Aspiração de Corpo Estranho no Idoso

Foreign body aspiration is common in children and in the elderly, who may present with subtle symptoms. Clinical suspicion is crucial and bronchoscopy is the main diagnostic and therapeutic procedure available. This is the case of a man, 78 years old, with a history of chronic obstructive pulmonary disease, who presented with respiratory distress following oral intake of tablets. History taking and physical examination raised suspicion. The diagnosis was confirmed with flexible bronchoscopy and rigid bronchoscopy was carried out for treatment. The patient’s condition is stable and he is under investigations for dysphagia.

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Stridor and respiratory failure due to tracheobronchomalacia: case report and review of the literature

Sao Paulo Medical Journal ◽

10.1590/s1516-31802012000100011 ◽

2012 ◽

Vol 130 (1) ◽

pp. 61-64 ◽

Cited By ~ 1

Author(s):

Ramon Andrade de Mello ◽

Adriana Magalhães ◽

Abílio José Vilas-Boas

Keyword(s):

Case Report ◽

Respiratory Failure ◽

Rare Case ◽

Rigid Bronchoscopy ◽

Chronic Obstructive ◽

Review Of The Literature ◽

Cross Sectional ◽

Obstructive Pulmonary Disease ◽

Copd Patients ◽

History Of

CONTEXT: Tracheobronchomalacia (TBM) results from structural and functional abnormalities of the respiratory system. It is characterized by excessive collapse: at least 50% of the cross-sectional area of the trachea and main bronchi. In this paper, we present a rare case of a patient with TBM who first presented with stridor and respiratory failure due to exacerbation of chronic bronchitis. CASE REPORT: An 81-year-old Caucasian man was admitted presenting coughing, purulent sputum, stridor and respiratory failure. He had a medical history of chronic obstructive pulmonary disease (COPD) and silicosis and was a former smoker. Axial computed tomography on the chest revealed marked collapse of the trachea in its middle third. Bronchoscopy showed characteristics compatible with TBM. He was treated with noninvasive ventilation, without any good response. Subsequently, a Dumon Y stent was placed by means of rigid bronchoscopy. After the procedure, he was discharged with a clinical improvement. CONCLUSION: TBM is fatal and often underdiagnosed. In COPD patients, stridor and respiratory failure may be helpful signs that should alert physicians to consider TBM as an early diagnosis. Thus, these signs may be important for optimizing the treatment and evolution of such patients.

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Aplasia - Congenital Lung Abnormality with Non-Development

Internet Journal of Allied Health Sciences and Practice ◽

10.46743/1540-580x/2012.1401 ◽

2012 ◽

Author(s):

Catherine Rivera ◽

Douglas Gardenhire

Keyword(s):

Lung Tissue ◽

Left Lung ◽

The Elderly ◽

Chronic Obstructive ◽

Class Iii ◽

Obstructive Pulmonary Disease ◽

Case Presentation ◽

Lung Abnormalities ◽

History Of

The following case presentation is of a 75-year-old male who presented to the emergency department with chronic obstructive pulmonary disease (COPD) exacerbation, secondary to pneumonia, and a history of a congenital left lung abnormality with non-development. Since the first report by de Pozzis in 1673, more than 200 cases of lung abnormalities with non-development have been recorded.1,2 The first proposed classification of underdevelopment of the lung was introduced by Schneider in 1912: Class I Agenesis - total absence of bronchus and lung, Class II Aplasia - rudimentary bronchus without lung tissue, and Class III Hypoplasia - bronchial hypoplasia and variable but reduced amount of lung tissue.1,2 The rarity of reports and applicable literature involving congenital lung abnormalities with non-development in the elderly, such as pulmonary aplasia, prompted this case presentation.

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Hospital Acquired Pneumonia

10.1093/med/9780199976805.003.0023 ◽

2016 ◽

Author(s):

Joshua Lupton

Keyword(s):

The Elderly ◽

Chronic Obstructive ◽

Microbial Infection ◽

Term Care ◽

Obstructive Pulmonary Disease ◽

Increased Risk ◽

History Of ◽

Hospital Acquired Pneumonia ◽

Pulmonary Parenchyma ◽

Hospital Acquired

Pneumonia consists of inflammation of the pulmonary parenchyma, typically resulting from a microbial infection. Hospital-acquired pneumonia (HAP) occurs in (typically elderly) patients in long-term care facilities, with regular IV therapy, with immunosuppression, or with a history of recent treatment at a hospital. It is associated with high mortality. The majority HAP patients present with some constellation of cough, fever, sputum production, and pleuritic chest pain. Patients with chronic obstructive pulmonary disease (COPD) and cystic fibrosis are at increased risk for pneumonia. The Infectious Disease Society of America requires infiltrates on chest x-ray or other imaging for the diagnosis of pneumonia. For hospitalized patients, empiric antimicrobial therapy for HAP should be given as soon as pneumonia is highly suspected. There is currently a vaccine available against Streptococcus pneumonia that all patients should be offered before discharge from the hospital. The elderly are already more susceptible to HAP due to decreased mobility and increased comorbidities.

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Medically Treated Opioid Overdoses Among the U.S. Elderly: Trends and Correlates

Innovation in Aging ◽

10.1093/geroni/igaa057.176 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 54-54

Author(s):

Peter Treitler ◽

Stephen Crystal ◽

Richard Hermida ◽

Jennifer Miles

Keyword(s):

Older Adults ◽

Pain Management ◽

The Elderly ◽

Opioid Use Disorder ◽

Chronic Obstructive ◽

Medicare Beneficiaries ◽

Older Individuals ◽

Opioid Use ◽

Policy And Practice ◽

Obstructive Pulmonary Disease

Abstract High rates of opioid prescribing and comorbid medical conditions increase risk of overdose among older adults. As the US population ages and the rates of opioid use disorder (OUD) increase in the elderly population, there is a need to characterize trends and correlates of overdose in order to more effectively target policy and practice. Using a ~40% random sample of 2015-2017 Medicare beneficiaries ages 65 and older with Part D pharmacy coverage, this study examined medically treated opioid overdoses among US older adults. The sample included 13-14 million beneficiaries per year. The rate of medically treated opioid overdoses among elderly Medicare beneficiaries increased by 15% from 6 per 10,000 in 2015 to 6.9 per 10,000 in 2017. Those with overdose were disproportionately female (63%), non-Hispanic white (83%), with diagnoses of pain conditions (96%), with diagnoses of major depression (63%), and with high rates of conditions that decrease respiratory reserve such as chronic obstructive pulmonary disease. 13% had co-occurring diagnosed alcohol use disorder, 36% were diagnosed with opioid dependence or abuse, and 12% were diagnosed with hepatitis C. Older individuals with overdose represent a complex mix of risk factors; identifying those most at risk (as well as those who have very low risk, whose pain management may be compromised by overly-rigid interpretation of opioid use guidelines) is key in order to address multiple risks, balancing risk reduction with appropriate pain management.

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Validation of Clinical Characteristics and Effectiveness of Pulmonary Rehabilitation in a COPD Population with Discrepancy between Exercise Tolerance and FEV1

Healthcare ◽

10.3390/healthcare9010053 ◽

2021 ◽

Vol 9 (1) ◽

pp. 53

Author(s):

Jun Horie ◽

Koichiro Takahashi ◽

Shuuichi Shiranita ◽

Kunihiko Anami ◽

Shinichiro Hayashi

Keyword(s):

Gait Speed ◽

Pulmonary Rehabilitation ◽

Exercise Tolerance ◽

Respiratory Illness ◽

Forced Expiratory Volume ◽

Walking Distance ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

St George's Respiratory Questionnaire ◽

History Of

This study’s objective was to examine the characteristics of patients with chronic obstructive pulmonary disease (COPD) presenting with various exercise tolerance levels. A total of 235 patients with stable COPD were classified into 4 groups: (1) LoFlo + HiEx—patients with a six-minute walking distance (6MWD) ≥350 m and percentage of predicted forced expiratory volume in 1 s (%FEV1.0) <50%; (2) HiFlo + HiEx—patients with a 6MWD ≥350 m and a %FEV1.0 ≥50%; (3) LoFlo + LoEx—patients with a 6MWD < 350 m and %FEV1.0 < 50%; and (4) HiFlo + LoEx—patients with a 6MWD <350 m and %FEV1.0 ≥ 50%. Aspects of physical ability in the HiFlo + LoEx group were significantly lower than those in the HiFlo + HiEx group. The HiFlo + LoEx group was characterized by a history of hospitalization for respiratory illness within the past year, treatment with at-home oxygen therapy, and lacking daily exercise habits. Following three months of pulmonary rehabilitation, the LoFlo + HiEx group significantly improved in the modified Medical Research Council dyspnea score, maximum gait speed, and 6MWD, while the HiFlo + LoEx group significantly improved in the percentage of maximal expiratory pressure, maximum gait speed, 6MWD, incremental shuttle walking distance, and St. George’s Respiratory Questionnaire score. The HiFlo + LoEx group had the greatest effect of three-month pulmonary rehabilitation compared to other groups.

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Imaging in alpha-1 antitrypsin deficiency: a window into the disease

Therapeutic Advances in Chronic Disease ◽

10.1177/20406223211024523 ◽

2021 ◽

Vol 12_suppl ◽

pp. 204062232110245

Author(s):

Yuh-Chin Tony Huang ◽

Marion Wencker ◽

Bastiaan Driehuys

Keyword(s):

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Essential Information ◽

Plain Chest Radiograph ◽

Antitrypsin Deficiency ◽

Alpha 1 Antitrypsin Deficiency ◽

History Of ◽

Detailed Assessment ◽

Alpha 1 Antitrypsin ◽

Magnetic Resonance Imaging Mri

Imaging modalities such as plain chest radiograph and computed tomography (CT) are important tools in the assessment of patients with chronic obstructive pulmonary disease (COPD) of any etiology. These methods facilitate differential diagnoses and the assessment of individual lung pathologies, such as the presence of emphysema, bullae, or fibrosis. However, as emphysema is the core pathological consequence in the lungs of patients with alpha-1 antitrypsin deficiency (AATD), and because AATD is associated with the development of other lung pathologies such as bronchiectasis, there is a greater need for patients with AATD than those with non-AATD-related COPD to undergo more detailed assessment using CT. In the field of AATD, CT provides essential information regarding the presence, distribution, and morphology of emphysema. In addition, it offers the option to quantify the extent of emphysema. These data have implications for treatment decisions such as initiation of alpha-1 antitrypsin (AAT) therapy, or suitability for surgical or endoscopic interventions for reducing lung volume. Furthermore, CT has provided vital insight regarding the natural history of emphysema progression in AATD, and CT densitometry has underpinned research into the efficacy of AAT therapy. Moving forward, hyperpolarized xenon gas (129Xe) lung magnetic resonance imaging (MRI) is emerging as a promising complement to CT by adding comprehensive measures of regional lung function. It also avoids the main disadvantage of CT: the associated radiation. This chapter provides an overview of technological aspects of imaging in AATD, as well as its role in the management of patients and clinical research. In addition, perspectives on the future potential role of lung MRI in AATD are outlined.

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Association between Chronic Obstructive Pulmonary Disease and Ménière’s Disease: A Nested Case–Control Study Using a National Health Screening Cohort

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18094536 ◽

2021 ◽

Vol 18 (9) ◽

pp. 4536

Author(s):

So-Young Kim ◽

Chang-Ho Lee ◽

Dae-Myoung Yoo ◽

Chan-Yang Min ◽

Hyo-Geun Choi

Keyword(s):

Meniere’S Disease ◽

Menière’S Disease ◽

Chronic Obstructive ◽

Meniere's Disease ◽

Ménière’S Disease ◽

Menière's Disease ◽

Obstructive Pulmonary Disease ◽

Region Of Residence ◽

History Of ◽

Ménière's Disease

This study explored the relation between Ménière’s disease and chronic obstructive pulmonary disease (COPD). The ≥40-year-old population of the Korean National Health Insurance Service-Health Screening Cohort was included. In total, 7734 Ménière’s disease patients and 30,936 control participants were enrolled. Control participants were matched for age, sex, income, and region of residence with Ménière’s disease participants. The odds of having Ménière’s disease given a history of COPD were analyzed using conditional logistic regression. Subgroup analyses were conducted according to age, sex, income, and region of residence. The odds of having Ménière’s disease were found to be 1.18-fold higher with a history of COPD than with no history of COPD (95% confidence intervals (CI) = 1.06–1.32, E-value (CI) = 1.64 (1.31)). The ≥60 years old, male, low-income, and rural subgroups showed increased odds of developing Ménière’s disease when a history of COPD was reported. A history of COPD was associated with an increased risk of Ménière’s disease in the adult population.

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Implementation of a Targeted Screening Program to Detect Airflow Obstruction Suggestive of Chronic Obstructive Pulmonary Disease within a Presurgical Screening Clinic

Canadian Respiratory Journal ◽

10.1155/2015/306720 ◽

2015 ◽

Vol 22 (4) ◽

pp. 209-214 ◽

Cited By ~ 5

Author(s):

Chantal Robitaille ◽

Esther Dajczman ◽

Andrew M Hirsch ◽

David Small ◽

Pierre Ernst ◽

...

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Pulmonary Disease ◽

Screening Program ◽

Tertiary Care ◽

Airflow Obstruction ◽

University Hospital ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Targeted Screening ◽

History Of

BACKGROUND: Targeted spirometry screening for chronic obstructive pulmonary disease (COPD) has been studied in primary care and community settings. Limitations regarding availability and quality of testing remain. A targeted spirometry screening program was implemented within a presurgical screening (PSS) clinic to detect undiagnosed airways disease and identify patients with COPD/asthma in need of treatment optimization.OBJECTIVE: The present quality assurance study evaluated airflow obstruction detection rates and examined characteristics of patients identified through the targeted screening program.METHODS: The targeted spirometry screening program was implemented within the PSS clinic of a tertiary care university hospital. Current or ex-smokers with respiratory symptoms and patients with a history of COPD or asthma underwent prebronchodilator spirometry. History of airways disease and smoking status were obtained during the PSS assessment and confirmed through chart reviews.RESULTS: After exclusions, the study sample included 449 current or ex-smokers. Abnormal spirometry results were found in 184 (41%) patients: 73 (16%) had mild, 93 (21%) had moderate and 18 (4%) had severe or very severe airflow obstruction. One hundred eighteen (26%) new cases of airflow obstruction suggestive of COPD were detected. One-half of these new cases had moderate or severe airflow obstruction. Only 34% of patients with abnormal spirometry results had reported a previous diagnosis of COPD. More than one-half of patients with abnormal spirometry results were current smokers.CONCLUSIONS: Undiagnosed airflow obstruction was detected in a significant number of smokers and ex-smokers through a targeted screening program within a PSS clinic. These patients can be referred for early intervention and secondary preventive strategies.

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Symptomatic Patent Foramen Ovale with Hemidiaphragm Paralysis

Case Reports in Pulmonology ◽

10.1155/2017/9848696 ◽

2017 ◽

Vol 2017 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Hussain Ibrahim ◽

Adnan Khan ◽

Shawn P. Nishi ◽

Ken Fujise ◽

Syed Gilani

Keyword(s):

Right Atrium ◽

Chronic Conditions ◽

Patent Foramen Ovale ◽

Hospital Admissions ◽

Clinical Suspicion ◽

Chronic Obstructive ◽

Foramen Ovale ◽

Obstructive Pulmonary Disease ◽

Benign Condition ◽

High Clinical Suspicion

Dyspnea accounts for more than one-fourth of the hospital admissions from Emergency Department. Chronic conditions such as Chronic Obstructive Pulmonary Disease, Congestive Heart Failure, and Asthma are being common etiologies. Less common etiologies include conditions such as valvular heart disease, pulmonary embolism, and right-to-left shunt (RLS) from patent foramen ovale (PFO). PFO is present in estimated 20–30% of the population, mostly a benign condition. RLS via PFO usually occurs when right atrium pressure exceeds left atrium pressure. RLS can also occur in absence of higher right atrium pressure. We report one such case that highlights the importance of high clinical suspicion, thorough evaluation, and percutaneous closure of the PFO leading to significant improvement in the symptoms.

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High prevalence of undiagnosed COPD among patients evaluated for suspected myocardial ischaemia

Open Heart ◽

10.1136/openhrt-2018-000848 ◽

2018 ◽

Vol 5 (2) ◽

pp. e000848 ◽

Cited By ~ 1

Author(s):

Andreas Jönsson ◽

Artur Fedorowski ◽

Gunnar Engström ◽

Per Wollmer ◽

Viktor Hamrefors

Keyword(s):

Myocardial Ischaemia ◽

Chronic Obstructive Lung Disease ◽

Chronic Obstructive ◽

Clinical Factors ◽

Obstructive Pulmonary Disease ◽

Presenting Symptoms ◽

High Prevalence ◽

History Of ◽

Artery Disease ◽

Global Initiative

ObjectiveChronic obstructive pulmonary disease (COPD) and coronary artery disease (CAD) are leading causes of global morbidity and mortality. Despite the well-known comorbidity between COPD and CAD, the presence of COPD may be overlooked in patients undergoing coronary evaluation. We aimed to assess the prevalence of undiagnosed COPD among outpatients evaluated due to suspected myocardial ischemia.MethodsAmong 500 outpatients who were referred to myocardial perfusion imaging due to suspected stable myocardial ischaemia, 433 patients performed spirometry. Of these, a total of 400 subjects (age 66 years; 45% women) had no previous COPD diagnosis and were included in the current study. We compared the prevalence of previously undiagnosed COPD according to spirometry criteria from The Global Initiative for Chronic Obstructive Lung Disease (GOLD) or lower limit of normal (LLN) and reversible myocardial ischaemia according to symptoms and clinical factors.ResultsA total of 134 (GOLD criteria; 33.5 %) or 46 patients (LLN criteria; 11.5%) had previously undiagnosed COPD, whereas 55 patients (13.8 %) had reversible myocardial ischaemia. The presenting symptoms (chest discomfort, dyspnoea) did not differ between COPD, myocardial ischaemia and normal findings. Except for smoking, no clinical factors were consistently associated with previously undiagnosed COPD.ConclusionsAmong middle-aged outpatients evaluated due to suspected myocardial ischaemia, previously undiagnosed COPD is at least as common as reversible myocardial ischaemia and the presenting symptoms do not differentiate between these entities. Patients going through a coronary ischaemia evaluation should be additionally tested for COPD, especially if there is a positive history of smoking.

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