In order to elucidate the behavior of opioid receptor in the airway smooth muscle (ASM) and potential role of the receptor in asthmatic attacks electrical field stimulation (EFS) was used to evaluate the effects of di...In order to elucidate the behavior of opioid receptor in the airway smooth muscle (ASM) and potential role of the receptor in asthmatic attacks electrical field stimulation (EFS) was used to evaluate the effects of different narcotics and naloxine (Nal) on isolated rabbit ASM and biochemical methods were used to assay the influences of morphine (Mor) and pethidine(Pet) on the activities of adenylcyclase (AAC) and phosphodiesterase(APDE) in homogenate derived from rabbit ASM.Nal was used to treat the bronchospasm during anesthesia. It shows that Mor increased the rabbit ASM contraction and Nal reversed this effect, while Nal itself did not affect ASM. Fentanyl(Fen) decreased the contraction and Pet not only decreased the contraction but relaxed the ASM. Mor decreased the AAC in the rabbit ASM but didn't affect the APDE in the rabbit ASM. Pet had no influence on both the AAC and the APDE. Nal effectively relieved the bronchospasm which failed to the traditional treatment during anesthsia. These indicate that the opioid receptor in the ASM is a new subtype one.Mor exhibits satuable binding the subtype receptor and exerts strong agonistic activity to induce bronchospasm, while Nal antagonizes this effect. Yet Fen and Pet don's bind this subtype receptor. Endogenous opioid-like peptides may also bind this subtype receptor. In patients with airway hyperreactivity (PAHR) Mor is contraindicated, Fen and Pet may be used. and the latter may be the best choice.Asthma or bronchospasm may be treated with Nal.展开更多
Background: Exercise-Induced Bronchospasm (EIB) is an inflammatory condition characterized by severe airway constriction following the mobilization of inflammatory cells and interleukin-6 (IL-6). When severe, EIB can ...Background: Exercise-Induced Bronchospasm (EIB) is an inflammatory condition characterized by severe airway constriction following the mobilization of inflammatory cells and interleukin-6 (IL-6). When severe, EIB can require the use of pressurized salbutamol to treat athletes. This study investigated the nature of the systemic changes in inflammatory cells and post-exercise IL-6 concentrations after salbutamol treatment in EIB-susceptible distance runners. Materials and Methods: This was an experimental study that enrolled 12 long-distance runners. In Session A, the participants completed a treadmill exercise test, and those who had a maximum expiratory volume per second (FEV1) that was decreased by at least 10% compared to their base value were placed in the EIB-susceptible group (EIB+) (n = 6). Those whose FEV1 did not meet this criterion were placed in the nonresponsive (EIB?) group (n = 6). Before the Session B exercise, athletes in the BIE+ group inhaled two puffs of salbutamol (EIB+ Salb), while their EIB? counterparts received no treatment. Spirometry was performed before and after the exercise using a Spirobank G portable spirometer. Blood samples were taken before, immediately after and 2 hours after the stress test. Results: The mean post-exercise FEV1 values were not significantly different (p > 0.05) between the EIB+ Salb group and the EIB? group. The systemic changes in inflammatory cells and IL-6 concentrations in the EIB+ runners after salbutamol treatment were similar to those observed in their EIB? counterparts. Conclusion: Salbutamol pretreatment improved the systemic immune status of EIB-susceptible athletes.展开更多
Severe bronchospasm and anaphylaxis are unanticipated emergencies that may occur in the ambulatory surgery setting. I present a case in which an asthmatic male with nasal congestion has anaphylaxis after induction, wi...Severe bronchospasm and anaphylaxis are unanticipated emergencies that may occur in the ambulatory surgery setting. I present a case in which an asthmatic male with nasal congestion has anaphylaxis after induction, with severe bronchospasm as the primary manifestation. During the course of hospitalization, he was exposed to aspirin and a second episode of severe bronchospasm occurred. He was diagnosed with both anaphylaxis to an anesthetic medication and Aspirin Exacerbated Respiratory Disease, or Samter’s Triad.展开更多
Context: Fine particles (PM2.5 and PM10) can accumulate in classrooms and in schoolyards located near urban roads. PM2.5 and PM10 can initiate, develop and exacerbate exercise-induced bronchospasm (EIB). This study ai...Context: Fine particles (PM2.5 and PM10) can accumulate in classrooms and in schoolyards located near urban roads. PM2.5 and PM10 can initiate, develop and exacerbate exercise-induced bronchospasm (EIB). This study aimed to assess the concentration levels of PM2.5 and PM10 in schools and to determine the rate of sensitivity to EIB among schoolchildren. Methods: A total of 128 students (67 girls and 61 boys) with an average age of 11 participated in this study. An ISAAC II questionnaire on respiratory symptoms was administered. PM2.5 and PM10 were measured. A 6-minute stress test was performed. Spirometry was performed. The ratio (I/O) of the concentrations of PM2.5 and PM10 recorded inside (I) the classrooms to those obtained outside (O) the classrooms was equal to 1 (I/O = 1). Results: The concentrations of PM2.5 and PM10 recorded inside the classrooms and those obtained outside the classrooms were higher than the values recommended by the WHO. 29 students out of 128 were diagnosed as sensitive to EIB [EIB (+)], i.e., a rate of sensitivity to EIB of 22.66%. A drop in postexercise PEF of 17.396% was observed among EIB (+) students. Conclusion: Schoolchildren in schools located near highways are exposed to high levels of PM2.5 and PM10 concentrations. Exposure to PM2.5 and PM10 played an important role in the initiation and exacerbation of exercise-induced bronchospasm in schoolchildren from schools located near highways. Effective programs for improving air quality in schools must be put in place to reduce the effects of particulate pollution on the respiratory health of school children.展开更多
Background: In African cities, chronic exposure to pollutants is the most common public health problem faced daily by motorcycle taxi drivers. In Benin, studies conducted on motorcycle drivers, have shown the presence...Background: In African cities, chronic exposure to pollutants is the most common public health problem faced daily by motorcycle taxi drivers. In Benin, studies conducted on motorcycle drivers, have shown the presence of nitrogen oxides, carbon monoxide, sulfur dioxide, volatile organic compounds and particulate matter in ambient air, which may affect lung function. Aims: This study aims to diagnose potential respiratory problems among 48 motorcycle taxi drivers (47.02 ± 8.75 years) compared to a control group made up of 52 people (46.38 ± 8.81 years) in Porto-Novo, Benin. Methods: A questionnaire, two exploration pulmonary function tests and two 6-minute walk tests were used to identify symptoms and changes in respiratory variables that reveal the existence of bronchospasm. Results: The frequency of respiratory symptoms noted among motorcycle taxi drivers is higher than that recorded among members of the control group. We observed that motorcycle drivers at rest and after physical effort have significantly lower respiratory variables (FVC, FEV1, PEF, FEF25-75, FEF50 and FEF25) (p < 0.05) than those recoded in control group. Conclusion: It can therefore be concluded that, because of the relatively long duration of exposure among motorcycle taxi drivers, the inhalation of automobile pollutants, may cause respiratory problems in this population.展开更多
An updated approach in the management of 50 patients with foreign body inhalation is presented. Certain risk factors that lead to complications and mortality due to endoscopic extraction of foreign bodies and thus det...An updated approach in the management of 50 patients with foreign body inhalation is presented. Certain risk factors that lead to complications and mortality due to endoscopic extraction of foreign bodies and thus determine prognosis were identified. Remedial measures to reduce morbidity and mortality due to bronchoscopic removal of foreign bodies are suggested. Fifty patients of suspected foreign body inhalation presented to a Unit of the Department of ENT, Head and Neck Surgery of Government Medical College associated SMHS Hospital Srinagar, Kashmir from March 2007 to June 2017. Of these, 49 patients were subjected to rigid tube bronchoscopy for removal of the aspirated foreign bodies and one coughed out the foreign body spontaneously during admission for bronchoscopy. History of foreign body inhalation was positive in 90% of patients and remaining was mostly referred from Paediatric Units with un-resolving collapse-consolidation of the lung. Whereas plain radiography of the chest and the soft tissues of neck were the primary imaging modality used in this study to detect the inhaled foreign bodies or their effects there are reports of virtual bronchoscopy being done with a multidetector computed tomography scanner in 3D image generation from axial cuts of the internal walls of the tracheobronchial tree in the management of patients suspected with foreign body aspiration. Bronchoscopy is a difficult and potentially hazardous procedure in the infant and young child. Telescopes and telescopic forceps were used during bronchoscopy to facilitate extraction of a foreign body inhaled. The type of a foreign body, site of its enlodgement and the complications encountered during its extraction were noted. During bronchoscopy the patients were connected to an ECG monitor and a pulse oximeter. 80% of the patients with foreign body inhalation were children in the age group of 0 - 5 years. There was a definite history of choking over the foreign body in 88% of the patients leading to acute respiratory distress in 46%. Cough alone or along with other symptoms occurred in most of the patients (96%). Persistent fever with respiratory symptoms unresponsive to treatment occurred in 38% of the patients with or without a positive history of foreign body inhalation. Right main bronchus was the commonest site of enlodgement of foreign body. In the present study, bean and peanut were the commonest types of foreign bodies inhaled (34%). Radiological findings in these patients include atelectasis with or without pneumonitis in 46.65% of the patients, normal chest/soft tissues of the neck in 24.45%, obstructive emphysema on the affected side in 24.45%, foreign body seen in the respiratory tract in 8.90% and bronchopneumonia in 2.22%. Complications associated with the endoscopic extraction of foreign bodies and the risk factors that lead to complications and mortality in patients with aspirated foreign bodies were identified in this study and the measures to reduce these complications and mortality rate to very low levels were suggested. Transient hypoxia, hypoxic bradycardia, transient cardiac arrest, bronchial perforation and death, laryngospasm, bronchospasm, subglottic oedema, reflex bradycardia and pneumothorax were among the few complications which occurred with the rigid endoscopic extraction of foreign bodies in the present study. Among the risk factors associated with the complications were prolonged bronchoscopy, semi-blind procedure, a vegetable foreign body, improper size and positioning of a bronchoscope and some other important factors which are detailed in the text of this paper to follow. Remedial measures on the basis of complications and the risk factors are suggested so as to decrease the morbidity and mortality due to endoscopic extraction of foreign bodies inhaled into the tracheobronchial tree.展开更多
Background:Estimated 4%-8%of pregnancies are complicated by asthma.Adequate management in this population is critical to minimize complications.Patients presenting with asthma exacerbation are typically managed with s...Background:Estimated 4%-8%of pregnancies are complicated by asthma.Adequate management in this population is critical to minimize complications.Patients presenting with asthma exacerbation are typically managed with standard bronchodilators and systemic corticosteroids.However,additional agents may be used in patients with refractory asthma exacerbation.Ketamine has been used in refractory bronchospasm,although its efficacy in published literature is heterogeneous.Case Presentation:We present a case of a pregnant patient with severe asthma exacerbation refractory to standard and salvage treatment who achieved termination of bronchospasm with ketamine infusion.Conclusion:After receiving ketamine infusion for several days,the patient had improved air flow and achieved successful extubation,without experiencing rebound bronchospasm.Although this individual clinical case alone cannot change guidelines or directives to use in refractory asthma exacerbations,it offers a possible treatment option to patients and providers in unusually severe cases with extenuating risk factors.展开更多
Background Lower exercise tolerance is an important component of asthma and the possible effects of non-invasive ven-tilation on exercise capacity in individuals with severe therapy-resistant asthma(STRA)are unknown.T...Background Lower exercise tolerance is an important component of asthma and the possible effects of non-invasive ven-tilation on exercise capacity in individuals with severe therapy-resistant asthma(STRA)are unknown.This study aimed to evaluate the immediate effect of continuous positive airway pressure(CPAP)on exercise tolerance in children with STRA.Methods We performed a controlled,randomized,crossover clinical trial including subjects aged 6 to 18 years old diagnosed with STRA.Clinical,anthropometric and lung function data were collected.The participants in the intervention group(IG)used CPAP(PEEP 10cmH2O and FiO20.21)for a period of 40 min.Subjects in the control group(CG)used CPAP with mini-mum PEEP at 1 cmH20 also for 40 min.Afterwards,subjects from both groups underwent cardiopulmonary exercise testing(CPET).After a 15-day washout period,on a subsequent visit,subjects participated in the opposite group to the initial one.Results Thirteen subjects with a mean age of 12.30±1.7 years were included.The variables of peak expiratory flow(PEF)and forced expiratory volume in the first second(FEV1)before using CPAP and after performing CPET did not show sig-nificant differences.Regarding CPET results,there was no significant difference(P=0.59)between groups at peak exercise for oxygen consumption—VO2(CG:33.4±6.3 and IG:34.5±5.9,mL kg^(-1)min^(-1)).However,the IG(12.4±2.1)presented a total test time(min)significantly(P=0.01)longer than the CG(11.5±1.3).Conclusion The results suggest that the use of CPAP before physical exercise increases exercise duration in children and adolescents with STRA.展开更多
文摘In order to elucidate the behavior of opioid receptor in the airway smooth muscle (ASM) and potential role of the receptor in asthmatic attacks electrical field stimulation (EFS) was used to evaluate the effects of different narcotics and naloxine (Nal) on isolated rabbit ASM and biochemical methods were used to assay the influences of morphine (Mor) and pethidine(Pet) on the activities of adenylcyclase (AAC) and phosphodiesterase(APDE) in homogenate derived from rabbit ASM.Nal was used to treat the bronchospasm during anesthesia. It shows that Mor increased the rabbit ASM contraction and Nal reversed this effect, while Nal itself did not affect ASM. Fentanyl(Fen) decreased the contraction and Pet not only decreased the contraction but relaxed the ASM. Mor decreased the AAC in the rabbit ASM but didn't affect the APDE in the rabbit ASM. Pet had no influence on both the AAC and the APDE. Nal effectively relieved the bronchospasm which failed to the traditional treatment during anesthsia. These indicate that the opioid receptor in the ASM is a new subtype one.Mor exhibits satuable binding the subtype receptor and exerts strong agonistic activity to induce bronchospasm, while Nal antagonizes this effect. Yet Fen and Pet don's bind this subtype receptor. Endogenous opioid-like peptides may also bind this subtype receptor. In patients with airway hyperreactivity (PAHR) Mor is contraindicated, Fen and Pet may be used. and the latter may be the best choice.Asthma or bronchospasm may be treated with Nal.
文摘Background: Exercise-Induced Bronchospasm (EIB) is an inflammatory condition characterized by severe airway constriction following the mobilization of inflammatory cells and interleukin-6 (IL-6). When severe, EIB can require the use of pressurized salbutamol to treat athletes. This study investigated the nature of the systemic changes in inflammatory cells and post-exercise IL-6 concentrations after salbutamol treatment in EIB-susceptible distance runners. Materials and Methods: This was an experimental study that enrolled 12 long-distance runners. In Session A, the participants completed a treadmill exercise test, and those who had a maximum expiratory volume per second (FEV1) that was decreased by at least 10% compared to their base value were placed in the EIB-susceptible group (EIB+) (n = 6). Those whose FEV1 did not meet this criterion were placed in the nonresponsive (EIB?) group (n = 6). Before the Session B exercise, athletes in the BIE+ group inhaled two puffs of salbutamol (EIB+ Salb), while their EIB? counterparts received no treatment. Spirometry was performed before and after the exercise using a Spirobank G portable spirometer. Blood samples were taken before, immediately after and 2 hours after the stress test. Results: The mean post-exercise FEV1 values were not significantly different (p > 0.05) between the EIB+ Salb group and the EIB? group. The systemic changes in inflammatory cells and IL-6 concentrations in the EIB+ runners after salbutamol treatment were similar to those observed in their EIB? counterparts. Conclusion: Salbutamol pretreatment improved the systemic immune status of EIB-susceptible athletes.
文摘Severe bronchospasm and anaphylaxis are unanticipated emergencies that may occur in the ambulatory surgery setting. I present a case in which an asthmatic male with nasal congestion has anaphylaxis after induction, with severe bronchospasm as the primary manifestation. During the course of hospitalization, he was exposed to aspirin and a second episode of severe bronchospasm occurred. He was diagnosed with both anaphylaxis to an anesthetic medication and Aspirin Exacerbated Respiratory Disease, or Samter’s Triad.
文摘Context: Fine particles (PM2.5 and PM10) can accumulate in classrooms and in schoolyards located near urban roads. PM2.5 and PM10 can initiate, develop and exacerbate exercise-induced bronchospasm (EIB). This study aimed to assess the concentration levels of PM2.5 and PM10 in schools and to determine the rate of sensitivity to EIB among schoolchildren. Methods: A total of 128 students (67 girls and 61 boys) with an average age of 11 participated in this study. An ISAAC II questionnaire on respiratory symptoms was administered. PM2.5 and PM10 were measured. A 6-minute stress test was performed. Spirometry was performed. The ratio (I/O) of the concentrations of PM2.5 and PM10 recorded inside (I) the classrooms to those obtained outside (O) the classrooms was equal to 1 (I/O = 1). Results: The concentrations of PM2.5 and PM10 recorded inside the classrooms and those obtained outside the classrooms were higher than the values recommended by the WHO. 29 students out of 128 were diagnosed as sensitive to EIB [EIB (+)], i.e., a rate of sensitivity to EIB of 22.66%. A drop in postexercise PEF of 17.396% was observed among EIB (+) students. Conclusion: Schoolchildren in schools located near highways are exposed to high levels of PM2.5 and PM10 concentrations. Exposure to PM2.5 and PM10 played an important role in the initiation and exacerbation of exercise-induced bronchospasm in schoolchildren from schools located near highways. Effective programs for improving air quality in schools must be put in place to reduce the effects of particulate pollution on the respiratory health of school children.
文摘Background: In African cities, chronic exposure to pollutants is the most common public health problem faced daily by motorcycle taxi drivers. In Benin, studies conducted on motorcycle drivers, have shown the presence of nitrogen oxides, carbon monoxide, sulfur dioxide, volatile organic compounds and particulate matter in ambient air, which may affect lung function. Aims: This study aims to diagnose potential respiratory problems among 48 motorcycle taxi drivers (47.02 ± 8.75 years) compared to a control group made up of 52 people (46.38 ± 8.81 years) in Porto-Novo, Benin. Methods: A questionnaire, two exploration pulmonary function tests and two 6-minute walk tests were used to identify symptoms and changes in respiratory variables that reveal the existence of bronchospasm. Results: The frequency of respiratory symptoms noted among motorcycle taxi drivers is higher than that recorded among members of the control group. We observed that motorcycle drivers at rest and after physical effort have significantly lower respiratory variables (FVC, FEV1, PEF, FEF25-75, FEF50 and FEF25) (p < 0.05) than those recoded in control group. Conclusion: It can therefore be concluded that, because of the relatively long duration of exposure among motorcycle taxi drivers, the inhalation of automobile pollutants, may cause respiratory problems in this population.
文摘An updated approach in the management of 50 patients with foreign body inhalation is presented. Certain risk factors that lead to complications and mortality due to endoscopic extraction of foreign bodies and thus determine prognosis were identified. Remedial measures to reduce morbidity and mortality due to bronchoscopic removal of foreign bodies are suggested. Fifty patients of suspected foreign body inhalation presented to a Unit of the Department of ENT, Head and Neck Surgery of Government Medical College associated SMHS Hospital Srinagar, Kashmir from March 2007 to June 2017. Of these, 49 patients were subjected to rigid tube bronchoscopy for removal of the aspirated foreign bodies and one coughed out the foreign body spontaneously during admission for bronchoscopy. History of foreign body inhalation was positive in 90% of patients and remaining was mostly referred from Paediatric Units with un-resolving collapse-consolidation of the lung. Whereas plain radiography of the chest and the soft tissues of neck were the primary imaging modality used in this study to detect the inhaled foreign bodies or their effects there are reports of virtual bronchoscopy being done with a multidetector computed tomography scanner in 3D image generation from axial cuts of the internal walls of the tracheobronchial tree in the management of patients suspected with foreign body aspiration. Bronchoscopy is a difficult and potentially hazardous procedure in the infant and young child. Telescopes and telescopic forceps were used during bronchoscopy to facilitate extraction of a foreign body inhaled. The type of a foreign body, site of its enlodgement and the complications encountered during its extraction were noted. During bronchoscopy the patients were connected to an ECG monitor and a pulse oximeter. 80% of the patients with foreign body inhalation were children in the age group of 0 - 5 years. There was a definite history of choking over the foreign body in 88% of the patients leading to acute respiratory distress in 46%. Cough alone or along with other symptoms occurred in most of the patients (96%). Persistent fever with respiratory symptoms unresponsive to treatment occurred in 38% of the patients with or without a positive history of foreign body inhalation. Right main bronchus was the commonest site of enlodgement of foreign body. In the present study, bean and peanut were the commonest types of foreign bodies inhaled (34%). Radiological findings in these patients include atelectasis with or without pneumonitis in 46.65% of the patients, normal chest/soft tissues of the neck in 24.45%, obstructive emphysema on the affected side in 24.45%, foreign body seen in the respiratory tract in 8.90% and bronchopneumonia in 2.22%. Complications associated with the endoscopic extraction of foreign bodies and the risk factors that lead to complications and mortality in patients with aspirated foreign bodies were identified in this study and the measures to reduce these complications and mortality rate to very low levels were suggested. Transient hypoxia, hypoxic bradycardia, transient cardiac arrest, bronchial perforation and death, laryngospasm, bronchospasm, subglottic oedema, reflex bradycardia and pneumothorax were among the few complications which occurred with the rigid endoscopic extraction of foreign bodies in the present study. Among the risk factors associated with the complications were prolonged bronchoscopy, semi-blind procedure, a vegetable foreign body, improper size and positioning of a bronchoscope and some other important factors which are detailed in the text of this paper to follow. Remedial measures on the basis of complications and the risk factors are suggested so as to decrease the morbidity and mortality due to endoscopic extraction of foreign bodies inhaled into the tracheobronchial tree.
文摘Background:Estimated 4%-8%of pregnancies are complicated by asthma.Adequate management in this population is critical to minimize complications.Patients presenting with asthma exacerbation are typically managed with standard bronchodilators and systemic corticosteroids.However,additional agents may be used in patients with refractory asthma exacerbation.Ketamine has been used in refractory bronchospasm,although its efficacy in published literature is heterogeneous.Case Presentation:We present a case of a pregnant patient with severe asthma exacerbation refractory to standard and salvage treatment who achieved termination of bronchospasm with ketamine infusion.Conclusion:After receiving ketamine infusion for several days,the patient had improved air flow and achieved successful extubation,without experiencing rebound bronchospasm.Although this individual clinical case alone cannot change guidelines or directives to use in refractory asthma exacerbations,it offers a possible treatment option to patients and providers in unusually severe cases with extenuating risk factors.
文摘Background Lower exercise tolerance is an important component of asthma and the possible effects of non-invasive ven-tilation on exercise capacity in individuals with severe therapy-resistant asthma(STRA)are unknown.This study aimed to evaluate the immediate effect of continuous positive airway pressure(CPAP)on exercise tolerance in children with STRA.Methods We performed a controlled,randomized,crossover clinical trial including subjects aged 6 to 18 years old diagnosed with STRA.Clinical,anthropometric and lung function data were collected.The participants in the intervention group(IG)used CPAP(PEEP 10cmH2O and FiO20.21)for a period of 40 min.Subjects in the control group(CG)used CPAP with mini-mum PEEP at 1 cmH20 also for 40 min.Afterwards,subjects from both groups underwent cardiopulmonary exercise testing(CPET).After a 15-day washout period,on a subsequent visit,subjects participated in the opposite group to the initial one.Results Thirteen subjects with a mean age of 12.30±1.7 years were included.The variables of peak expiratory flow(PEF)and forced expiratory volume in the first second(FEV1)before using CPAP and after performing CPET did not show sig-nificant differences.Regarding CPET results,there was no significant difference(P=0.59)between groups at peak exercise for oxygen consumption—VO2(CG:33.4±6.3 and IG:34.5±5.9,mL kg^(-1)min^(-1)).However,the IG(12.4±2.1)presented a total test time(min)significantly(P=0.01)longer than the CG(11.5±1.3).Conclusion The results suggest that the use of CPAP before physical exercise increases exercise duration in children and adolescents with STRA.
