phenylephrine-hydrochloride and Dyspnea

The perception of breathlessness is mechanistically linked to the awareness of increased inspiratory neural drive (IND). Stimulation of upper airway cold receptors on the trigeminal nerve (TGN) with TGN agonists such as menthol or cool air to the face/nose has been hypothesized to reduce breathlessness by decreasing IND. The aim of this systematic scoping review was to identify and summarize the results of studies in animals and humans reporting on the impact of TGN stimulation or blockade on measures of IND. Thirty-one studies were identified, including 19 in laboratory animals and 12 in human participants. Studies in laboratory animals consistently reported that as TGN activity increased, measures of IND decreased (e.g., phrenic nerve activity). In humans, stimulation of the TGN with a stream of cool air to the face/nose decreased the sensitivity of the ventilatory chemoreflex response to hypercapnia. Otherwise, TGN stimulation with menthol or cool air to the face/note had no effect on measures of IND in humans. This review provides new insight into a potential neural mechanism of breathlessness relief with selected TGN agonists.

Topics: Animals; Dyspnea; Humans; Menthol; Nose; Olfactory Nerve; Trigeminal Nerve

Pepper (oleoresin capsicum) spray is one of the most common riot-control measures used today. Although not lethal, exposure of pepper spray can cause injury to different organ systems. This review aimed to summarise the major clinicopathological effects of pepper spray in humans.. MEDLINE, EMBASE database, and Cochrane Database of Systematic Reviews were used to search for terms associated with the clinicopathological effects of pepper spray in humans and those describing the pathophysiology of capsaicin. A phone interview with two individuals recently exposed to pepper spray was also conducted to establish clinical symptoms.. Major key words used for the MEDLINE search were "pepper spray", "OC spray", "oleoresin capsicum"; and other key words as "riot control agents", "capsaicin", and "capsaicinoid". We then combined the key words "capsaicin" and "capsaicinoid" with the major key words to narrow down the number of articles. A search with other databases including EMBASE and Cochrane Database of Systematic Reviews was also conducted with the above phrases to identify any additional related articles.. All article searches were confined to human study. The bibliography of articles was screened for additional relevant studies including non-indexed reports, and information from these was also recorded. Non-English articles were included in the search.. Fifteen articles were considered relevant. Oleoresin capsicum causes almost instantaneous irritative symptoms to the skin, eyes, and respiratory system. Dermatological effects include a burning sensation, erythema, and hyperalgesia. Ophthalmic effects involve blepharospasm, conjunctivitis, peri-orbital oedema, and corneal pathology. Following inhalation, a stinging or burning sensation can be felt in the nose with sore throat, chest tightness, or dyspnoea. The major pathophysiology is neurogenic inflammation caused by capsaicinoid in the pepper spray. There is no antidote for oleoresin capsicum. Treatment consists of thorough decontamination, symptom-directed supportive measures, and early detection and treatment of systemic toxicity. Decontamination should be carefully carried out to avoid contamination of the surrounding skin and clothing.. Pepper (oleoresin capsicum) spray is an effective riot-control agent and does not cause life-threatening clinical effects in the majority of exposed individuals. Early decontamination minimises the irritant effects.

Topics: Aerosols; Decontamination; Dyspnea; Eye Diseases; Humans; Inhalation Exposure; Neurogenic Inflammation; Nose; Pharyngitis; Plant Extracts; Riot Control Agents, Chemical; Skin Diseases

Empty nose syndrome (ENS) is a poorly understood and rare iatrogenic disorder resulting from the destruction of normal nasal tissue. In severe forms, it can be debilitating. In this article, the authors elucidate the distinction between ENS and atrophic rhinitis, and provide a systematic approach to the diagnosis and management of ENS. They urge a judicious and cautious approach to turbinate resection, to help better prevent this sequela of nasal surgery. They state that patients with ENS can be rehabilitated and their quality of life substantially improved with nasal augmentation as a means to help restore nasal anatomy toward the premorbid state.

Topics: Dyspnea; Humans; Iatrogenic Disease; Nasal Obstruction; Nose; Pulmonary Ventilation; Quality of Life; Rhinitis, Atrophic; Syndrome

Menthol, in lozenges, nasal sprays, vapo-rubs, inhalers, and cough syrups, is widely used as a treatment for rhinitis that is associated with acute upper respiratory tract infection and allergy. Menthol as a plant extract has been used in traditional medicine in Asia for the treatment of respiratory diseases for hundreds of years, but it was only introduced to the West as a medicine at the end of the 19th century. With the recent discovery of a menthol receptor on the sensory nerves that modulate the cool sensation, menthol has graduated from the realms of herbal medicine into the field of molecular pharmacology. This review concerns the physiologic and pharmacologic mechanisms that underlie the widespread use of menthol as a treatment for the relief of nasal congestion associated with rhinitis and its effects on the drive to breathe and symptomatic relief of dyspnea.

Topics: Dyspnea; Humans; Menthol; Nose; Sensation; Structure-Activity Relationship

Research is equivocal regarding endurance performance benefits of external nasal dilators, and currently research focusing on internal nasal dilators is non-existent. Both devices are used within competitive cycling. This study examined the influence of external and internal nasal dilation on cycling economy of motion and 20-km time trial performance.. The study utilized a randomized, counterbalanced cross-over design.. Fifteen trained cyclists completed three exercise sessions consisting of a 15min standardized warm up and 20-km cycling time trial while wearing either a Breathe Right. No differences were observed for mean 20-km power output between the internal (270±45W) or external dilator (271±44W) and control (272±44W). No differences in the economy of motion were observed throughout the 15-min warm up between conditions.. The Turbine

Topics: Adult; Analysis of Variance; Bicycling; Cross-Over Studies; Dilatation; Dyspnea; Exercise Test; Heart Rate; Humans; Male; Middle Aged; Muscle Fatigue; Nose; Oxygen Consumption; Physical Endurance; Physical Exertion

Nasal dilators are being developed for the purpose of increasing air flow in the nasal valve. The aim of this study is to evaluate the use of the internal nasal dilator (IND) by adolescent athletes.. A double-blind, crossover clinical trial in which we evaluated 54 adolescents using experimental and placebo INDs, submitted to a cardio-respiratory test in randomized order. The predicted values for the peak nasal inspiratory flow (PNIF) were obtained and the intensity of dyspnea was evaluated using the visual analog scale method after the race.. In relation to PNIF (% predicted), when participants used the experimental IND, significantly higher means were found in comparison with the placebo (104.27±24.67L/min and 97.73±25.61L/min, respectively) (p=0.010). There were no significant differences observed in terms of heart rate (HR), pulse oximetry (SpO2) and maximal oxygen uptake (VO2max), before and after the cardio-respiratory test. There was also no significant difference (p>0.05) between the use of experimental and placebo INDs on dyspnea scale measurements after completion of the cardio-respiratory test.. Results suggested that the Airmax® IND improves nasal patency, as measured by PNIF, in healthy adolescent athletes. There was no statistically significant difference in the values for heart rate and SpO2. There was also no difference between the conditions tested for the mean VO2max. Further studies should be conducted to evaluate the effect of IND in adolescent athletes with chronic diseases, such as asthma and allergic rhinitis, and also using other cardio-respiratory assessment methods.

Topics: Adolescent; Athletes; Child; Cross-Over Studies; Dilatation; Double-Blind Method; Dyspnea; Exercise Test; Female; Humans; Male; Nose; Respiratory Function Tests; Soccer

Athletes and coaches have begun to use external nasal dilators with the perception that they enhance performance and make it "easier to breathe." This study was conducted to ascertain whether application of an external nasal dilator would enhance performance, as measured by maximal oxygen uptake (VO2max), maximal ventilation (V(Emax)), maximal work rate (Wr(max)) or ratings of perceived exertion and dyspnea (RPE, RPD).. Fifteen subjects (F = 10; M = 5: age, 20+/-1.4, mean +/- SD) performed three incremental exercise tests to fatigue on an ergometer at 1-wk intervals in randomized order. One test was conducted without a nasal dilator, using a nose clip and mouthpiece for oxygen uptake and ventilatory measurements (control, C). The other two tests used a Rudolph 8900 breathing mask that included the nose in the breathing circuit and subjects wore either a placebo (P) or the active dilator (A). RPE for total body (20-point scale) and for dyspnea (10-point scale) were also measured on all tests.. There were no significant differences in VO2max (mean +/- SD; C = 3.12+/-1.1; P = 3.12 + 1.06; A = 3.04+/-0.94). V(Emax) (C = 117+/-26; P = 125+/-31; A = 122+/-26), Wr(max) (C = 256+/-73; P = 255+/-70; A = 257+/-74), RPE (C = 18.8+/-1.78; P = 18.9+/-1.33; A = 18.9+/-1.22), or RPD (C = 9.1+/-1.58; P = 9.3+/-1.2; A = 9.13+/-1.2) during exercise between any group.. Thus, it is concluded that an external nose dilator does not enhance performance as measured by VO2max, V(Emax), Wr(max), or perceived performance as measured by RPE and RPD.

Topics: Adolescent; Adult; Dyspnea; Ergometry; Female; Humans; Male; Nose; Oxygen Consumption

Topics: Dyspnea; Humans; Infant, Newborn; Nose; Respiratory Distress Syndrome; Respiratory Distress Syndrome, Newborn

Assessment of inspiratory dyspnoea associated with upper airway obstruction is based on subjective clinical and nasal fibreoptic laryngoscopy (NFL) signs. The aim of this study was to determine whether peak inspiratory flow (PIF) measurement could indicate the need for upper airway release surgery in patients with acute inspiratory dyspnoea during emergency.. A retrospective single-institution study (February 2018-March 2020) of 48 patients with acute inspiratory dyspnoea and PIF measurement (Peak Flow In-Check Dial G16. Forty-eight patients were included in this study. Thirty-five patients underwent surgery (PIF: 36 L/min), and 13 patients did not (PIF: 58 L/min) (p = 0.0009). Three of these 13 patients underwent an operation later (PIF value: 42 L/min versus 63 L/min for the 10 others [p = 0.25]).. PIF measurement is a quantitative, objective, inexpensive, non-invasive, and quick test that is potentially useful for general practitioners, mobile medical teams, or for ear-nose-and-throat specialists. A threshold of 42 L/min can help doctors in emergency decision making to refer patients to an ear-nose-and-throat specialist to release the upper airway and perform surgery or to choose medical monitoring for patients with emergency inspiratory dyspnoea.

Topics: Dyspnea; England; Humans; Inspiratory Capacity; Nose; Retrospective Studies

Upper airway injuries can be fatal in burn patients if not recognized, a scenario that causes a significant amount of anxiety for physicians providing initial assessment of burn patients. Early elective intubation is often performed; sometimes unnecessarily. However, some providers employ nasolaryngoscopy for patients presenting with facial burns or signs/symptoms of upper airway injury in order to assess the need for intubation, but this practice is not considered standard of care and may also be unnecessary. Evidence is currently lacking about the utility of nasolaryngoscopy as an adjuvant assessment during evaluation of potential upper airway burn injuries. The objective of this study was to determine if nasolaryngoscopy provides additional information to the history and physical in making the decision to electively intubate patients with facial burns.. This study was a retrospective analysis of all patients who underwent fiberoptic nasolaryngoscopy after facial burn injury to evaluate for upper airway injury associated with burns over a 2 year period at a regional burn center. During this time period, all patients who presented with facial burns, soot, or carbonaceous sputum underwent nasolaryngoscopy to look for upper airway injury regardless of mechanism of injury. Patients intubated prior to arrival were excluded from the study. Patients were considered to have signs/symptoms of airway injury (symptomatic) if they presented with dyspnea, tachypnea, hypoxia, or significant burns to buccal mucosa. Procedure notes were used to determine if supraglottic/glottic injury (erythema or edema) was present on nasolaryngoscopy. Presence of pathologic changes and whether they led to intubation were evaluated in the asymptomatic and the symptomatic groups of patients. Select individual records were inspected further to help determine if the nasolaryngoscopy findings altered management plans and if intubation was ultimately necessary based upon the presence or absence of a cuff leak and the duration of intubation.. Twenty-two patients were symptomatic upon presentation, 14 of which had positive findings on laryngoscopy and 7 (50%) were intubated. One-hundred and eighty-eight patients were asymptomatic, 58 (31%) of which had either erythema or edema or carbonaceous debris on nasolaryngoscopy, and only 2 (1%) were intubated. These patients were both extubated within two days. None of the 130 asymptomatic patients with negative nasolaryngoscopy were intubated.. This study showed disparity between signs and symptoms of airway injury and nasolaryngoscopy findings. Asymptomatic patients showed pathologic changes in 30% of scopes, but this finding only changed management 1% of the time. Furthermore, the two patients in this group were extubated quickly, suggesting they may have been suitable for observation without intubation. These results indicate that the presence of erythema or edema is of questionable clinical significance in asymptomatic patients and nasolaryngoscopy is of limited benefit in this group. Only 50% of the symptomatic patients with airway injury evident on nasolaryngoscopy were actually intubated, also bringing into question the significance of the pathologic changes in this group. However, negative nasolaryngoscopy may have had some benefit in preventing intubation in a few, select symptomatic patients. This study suggests that a thorough history and physical is the best tool to identify patients at higher risk of upper airway injury who need intubation, but this should be further studied in prospective trials to determine the definitive role of nasolaryngoscopy.

Topics: Adult; Burn Units; Burns; Burns, Inhalation; Diagnostic Techniques, Respiratory System; Dyspnea; Facial Injuries; Female; Humans; Hypoxia; Laryngoscopy; Larynx; Logistic Models; Male; Nose; Pharynx; Retrospective Studies; Smoke Inhalation Injury; Tachypnea

Breathing discomfort (dyspnea) during mechanical ventilation in the ICU may contribute to patient distress and complicate care. Assessment of nonverbal cues may allow caregivers to estimate patient breathing discomfort. This study assesses the accuracy of those caregiver estimates.. Thirty subjects were identified from ventilated, hemodynamically stable patients in the special care unit of Maine Medical Center. Those with impaired neurological function or too unstable to waken were excluded. Subjects provided a subjective score of breathing discomfort (0-10 using a modified Borg scale) during daily wake-up from sedation (sedation-agitation score of 3 or 4). Clinicians (physicians, respiratory therapists, and nurses) then provided a blinded estimate of subject breathing discomfort (0-10) through observation of the subject and inspection of ventilator parameters alone. Subject scores and caregiver estimates were compared.. All subjects reported breathing discomfort with median score (interquartile range) of 4 (3-4). Caregiver estimates of breathing discomfort were significantly lower than subject scores (2 [0-3]), and the discrepancy was seen in all professions (physicians 1 point lower [0-2], P = .02; respiratory therapists 1 point lower [0-2], P = .01; nurses 2 points lower [1-3], P < .001). There was a positive correlation between subject breathing discomfort and degree of underestimation (ie, the degree of underestimation increased as the subject scores rose). The 3 most commonly used cues were subjects' facial expression, use of accessory muscles, and nasal flaring.. Significant breathing discomfort is prevalent in mechanically ventilated ICU patients and is underestimated by caregivers, regardless of profession. The increasing disparity in caregiver estimate as breathing discomfort rises may expose patients to levels of dyspnea that promote anxiety and fear. This study demonstrates the need for further development and standardization of methods to assess dyspnea in nonverbal patients.

Topics: Dyspnea; Facial Expression; Female; Humans; Intensive Care Units; Male; Nose; Nurses; Observation; Observer Variation; Physicians; Respiration, Artificial; Respiratory Mechanics; Respiratory Therapy; Severity of Illness Index

To determine whether the presence of nasal flaring is a clinical sign of respiratory acidosis in patients attending emergency departments for acute dyspnea.. Single-center, prospective, observational study of patients aged over 15 requiring urgent attention for dyspnea, classified as level II or III according to the Andorran Triage Program and who underwent arterial blood gas test on arrival at the emergency department. The presence of nasal flaring was evaluated by two observers. Demographic and clinical variables, signs of respiratory difficulty, vital signs, arterial blood gases and clinical outcome (hospitalization and mortality) were recorded. Bivariate and multivariate analyses were performed using logistic regression models.. The sample comprised 212 patients, mean age 78years (SD=12.8), of whom 49.5% were women. Acidosis was recorded in 21.2%. Factors significantly associated with the presence of acidosis in the bivariate analysis were the need for pre-hospital medical care, triage level II, signs of respiratory distress, presence of nasal flaring, poor oxygenation, hypercapnia, low bicarbonates and greater need for noninvasive ventilation. Nasal flaring had a positive likelihood ratio for acidosis of 4.6 (95% CI 2.9-7.4). In the multivariate analysis, triage level II (aOR 5.16; 95% CI: 1.91 to 13.98), the need for oxygen therapy (aOR 2.60; 95% CI: 1.13-5.96) and presence of nasal flaring (aOR 6.32; 95% CI: 2.78-14.41) were maintained as factors independently associated with acidosis.. Nasal flaring is a clinical sign of severity in patients requiring urgent care for acute dyspnea, which has a strong association with acidosis and hypercapnia.

Topics: Acidosis, Respiratory; Aged; Aged, 80 and over; Blood Gas Analysis; Case-Control Studies; Dyspnea; Emergency Service, Hospital; Female; Humans; Hypercapnia; Logistic Models; Male; Middle Aged; Multivariate Analysis; Noninvasive Ventilation; Nose; Oxygen Inhalation Therapy; Physical Examination; Prospective Studies; Severity of Illness Index; Triage

Topics: Aged; Antigens, Fungal; Asthma; Blastomyces; Blastomycosis; Carcinoma, Squamous Cell; Delayed Diagnosis; Diagnosis, Differential; Dyspnea; Glucocorticoids; Humans; Lung; Male; Nose; Nose Neoplasms; Pulmonary Embolism; Radiography; Venous Thrombosis

To determine if the presence of nasal flaring is indicative of severe respiratory insufficiency.. Prospective observational study of patients consulting in the Emergency Department because of dyspnea whose triage level is II or III in the Spanish Triage System (MAT-SET). Vital signs, SpO2, arterial blood gases and nasal flaring presence were recorded, as well as the need for hospital admission and length of hospital stay. Data are presented as median (25-75th percentile).. A total of 43 patients were analyzed (70% men, aged 77 (67-82) years), 7 of whom showed nasal flaring. Those having flaring had higher respiratory rate (36 (34-40) vs. 25 (20-28) vs., p=0.001) and were more acidotic (pH 7.34 [7.23-7.40] vs. 7.42 [7.39-7.46] vs., p=0.03) than patients without this sign. There were no differences between groups in SpO2, PaCO2, heart rate and arterial pressure. There were no differences in the rate of hospital admission-(6 patients [85.7%] in nasal flaring group vs 29 patients [80.5%] in the non nasal flaring group [p=0,06], or in the length of the hospital stay-3 days [1-16] in nasal flaring group vs. 6 days [1-10] in the non nasal flaring group, p=0.6). All patients with nasal flaring had tachypnea.. In our study, nasal flaring does not indicate severity in dyspneic patients in spite of its association with tachypnea and acidosis.

Topics: Aged; Aged, 80 and over; Dyspnea; Female; Humans; Male; Nose; Physical Examination; Predictive Value of Tests; Prospective Studies; Severity of Illness Index

ENDS (external nasal dilator strips) are adhesive bands containing a central elastic strip providing a spring action. The possibility of reducing the cumulated effort of continuous breathing or decreasing the perception of exertion would be of major benefit to oncological dyspneic patients, namely in presence of a cachexia-asthenia complex.. Nine patients complaining of dyspnea were included in this pilot study. The ENDS were applied at 0800 and at 1600. Perception of dyspnea and tolerability was assessed 12 h after the first application of the ENDS. No other treatment changes were performed during the evaluation time.. As a result of the application of ENDS, one patient perceived a good improvement of dyspnea, three moderate, two little, and three none. Tolerability was good for four patients and moderate for another four. Seven out of nine patients decided to carry on with the application of ENDS afterwards.. The application of ENDS may be useful in cancer patients with dyspnea. It could be particularly helpful to patients suffering from cachexia and profound fatigue. However, further research is needed to affirm that ENDS might have an important place in relieving dyspnea.

Topics: Aged; Aged, 80 and over; Dilatation; Dyspnea; Female; Humans; Male; Middle Aged; Neoplasms; Nose; Pilot Projects; Respiration; Treatment Outcome

To evaluate whether the core-peripheral temperature gradient could be used to distinguish between cardiac and respiratory causes of dyspnoea.. In total, 50 patients were enrolled in the study, based on the following inclusion criteria: (a) a primary presenting complaint of dyspnoea; (b) age > 40 years; (c) respiratory rate > 20 breaths/min; (d) hypoxia. The tympanic temperature and the temperature of the nasal tip were recorded, and the patient's discharge data and chest x ray results checked. Where there was discordance, arbitration was carried out by another researcher.. Four patients were excluded, hence the final study sample was 46 patients. There was a statistically significant difference between the mean temperature gradients of the two study populations (p < 0.001). A gradient of > 8 degrees C was able to rule in a cardiovascular cause (92% specificity) whereas one of < 5 degrees C could rule it out (100% sensitivity).. The test is safe, non-invasive and inexpensive. Although there were some limitations to the study, the test can still be commended as a useful adjunct to the emergency assessment of the acutely breathless patient.

Topics: Aged; Aged, 80 and over; Body Temperature; Cardiovascular Diseases; Dyspnea; Emergency Service, Hospital; Female; Humans; Male; Middle Aged; Nose; Sensitivity and Specificity; Skin Temperature; Tympanic Membrane

Inspiratory muscle weakness is a recognised cause of unexplained dyspnoea. It may be suggested by the finding of a low static inspiratory mouth pressure (MIP), but MIP is a difficult test to perform, with a wide normal range; a low MIP may also occur if the patient has not properly performed the manoeuvre. Further investigation conventionally requires balloon catheters to obtain oesophageal (Poes) and transdiaphragmatic pressure (Pdi) during sniffs or phrenic nerve stimulation. Two non-invasive tests of inspiratory muscle strength have recently been described--nasal pressure during a maximal sniff (Sn Pnas) and mouth pressure during magnetic stimulation of the phrenic nerves (Tw Pmo). The use of these two tests in combination might identify patients without inspiratory muscle weakness who are unable to produce a satisfactory MIP< therefore avoiding the need for investigation with balloon catheters.. Thirty consecutive patients with clinically suspected inspiratory muscle weakness and a low MIP underwent both conventional (Sn Poes and Tw Pdi) and non-invasive testing (Sn Pnas and Tw Pmo). Weakness was considered to be excluded by a Sn Poes of > or = 80 cm H20 or a Tw Pdi of > or = 20 cm H20. The limit values used to test the hypothesis were Sn Pnas > or = 70 cm H20 or Tw Pmo > or = 12 cm H20.. Inspiratory muscle weakness was excluded in 17 of the 30 patients. Fifteen of these would have been identified using Sn Pnas and Tw Pmo, with better results when the two tests were combined. The cut off values selected for Sn Pnas and Tw Pmo were shown by ROC plots to indicate normal strength conservatively, avoiding failure to detect mild degrees of weakness. No patient with global weakness was considered normal by Sn Pnas or Tw Pmo.. In most patients with normal inspiratory strength and a low MIP, Tw Pmo and Sn Pnas used in combination can reliably exclude global inspiratory muscle weakness, reducing the number of patients who need testing with balloon catheters.

Topics: Adult; Aged; Diaphragm; Dyspnea; Female; Humans; Magnetics; Male; Middle Aged; Mouth; Muscle Weakness; Nose; Phrenic Nerve; Pressure; Respiration; Respiratory Muscles

Very little information is available on the acute histopathological bronchial alterations caused by reactive airways dysfunction syndrome (RADS). We had the opportunity to carry out sequential bronchial biopsies in a subject with RADS due to chlorine (60 h, 15 days, 2 and 5 months after the acute exposure), and also to assess spirometry and bronchial responsiveness to methacholine. A 36 year old worker in a water-filtration plant (nonsmoker) abruptly inhaled high concentrations of chlorine on September 12, 1994. He experienced immediate nasal and throat burning, retrosternal burning and wheezing, and these symptoms persisted during and after the workshift. Two days later, he complained of retrosternal burning, dyspnoea and wheezing. Inspiratory wheezing was documented. His forced expiratory volume in one second (FEV1) was 66% of predicted and the provocative concentration of methacholine causing a 20% fall in FEV1 (PC20) was slightly abnormal (2.5 mg.mL-1). On the following day, the patient underwent bronchial biopsies, which showed almost complete replacement of the epithelium by a fibrinohaemorhagic exsudate. The subject was prescribed inhaled steroids. Fifteen days after the accident, the PC20 was improved to 6 mg.mL-1. Bronchial biopsies showed considerable epithelial desquamation with an inflammatory exudate and swelling of the subepithelial space. Five weeks after the accident, the PC20 was normal (57 mg.mL-1). Inhaled steroids were stopped. Two months after the accident, the PC20 deteriorated to 4 mg.mL-1. Biopsies then showed regeneration of the epithelium by basal cells and there was still a pronounced inflammatory infiltrate. Inhaled steroids were restarted. Three and five months later, the PC20 was normal (24 mg.mL-1). Bronchial biopsies showed a greatly improved epithelium and reduction of the inflammatory infiltrate. This case report shows that reactive airways dysfunction syndrome can cause acute, marked, though partially reversible, histological abnormalities. Inhaled steroids may modulate changes in bronchial responsiveness in this condition.

Topics: Adult; Aerosols; Anti-Infective Agents; Biopsy; Bronchi; Bronchial Hyperreactivity; Chest Pain; Chlorine; Dyspnea; Epithelium; Follow-Up Studies; Forced Expiratory Volume; Humans; Inflammation; Male; Nose; Occupational Diseases; Pharynx; Regeneration; Respiratory Sounds; Spirometry; Syndrome; Water Purification

Lung volume reduction surgery (LVRS) in patients with severe lung emphysema restores the thoracic configuration to a more normal functional capacity. The aim of this study was to investigate whether reduction in intrathoracic volume by LVRS improves the inspiratory muscle force generation of the respiratory pump. Pulmonary function tests, maximal inspiratory mouth pressure (MIP), sniff nasal inspiratory pressure (SNIP), sniff transdiaphragmatic pressure (Pdi), and inspiratory mouth occlusion pressure (P0.1) were measured in 17 emphysematous patients (mean (+/- SEM) age 53 +/- 2 yrs) before and 1 month after LVRS. The mean value of forced expiratory volume in one second (FEV1) increased (0.82 +/- 0.07 vs 1.12 +/- 0.08 L; p < 0.0001), whilst there was a decrease (p < 0.0001) in residual volume (RV) (337 +/- 31 vs 250 +/- 21 % of predicted), functional residual capacity (FRC) (210 +/- 9 vs 159 +/- 9% pred), and total lung capacity (TLC) (138 +/- 6 vs 110 +/- 5% pred). The mean value of MIP increased by 52% from 4.8 +/- 0.4 to 7.3 +/- 0.6 kPa (p < 0.001), the mean value of SNIP increased by 66% from 3.9 +/- 0.4 to 6.5 +/- 0.5 kPa (p < 0.001), and the mean value of Pdi increased by 28% from 6.0 +/- 0.6 to 7.7 +/- 0.8 kPa (p < 0.05) after LVRS. P0.1 decreased on average by 24% from 0.46 +/- 0.03 to 0.35 +/- 0.02 kPa after LVRS. No significant correlations were found between inspiratory muscle (MIP, SNIP, Pdi) and respiratory drive (P0.1) indices, lung function data, 6 min walk distance, or dyspnoea score. In conclusion, the observed clinical improvement of patients with severe emphysema after lung volume reduction surgery results, in part, from an increased ability of the inspiratory muscles to generate force, which is paralleled by a significant decrease in central respiratory drive.

Topics: Adult; Diaphragm; Dyspnea; Female; Forced Expiratory Volume; Functional Residual Capacity; Humans; Inhalation; Male; Middle Aged; Mouth; Nose; Pneumonectomy; Pressure; Pulmonary Emphysema; Residual Volume; Respiratory Mechanics; Respiratory Muscles; Thorax; Total Lung Capacity; Walking

A 9-year-old female llama was evaluated for chronic dermatosis involving the external nares. The condition had been diagnosed as a fungal infection. Examination of punch biopsy specimens confirmed the diagnosis of Conidiobolus coronatus. Because of the chronicity of the disease and history of ineffective drug treatment, excision of infected tissue was attempted. Permanent nasal openings were created by suturing the nasal mucosa to the skin after debulking of infected tissue. Excision of most of the infected tissue enabled the llama to breathe easily for 3 years. Because C coronatus does not usually induce deep infections, it may continue to remain dormant in this llama.

Topics: Animals; Camelids, New World; Dermatomycoses; Dyspnea; Female; Fungi; Nose; Pregnancy; Pregnancy Complications, Infectious

Patients with chronic obstructive pulmonary disease [COPD] breath at large lung volumes because of dynamic hyperinflation. Their end-tidal lung volumes will then be much above the equilibrium position of the respiratory system and the elastic recoil pressure would be above zero at end-tidal exhalation. This auto or intrinsic positive end-expiratory pressure [auto-PEEP] contributes to the elastic work of inspiration and the sensation of dyspnoea. The purpose of this study was to offset the auto-PEEP in patients with exacerbated chronic airflow obstruction by applying continuous positive airway pressure via the nose [nasal-CPAP]. Nine out of 14 patients experienced alleviation of dyspnoea while on nasal-CPAP [4 to 8 cmH2O]. These 9 patients had significantly more severe hyperinflation than the 5 patients who did not respond positively to nasal-CPAP. While there is a complex relationship between intrinsic and extrinsically applied PEEP in patients with COPD, the result of this study is consistent with the notion that CPAP may alleviate dyspnoea by reducing auto-PEEP, improving lung mechanics and unloading the inspiratory muscles. Nasal-CPAP may have a potential therapeutic role in exacerbations of COPD.

Topics: Dyspnea; Female; Humans; Lung Diseases, Obstructive; Lung Volume Measurements; Male; Masks; Maximal Expiratory Flow Rate; Nose; Positive-Pressure Respiration; Respiratory Mechanics

Recently, we had opportunity to use an oxygen saturation pulse oximeter (minolta pulsox-7) which is a compact, light-weight device and allows continuous, percutaneous easy determination of arterial blood oxygen saturation. We obtained the following results from clinical application of this device in the field of otorhinolaryngology. 1. There was a high coefficient of correlation (0.899) between the values of oxygen saturation determined with a Minolta Pulsox-7 and an arterial blood gas analyzer. 2. This instrument was simple to handle and was clinically applicable, and seems to be highly useful for a) timing of tracheostomy, b) objective evaluation of dyspnea, c) monitor of nasal surgery under local anesthesia.

Topics: Adult; Aged; Anesthesia, Local; Dyspnea; Female; Humans; Male; Nose; Otorhinolaryngologic Diseases; Oximetry; Oxygen; Tracheostomy

Relapsing polychondritis (RP) is a rare disease characterized by auricular, nasal and respiratory tract chondritis, ocular inflammation, inflammatory polyarthritis and cardiovascular abnormalities. Here we describe a patient with a five-year history of mild nasal and auricular chondritis, which suddenly developed into a severe aortic insufficiency with rest dyspnea. The pathogenesis and the management of this rare connective tissue disease are discussed.

Topics: Adult; Aortic Valve Insufficiency; Dyspnea; Ear, External; Heart Block; Humans; Male; Nose; Polychondritis, Relapsing; Tachycardia; Ultrasonography

Topics: Age Factors; Animals; Australia; Cattle; Cattle Diseases; Dyspnea; Granuloma; Nose; Nose Diseases; Species Specificity; Weather

Topics: Animals; Dyspnea; Functional Laterality; Humans; Lung; Nasal Septum; Nose; Nose Deformities, Acquired; Reflex; Respiration; Respiratory Physiological Phenomena; Respiratory System

Topics: Dyspnea; Humans; Laryngeal Cartilages; Nose; Osteochondritis; Pathology; Tracheotomy

Topics: Asphyxia Neonatorum; Dyspnea; Humans; Infant, Newborn; Infant, Newborn, Diseases; Nose; Nose Deformities, Acquired; Respiration Disorders; Respiratory Tract Diseases