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Fulltext The association of spirometric small airways obstruction with respiratory symptoms, cardiometabolic diseases, and quality of life: results from the Burden of Obstructive Lung Disease (BOLD) study

Knox-Brown B, Patel J, Potts J, Ahmed R, Aquart-Stewart A, Barbara C, et al.

Respir Res, 2023 May 23;24(1):137.
PMID: 37221593 DOI: 10.1186/s12931-023-02450-1

BACKGROUND: Spirometric small airways obstruction (SAO) is common in the general population. Whether spirometric SAO is associated with respiratory symptoms, cardiometabolic diseases, and quality of life (QoL) is unknown.
METHODS: Using data from the Burden of Obstructive Lung Disease study (N = 21,594), we defined spirometric SAO as the mean forced expiratory flow rate between 25 and 75% of the FVC (FEF25-75) less than the lower limit of normal (LLN) or the forced expiratory volume in 3 s to FVC ratio (FEV3/FVC) less than the LLN. We analysed data on respiratory symptoms, cardiometabolic diseases, and QoL collected using standardised questionnaires. We assessed the associations with spirometric SAO using multivariable regression models, and pooled site estimates using random effects meta-analysis. We conducted identical analyses for isolated spirometric SAO (i.e. with FEV1/FVC ≥ LLN).
RESULTS: Almost a fifth of the participants had spirometric SAO (19% for FEF25-75; 17% for FEV3/FVC). Using FEF25-75, spirometric SAO was associated with dyspnoea (OR = 2.16, 95% CI 1.77-2.70), chronic cough (OR = 2.56, 95% CI 2.08-3.15), chronic phlegm (OR = 2.29, 95% CI 1.77-4.05), wheeze (OR = 2.87, 95% CI 2.50-3.40) and cardiovascular disease (OR = 1.30, 95% CI 1.11-1.52), but not hypertension or diabetes. Spirometric SAO was associated with worse physical and mental QoL. These associations were similar for FEV3/FVC. Isolated spirometric SAO (10% for FEF25-75; 6% for FEV3/FVC), was also associated with respiratory symptoms and cardiovascular disease.
CONCLUSION: Spirometric SAO is associated with respiratory symptoms, cardiovascular disease, and QoL. Consideration should be given to the measurement of FEF25-75 and FEV3/FVC, in addition to traditional spirometry parameters.

Matched MeSH terms: Airway Obstruction*
Fulltext The Site of Airway Collapse in Sleep Apnea, Its Associations with Disease Severity and Obesity, and Implications for Mechanical Interventions

Sung CM, Tan SN, Shin MH, Lee J, Kim HC, Lim SC, et al.

Am J Respir Crit Care Med, 2021 07 01;204(1):103-106.
PMID: 33826879 DOI: 10.1164/rccm.202011-4266LE
Matched MeSH terms: Airway Obstruction/complications*; Airway Obstruction/therapy*
Cardiovascular causes of tracheobronchial compression: a decade experience in a Paediatric Congenital Heart Centre

Yubbu P, Abdul Latiff H, Musa H, Devaraj NK, Mohd Razif NA, Sivalingam S, et al.

Cardiol Young, 2021 Jun 03.
PMID: 34080535 DOI: 10.1017/S1047951121002110

BACKGROUND: Vascular compression of the airway often complicates CHD management. This study evaluated the use of CT in determining cardiovascular causes, clinical manifestations, and outcome of tracheobronchial compression among children with CHD.
METHODS: A retrospective review of clinical records of all patients with CT scan evidence of tracheobronchial compression from January 2007 to December 2017 at National Heart Institute. Cardiovascular causes of tracheobronchial compression were divided into three groups; group I: vascular ring/pulmonary artery sling, II: abnormally enlarged or malposition cardiovascular structure due to CHD, III: post-CHD surgery.
RESULTS: Vascular tracheobronchial compression was found in 81 out of 810 (10%) patients who underwent CT scan. Group I lesions were the leading causes of vascular tracheobronchial compression (55.5%), followed by group II (34.6%) and group III (9.9%). The median age of diagnosis in groups I, II, and III were 16.8 months, 3 months, and 15.6 months, respectively. Half of group I patients are manifested with stridor and one-third with recurrent chest infections. Persistent respiratory symptoms, lung atelectasis, or prolonged respiratory support requirement were clues in groups II and III. Higher morbidity and mortality in younger infants with severe obstructive airway symptoms, associated airway abnormalities, and underlying complex cyanotic CHD.
CONCLUSIONS: Vascular ring/pulmonary artery sling and abnormally enlarged or malposition cardiovascular structure were the leading causes of cardiovascular airway compression. A high index of suspicion is needed for early detection due to its non-specific presentation. The outcome often depends on the severity of airway obstruction and complexity of cardiac lesions.

Matched MeSH terms: Airway Obstruction
Usage of airway ultrasound as an assessment and prediction tool of a difficult airway management

Adi O, Fong CP, Sum KM, Ahmad AH

Am J Emerg Med, 2021 04;42:263.e1-263.e4.
PMID: 32994082 DOI: 10.1016/j.ajem.2020.09.011

Airway assessment is important in emergency airway management. A difficult airway can lead to life-threatening complications. A perfect airway assessment tool does not exist and unanticipated difficulty will remain unforeseen. Current bedside clinical predictors of the difficult airway are unreliable but airway ultrasound can be used as an adjunct to predict difficult laryngoscopy. We report a case of a 60-year-old man presenting to the emergency department with shortness of breath, hoarseness of voice and stridor. Airway ultrasound revealed a large laryngeal mass narrowing the upper airway, extending to bilateral vocal cords with heterogenous echogenicity. In view of impending complete upper airway obstruction, acute respiratory distress and airway ultrasound findings, urgent emergency tracheostomy was chosen as definitive airway over endotracheal intubation or surgical cricothyroidotomy. Point of care ultrasound (POCUS) was used to evaluate this patient with severe upper airway obstruction. A laryngeal mass was detected by ultrasound and this pointed towards the presence of a difficult airway. POCUS was a good non-invasive tool used for airway assessment in this uncooperative and unstable patient. Ultrasound predictors of the difficult airway include the inability to visualize the hyoid bone, short hyomental distance ratio, high pretracheal anterior neck thickness and large tongue size. Besides airway assessment, ultrasound can also help to predict endotracheal tube size, confirm intubation and guide emergency airway procedures such as cricothyroidotomy and tracheostomy. Point of care ultrasound of the upper airway can be used in airway assessment to identify distorted airway anatomy, pathological lesions and guide treatment decisions.

Matched MeSH terms: Airway Obstruction/etiology
Fulltext A Five-Year Review on Pediatric Foreign Body Aspiration

Nasir ZM, Subha ST

Int Arch Otorhinolaryngol, 2021 Apr;25(2):e193-e199.
PMID: 33968219 DOI: 10.1055/s-0040-1709739

Introduction Foreign body aspiration is a leading cause of accidental death in children. Clinical presentation varies from non-specific respiratory symptoms to respiratory failure making diagnosis challenging. Objective To review pediatric patients who underwent bronchoscopy due to suspicion of foreign body aspiration at a tertiary center in Malaysia. Methods We retrospectively studied patients < 11 years old who underwent bronchoscopy from 2008 to 2018. Results Over the 10-year period, 20 patients underwent bronchoscopy, and 16 were found to have foreign body aspiration with equal gender distribution. The most common age group was < 3 years old (75%). The most common clinical presentations were choking (82%) and stridor (31%). Foreign bodies were removed using flexible bronchoscope in 8 cases (50%), and difficulties were encountered in 6 cases (75%). Rigid ventilating bronchoscope was used in 8 cases (50%) with no difficulty. The most common object found was peanut (19%). The majority of foreign bodies were lodged in the right bronchus (43%). Eight patients (80%) received delayed treatment due to delayed diagnosis. The length of hospital stay was longer in the younger age groups. Conclusion Clinical presentation and chest radiograph findings were comparable across all age groups. The most difficulties encountered during foreign body removal were via flexible bronchoscope, in children < 3 years old. There was no significant correlation between age and type of foreign body aspiration. The majority of patients who received delayed treatment were < 3 years old. The length of hospital stay was longer in the younger age groups.

Matched MeSH terms: Airway Obstruction
Fulltext Nasopharyngeal diffuse large B-cells lymphoma causing acute airway obstruction amid COVID-19 crisis: an anaesthetist's nightmare

Yeap TB, Teah MK, Quay YJJ, Wong MTF

BMJ Case Rep, 2021 Jan 28;14(1).
PMID: 33509897 DOI: 10.1136/bcr-2020-241008

Acute stridor is often an airway emergency. We present a valuable experience handling an elderly woman who was initially treated as COVID-19 positive during the pandemic in November 2020. She needed an urgent tracheostomy due to nasopharyngeal (NP) diffuse large B-cell lymphoma causing acute airway obstruction. Fortunately, 1 hour later, her NP swab real-time PCR test result returned as SARS-CoV-2 negative. This interesting article depicts the importance of adequate preparations when handling potentially infectious patients with anticipated difficult airway and the perioperative issues associated with it.

Matched MeSH terms: Airway Obstruction/etiology*; Airway Obstruction/surgery
Fulltext Congenital tongue base lipoblastoma causing neonatal airway compromise

Wan MH, Tengku Nun Ahmad TE, Naicker MS, Abu Bakar MZ

BMJ Case Rep, 2021 Jan 18;14(1).
PMID: 33462056 DOI: 10.1136/bcr-2020-239554

Lipoblastomas are benign tumours of immature fat cells presenting in infancy. A lipoblastoma within the airway lumen causing airway compromise is an extremely rare occurrence. We present a 6 hours of life girl who had airway compromise due to a lobulated mass at the base of the tongue. The mass was excised after emergency endotracheal intubation.

Matched MeSH terms: Airway Obstruction/diagnosis; Airway Obstruction/etiology*; Airway Obstruction/surgery
Fulltext Massive airway myiasis: an extreme rarity

Teah MK, Chu YM, Shanmuganathan SD, Yeap TB

BMJ Case Rep, 2020 Dec 09;13(12).
PMID: 33298493 DOI: 10.1136/bcr-2020-237764

Intubations are important live saving skills to maintain adequate ventilation and oxygenation. Common indications include impending upper airway obstruction, respiratory failure and impaired conscious level. Oral myiasis is an infrequently found disease which is characterised by ectoparasitic infestation of body tissues by fly maggots.We present a case report and share valuable experiences on a patient with massive airway myiasis causing upper airway obstruction which require emergency intubation.

Matched MeSH terms: Airway Obstruction/etiology
Massive paediatric pulmonary haemorrhage in Dieulafoy's disease: Roles of CT angiography, embolisation and bronchoscopy

Woodhull S, Bush A, Tang AL, Padley S

Paediatr Respir Rev, 2020 Nov;36:100-105.
PMID: 32680823 DOI: 10.1016/j.prrv.2020.06.001

Acute, major pulmonary haemorrhage in children, is rare, may be life-threatening and at times presents atypically. Dieulafoy's disease of the bronchus presenting with recurrent or massive hemoptysis was first described in adults. Prior to reviewing the literature, we report an illustrative case of bronchial Dieulafoy's disease (BDD) in a child presenting unusually with massive apparent hematemesis. The source of bleeding is a bronchial artery that fails to taper as it terminates within the bronchial submucosa. A high index of suspicion is required to identify such lesions via radiological imaging and the role of bronchial artery embolisation is highlighted with video images of angiography included.

Matched MeSH terms: Airway Obstruction/etiology; Airway Obstruction/pathology
Fulltext Novel role of focused airway ultrasound in early airway assessment of suspected laryngeal trauma

Adi O, Sum KM, Ahmad AH, Wahab MA, Neri L, Panebianco N

Ultrasound J, 2020 Aug 12;12(1):37.
PMID: 32783133 DOI: 10.1186/s13089-020-00186-3

BACKGROUND: Upper airway injury secondary to blunt neck trauma can lead to upper airway obstruction and potentially cause a life-threatening condition. The most important aspect in the care of laryngeal trauma is to establish a secure airway. Focused airway ultrasound enables recognition of important upper airway structures, offers early opportunity to identify life-threatening upper airway injury, and allows assessment of the extent of injury. This information that can be obtained rapidly at the bedside has the potential to facilitate rapid intervention.
CASE PRESENTATION: We report a case series that illustrate the diagnostic value of focused airway ultrasound in the diagnosis of laryngeal trauma in patients presenting with blunt neck injury.
CONCLUSION: Early recognition, appropriate triaging, accurate airway evaluation, and prompt management of such injuries are essential. In this case series, we introduce the potential role of focused airway ultrasound in suspected laryngeal trauma, and the correlation of these exam findings with that of computed tomography (CT) scanning, based on the Schaefer classification of laryngeal injury.

Matched MeSH terms: Airway Obstruction
An unusual cause of subacute airway obstruction in a hemodialysis patient with brachio-cephalic arteriovenous fistula: A rare presentation of central venous occlusion

Hamzan MI, Hamid AR, Halim AS, Mat Saad AZ

Hemodial Int, 2020 04;24(2):E33-E36.
PMID: 32141217 DOI: 10.1111/hdi.12832

A young lady with an arteriovenous (AV) fistula on hemodialysis was referred for surgical management following a failed endovascular approach to relieve central venous occlusion. She had an obstructed left brachiocephalic vein with a history of numerous central vein catheter placements. Alternative routes for new arteriovenous fistula creation had been exhausted due to previous contralateral upper limb fistula rupture and ligation. To the best of our knowledge, no similar cases of airway obstruction in central venous occlusion occurring in hemodialysis patients with AV fistula have been reported. The importance of identifying the possible emergency red flags in hemodialysis patients with central venous occlusion is important to prevent unwanted consequences.

Matched MeSH terms: Airway Obstruction/economics*; Airway Obstruction/etiology*
Fulltext Defining the prevalence and predictors of restrictive and obstructive airway pattern in a non-selected Malaysian population

Faisal, A.H., Andrea, Y.L.B., Nina, M., Tidi, H., Ahmad Izuanuddin, I.

Medicine & Health, 2020;15(2):140-152.
MyJurnal

Insiden penyakit paru-paru obstruktif kronik (COPD) di Malaysia semakin meningkat. Tiada kajian yang dilaporkan tentang obstruksi aliran udara spirometrik, termasuk corak restriktif dan obstruksif pada populasi di Malaysia. Kajian ini dilakukan untuk mengira prevalens dan meramal obstruksi aliran udara dan menjalankan pemeriksaan gejala COPD menggunakan peralatan baru AirSmart® Spirometry dan COPD Population Screener (COPD-PS). Kajian keratan rentas dilakukan di dua hospital tertiari menggunakan COPD-PS dan AirSmart® Spirometry. Terdapat 265 subjek yang direkrut dengan 11% dan 16% populasi yang masing-masing disaring mempunyai corak yang restriktif dan obstruksif. Dua puluh peratus subjek mempunyai skor COPD-PS lebih daripada lima. Tujuh puluh empat peratus subjek dengan corak obstruktif aktif atau bekas perokok (p=0,03, p

Matched MeSH terms: Airway Obstruction
Dilemma in management of cervico-facial cystic hygroma

Tamilselvi R, Tang IP, Linger S, Mohd Soffian MS

Med J Malaysia, 2019 Oct;74(5):450-451.
PMID: 31649229

Cervico facial cystic hygroma and tongue lymphagioma is rare representative of spectrum of lymphatic malformations. Conservative management with sclerosants alone has proven to be successful. However, sudden enlargement of these cervico facial lymphangiomas leads to catastrophic airway obstruction leading to debility in feeding and speech. Therefore, surgery is indicated in such case to prevent such a catastrophic problem. We report here the case of a 3-yearold boy with cervico facial hygroma involving the tongue. We successfully treated him with a combination of surgery and OK432 injection.

Matched MeSH terms: Airway Obstruction
Fulltext Stridor Secondary to Acquired Subglottic Cyst: Rarity Makes it Missed

See GB, Mesran I

Indian J Otolaryngol Head Neck Surg, 2019 Oct;71(Suppl 1):45-48.
PMID: 31741928 DOI: 10.1007/s12070-016-0992-2

Subglottic cysts (SGCs) are a rare cause of airway obstruction in children. Medical advances, higher survival rates for preterm infants, and improved diagnostic equipment have increased the number of reported cases of SGCs over the last three decades, the majority occurring in infants who had been extremely premature neonates and had suffered from respiratory distress, therefore having been intubated and managed in neonatal ICUs. Symptoms of laryngeal cysts depend on the size and the location of the cyst and include a change in the tone of voice, dysphonia, hoarseness, dysphagia, stridor, and dyspnea. This condition is often misdiagnosed as laryngomalacia, asthma, croup, or other diseases, due to the fact that it manifests as recurring respiratory infections, stridor, and wheezing. Death can occur in severe cases that are not treated. When present, it may account for severe inspiratory stridor that compromise the airway. The accepted gold standard treatment is direct laryngoscopy with marsupialization of the cyst to prevent recurrence. Two cases of subglottic cyst in our centre are described here. Although all cases presented differently, but in both of our cases, which have previous history of intubation with prematurity were initially diagnosed as laryngomalacia and croup.

Matched MeSH terms: Airway Obstruction
Fulltext Obstructive retrosternal goitre mimicking severe bronchial asthma in pregnancy

Loo GH, Wan Mat WR, Muhammad R, Azman M

BMJ Case Rep, 2019 Aug 04;12(8).
PMID: 31383679 DOI: 10.1136/bcr-2019-229763

Acute airway obstruction in pregnancy remains a challenge to manage. Failure of appropriate and timely airway management may lead to maternal morbidity and mortality such as aspiration pneumonitis or worst hypoxaemic cardiopulmonary arrest. 1 As pregnancy may exacerbate asthma attacks, parturient presenting with wheezing or shortness of breath will commonly be treated as suffering from an asthmatic attack. 2 However, it is important to note other possible differential diagnoses. Thyroid disease is relatively common in women of childbearing age. The thyroid gland undergoes several changes during pregnancy, which may lead to altered function as well as gland enlargement and cause upper airway obstruction and symptoms similar to a bronchial asthma attack. 3 4 With that in mind, we report a case of a parturient with long-standing goitre in her second trimester who presented to our institution with acute respiratory symptoms and cardiopulmonary arrest.

Matched MeSH terms: Airway Obstruction/diagnosis*; Airway Obstruction/etiology
Resolution of asthmatic symptoms following successful endoscopic resection of tracheal mucoepidermoid carcinoma

Hanif Khan A, Faisal M, Mohd Ali R, Abdul Rahaman JA

BMJ Case Rep, 2019 Jan 17;12(1).
PMID: 30659001 DOI: 10.1136/bcr-2018-226202

Mucoepidermoid carcinoma (MEC) is a rare tumour of the trachea accounting for up to 0.2% of reported primary lung malignancy. We report a case of a 54-year-old man, ex-smoker, whose presentation mimicked adult onset asthma with cough and wheezing, which did not respond to conventional treatment. He had occasional haemoptysis and weight loss in which CT scan performed for malignancy screening showed a protruding mass in the distal trachea causing endobronchial obstruction. Bronchoscopic intervention was performed to relieve the obstruction that resulted in resolution of asthmatic symptoms. Histological diagnosis confirmed MEC. This case emphasised the importance of a high index of suspicion in an unusual presentation of a common disease and the pivotal role of bronchoscopic intervention in malignant central airway obstruction.

Matched MeSH terms: Airway Obstruction
Fulltext Management of palatal fracture and airway challenge in a child —a red flag

Lim, Min Jim, Tengku Aszraf Tengku Shaeran, Soon, Eu Chong

Malaysian Journal of Paediatrics and Child Health, 2019;25(1):19-22.
MyJurnal

Airway managements in maxillofacial fracture patients are complex and crucial. Trauma to the maxillofacial region may cause hemorrhage, swelling which may lead to pulmonary aspiration and airway obstruction. Airway managements in maxillofacial fracture patients are complex and crucial. Besides being uncooperative, presence of fractures and soft tissue injuries posed challenges in managing pediatric patient who already have smaller airway opening. This condition is an important red flag which required extra caution from the treating clinicians. A 6-year-old boy was involved in a road traffic accident and presented with profuse bleeding from the oral cavity and nostrils. Physical examination showed oozing of blood with step deformity of the midpalate. Multiple attempts in intubation resulted in failure before succeeding with the aid of suction devices. After intubation was done, intraoral bleeding was successfully managed with transpalatal wiring and nasal packing. The patient was ventilated in the intensive care unit and was extubated two days later. He was discharged well from hospital after one week of admission. Airway management is a rush against time, particularly in a pediatric patient suffering from a palatal fracture. The need for helping hands for suction and child control must be emphasized to ensure the patient’s survival.

Matched MeSH terms: Airway Obstruction
Aspiration Avoiding Tracheostomy in Neonatal Cystic Oral Lesion

Nasir MSNM, Ishak MN, Abd Wahid FH, Asif JA, Mohamad I

Medeni Med J, 2019;34(4):400-403.
PMID: 32821468 DOI: 10.5222/MMJ.2019.44977

Oral cyst is uncommon in the neonatal period. Depending on the size and site of occurrence, its symptoms may vary. If not diagnosed and managed expeditiously, these oral cysts may cause significant and potentially fatal morbidity and mortality. We report a successfully managed case of oral cyst in neonate that presented with huge tongue at birth and complaints of impending airway obstruction. She was referred for tracheostomy as intubation was impossible. We attempted needle aspiration and the airway successfully relieved without the need for tracheostomy.

Matched MeSH terms: Airway Obstruction
Fulltext Comparison of automatic airway analysis function of Invivo5 and Romexis software

Kamaruddin N, Daud F, Yusof A, Aziz ME, Rajion ZA

PeerJ, 2019;7:e6319.
PMID: 30697493 DOI: 10.7717/peerj.6319

Background: Visualization and calculation of the airway dimensions are important because an increase of airway resistance may lead to life-threatening emergencies. The visualization and calculation of the airway are possible using radiography technique with their advance software. The aim of this study was to compare and to test the reliability of the measurement of the upper airway volume and minimum area using airway analysis function in two software.
Methods: The sample consisted of 11 cone-beam computed tomography (CBCT) scans data, evaluated using the Invivo5 (Anatomage) and Romexis (version 3.8.2.R, Planmeca) software which afford image reconstruction, and airway analysis. The measurements were done twice with one week gap between the two measurements. The measurement obtained was analyzed with t-tests and intraclass correlation coefficient (ICC), with confidence intervals (CI) was set at 95%.
Results: From the analysis, the mean reading of volume and minimum area is not significantly different between Invivo5 and Romexis. Excellent intrarater reliability values were found for the both measurement on both software, with ICC values ranging from 0.940 to 0.998.
Discussion: The results suggested that both software can be used in further studies to investigate upper airway, thereby contributing to the diagnosis of upper airway obstructions.

Matched MeSH terms: Airway Obstruction
Fulltext Point-of-Care Airway Ultrasonography Prior to an Emergency Cricothyroidotomy: Case Report

Iqhbal M, Noor JM, Karim NA, Ismail I, Sanib H, Mokhtar MA, et al.

Sultan Qaboos Univ Med J, 2018 May;18(2):e219-e222.
PMID: 30210855 DOI: 10.18295/squmj.2018.18.02.017

The use of ultrasonography in acute and critical care medicine is becoming increasingly common. However, use of an airway ultrasound as an adjunct to determine the type of intervention needed and assess complications is not common practice. We report a 56-year-old male who presented to the Emergency Department of the Sungai Buloh Hospital, Selangor, Malaysia, in 2015 with hoarseness, stridor and impending respiratory failure. A point-of-care ultrasound performed to assess the neck and vocal cords indicated a heterogeneous echogenic mass in the larynx, thus ruling out a cricothyroidotomy. The patient was therefore referred for an emergency tracheostomy. This case highlights the importance of point-of-care airway ultrasonography in the assessment of patients with stridor. This imaging technique not only helps to detect the cause of the stridor, but also to determine the feasibility of a cricothyroidotomy in emergency cases.

Matched MeSH terms: Airway Obstruction/etiology

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