phenylephrine-hydrochloride and Bronchial-Spasm

The upper airways are a complex structure with multiple functions; many of the muscles participate in the act of respiration. The neural control of upper airway muscles is distinct from that of chest wall muscles under a variety of circumstances. Coordinated activation of upper airway muscles, both regionally and inter-regionally, results in changes in upper airway size and resistance, alterations in the route of airflow, and increases in the ability of the airways to resist collapse. Several disorders have now been described in which neuromuscular drive abnormalities and/or mechanical dysfunction of the upper airways occur, resulting in clinical disease.

Topics: Afferent Pathways; Behavior; Blood Pressure; Bronchial Spasm; Humans; Hypercapnia; Hypoxia; Laryngeal Diseases; Larynx; Lip; Mechanoreceptors; Muscles; Neuromuscular Diseases; Nose; Palate, Soft; Pharynx; Pulmonary Stretch Receptors; Reflex; Respiration; Respiratory Physiological Phenomena; Respiratory System; Sleep Apnea Syndromes; Vagus Nerve; Vocal Cords

Aspirin (ASA) and other non-steroidal anti-inflammatory drugs, which are cyclooxygenase (COX) inhibitors, precipitate asthmatic attacks in ASA-intolerant patients, while sodium salicylate, hardly active on COX by itself, is well tolerated by these patients. However, salicylate moiety appears to interfere with aspirin inhibitory action on platelets and vascular COX. Such interaction, if present at the level of respiratory tract, may be of interest to pathogenesis of ASA-induced asthma. We performed a double-blind, placebo-controlled, randomized cross-over study on the effect of choline magnesium trisalicylate (CMT, trilisate) pre-treatment on ASA-induced adverse reactions in nine patients. Pulmonary function tests, nasal symptoms score, PNIF and serum salicylate levels were monitored following challenges with threshold doses of ASA. Trilisate administered at a dose of 3000 mg daily for 3 days, offered a moderate protection against ASA-induced symptoms; it diminished the severity and/or delayed the appearance of FEV1 fall. Maximal decreases in FEV1 as well as reaction intensity indexes were significantly lower (P less than 0.02 and P less than 0.002, respectively) after trilisate pre-treatment as compared to placebo. Trilisate also attenuated nasal symptoms in three out of five patients. Although the precise mechanism of the protective action of trilisate is unknown, our data support the possibility of interaction between salicylate and ASA on cyclo-oxygenase locus in the respiratory tract in ASA-intolerant patients.

Topics: Adult; Anti-Inflammatory Agents, Non-Steroidal; Aspirin; Asthma; Bronchial Spasm; Choline; Double-Blind Method; Drug Hypersensitivity; Drug Tolerance; Female; Humans; Male; Middle Aged; Nose; Salicylates

Topics: Adult; Anesthesia, General; Asthma; Bronchial Spasm; Cholinesterase Inhibitors; Humans; Male; Nasal Septum; Neostigmine; Nose

Vocal cord dysfunction (VCD) has been reported in adolescents only rarely. Two patients are described whose initial diagnosis was exercise-induced bronchospasm (EIB). However, evaluation revealed inspiratory stridor and flattening of the inspiratory limb of the flow-volume curve. Flexible fiberoptic rhinolaryngoscopy revealed adduction of vocal cords during inspiration. Patients were treated with speech therapy and have remained free of symptoms. VCD should be considered in adolescents who are unresponsive to treatment for EIB.

Topics: Adolescent; Bronchial Spasm; Child; Diagnosis, Differential; Endoscopy; Female; Fiber Optic Technology; Follow-Up Studies; Forced Expiratory Volume; Humans; Inhalation; Laryngeal Diseases; Laryngoscopy; Nose; Physical Exertion; Pulmonary Ventilation; Respiratory Sounds; Speech Therapy; Vital Capacity; Vocal Cords

Sinusitis should be suspected in cases of chronic, difficult to control asthma or other pulmonary diseases. Appropriate measures to diagnose and treat sinus disease are listed, and an upright Waters roentgenogram may be all that is required for diagnosis. A true sino-bronchial reflex is proposed in these patients. Nasal receptors and reflexes are effective in the physiology of the nose, and in many cases, the diagnosis and treatment of rhinitis and sinusitis results in the improvement of various chronic pulmonary conditions.

Topics: Asthma; Bronchial Spasm; Cranial Nerves; Humans; Male; Middle Aged; Nose; Paranasal Sinuses; Pharynx; Receptors, Neurotransmitter; Sinusitis

In the first step of a study of the relation of nasal and oral breathing during moderate treadmill exercise to the onset of bronchoconstriction in young patients with perennial bronchial asthma, it was observed that most subjects spontaneously breathed with their mouths open when instructed to breathe "naturally." Subsequently, when they were required to breathe only through the nose during the exercise, an almost complete inhibition of the postexercise bronchoconstrictive airway response was demonstrated. When instructed to breathe only through the mouth during exercise, an increased bronchoconstrictive airway response occurred, as measured by spirometry, flow-volume relationships, and body plethysmography. These findings suggest that the nasopharynx and the oropharynx play important roles in the phenomenon of exercise-induced bronchoconstriction.

Topics: Adolescent; Asthma; Bronchial Spasm; Child; Female; Humans; Lung; Lung Volume Measurements; Male; Mouth Breathing; Nose; Physical Exertion

Topics: Adenoidectomy; Adolescent; Asthma; Bronchial Diseases; Bronchial Spasm; Child; Constriction, Pathologic; Focal Infection; Humans; Nasal Cavity; Nose; Palatine Tonsil; Respiratory Tract Infections; Tonsillectomy; Tonsillitis