study FEV1/FVC% is a more sensitive index of early obstructive changes induced by smoking than measurement of flow at low lung volumes.

scholarly journals EVALUATION OF ADENOIDS BY ORONASAL AND NASAL SPIROMETRY

2018 ◽  
Vol 11 (10) ◽  
pp. 272 ◽  
Author(s):  
Gayatri Devi R ◽  
Sethu G
Keyword(s):  
Flow Rate ◽  
Upper Airway ◽  
Cost Effective ◽  
Forced Expiratory Volume ◽  
Adenoid Hypertrophy ◽  
Before And After ◽  
Forced Expiratory Flow ◽  
Expiratory Flow ◽  
Age Range ◽  
Peak Inspiratory Flow Rate

Objectives: The main aim of this study is to compare the oronasal and nasal spirometry among adenoid hypertrophy children before and after surgery.Methods: A total of 40 healthy and 40 adenoid hypertrophy children were recruited for this study with the age range from 6 to 15 years. All the children were examined by two measurements (1) oronasal spirometry and (2) nasal spirometry. Forced vital capacity (FVC), forced expiratory volume in 1 s (FEV 1), FEV 1/FVC%, forced expiratory time (FET), peak expiratory flow rate, peak inspiratory flow rate (PIFR), and forced expiratory flow (FEF)25-75, FEF25%, FEF50%, FEF75%, FIF25%, FIF50%, and FIF75% were recorded.Results: All the parameters were significantly reduced in adenoid hypertrophy by nasal spirometry when compared to oronasal spirometry. FEV1/ FVC% was insignificant from oral to nasal values among adenoid hypertrophy in both the sexes. FET can act as an indicator for upper airway obstruction which shown significantly in adenoid hypertrophy but insignificant among control and adenoidectomy. Inspiratory parameters also had shown more variation in nasal than oronasal spirometry.Conclusion: Significant differences were found in many parameters between oronasal and nasal spirometry among adenoids and adenoidectomy. Nasal spirometry is a portable one, simple, and less cost-effective and so it can be used to determine the obstruction in the nose nasopharynx region.

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