phenylephrine-hydrochloride and Pulmonary-Disease--Chronic-Obstructive

Besides the anatomic continuity of the upper and lower airways, inflammation in one part of the airway influences the homeostasis of the other. The mechanisms underlying this interaction have been studied primarily in allergic disease, showing systemic immune activation, induction of inflammation at a distance, and a negative impact of nasal inflammation on bronchial homeostasis. In addition to allergy, other inflammatory conditions of the upper airways are associated with lower airway disease. Rhinosinusitis is frequently associated with asthma and chronic obstructive pulmonary disease. The impairment of purification, humidification, and warming up of the inspired air by the nose in rhinosinusitis may be responsible in part for bronchial pathology. The resolution of sinonasal inflammation via medical and/or surgical treatment is responsible for the beneficial effect of the treatment on bronchial disease. This article provides a comprehensive overview of the current knowledge of upper and lower airway communication beyond allergic disease.

Topics: Asthma; Bronchi; Humans; Nose; Pulmonary Disease, Chronic Obstructive; Rhinitis; Sinusitis

The interaction between upper and lower airway disease has been recognized for centuries, with recent studies showing a direct link between upper and airway inflammation in allergic patients. The mechanisms underlying the interaction between nasal and bronchial inflammation have primarily been studied in allergic disease, showing systemic immune activation after allergen inhalation, induction of inflammation at a distance, and a negative impact of nasal inflammation on bronchial homeostasis. Therefore, allergic rhinitis and asthma are considered part of the global airway allergy syndrome. Besides allergy, other inflammatory conditions such as the common cold, acute rhinosinusitis, and chronic rhinosinusitis are associated with lower airway disease. Chronic sinus disease with or without nasal polyps are frequently found in patients with asthma and chronic obstructive pulmonary disease with improvement of bronchial symptoms and respiratory function by adequate medical and surgical therapy for rhinosinusitis. The resolution of sinonasal inflammation and hence sinonasal functions by medical or surgical treatment is considered responsible for the beneficial effect of treatment on bronchial disease. This article aims at providing a comprehensive overview of the current knowledge on the interaction between common cold, acute and chronic rhinosinusitis, and lower airway biology.

Topics: Bronchi; Combined Modality Therapy; Common Cold; Humans; Nose; Prevalence; Prognosis; Pulmonary Disease, Chronic Obstructive; Respiratory Function Tests; Respiratory Mucosa; Rhinitis; Sinusitis

.A reduction in nasal airflow associated with anatomical defects of the nose such as nasal septal deviation has been proposed to cause nasal pathology. . The majority of animal experiments where one nasal passage is surgically closed over several months report only minor changes in the histology of the nasal epithelium and no rhinitis or sinusitis. .Complete abolition of nasal airflow associated with laryngectomy or the treatment of atrophic rhinitis is not associated with the development of rhinitis or sinusitis. . Radiological studies have shown a lack of association between the degree of nasal septal deviation and evidence of rhinosinusitis. .Such studies provide evidence that reduced nasal airflow causes no significant nasal disease. . There is no convincing evidence that a reduction in nasal airflow is a causative factor for rhinitis or sinusitis.

Topics: Animals; Humans; Laryngectomy; Nasal Mucosa; Nasal Septum; Nose; Olfaction Disorders; Paranasal Sinuses; Pulmonary Disease, Chronic Obstructive; Pulmonary Ventilation; Rhinitis; Rhinitis, Atrophic; Rhinomanometry; Sinusitis

Hypercapnia is associated with worse clinical outcomes in exacerbations of COPD. The present study aimed to determine the effects of nasal high flow (NHF) therapy on transcutaneous partial pressure of carbon dioxide (PtCO. In a single-blind randomized controlled cross-over trial, 48 participants with COPD were allocated in random order to all of four 20 min interventions: NHF at 15 L/min, 30 L/min and 45 L/min or breathing room air with each intervention followed by a washout period of 15 min. The primary outcome measure was PtCO. NHF results in a small flow-dependent reduction in PtCO

Topics: Aged; Aged, 80 and over; Blood Gas Monitoring, Transcutaneous; Carbon Dioxide; Cross-Over Studies; Female; Humans; Hypercapnia; Male; Middle Aged; Nose; Oxygen Inhalation Therapy; Partial Pressure; Pulmonary Disease, Chronic Obstructive; Respiratory Rate; Single-Blind Method

Nasal Highflow (NHF) delivers a humidified and heated airflow via nasal prongs. Current data provide evidence for efficacy of NHF in patients with hypoxemic respiratory failure. Preliminary data suggest that NHF may decrease hypercapnia in hypercapnic respiratory failure. The aim of this study was to evaluate the mechanism of NHF mediated PCO. In 36 hypercapnic COPD patients (PCO. This study demonstrates effective PCO. Clinical Trials: NCT02504814; First posted July 22, 2015.

Topics: Aged; Blood Gas Analysis; Cannula; Carbon Dioxide; Female; Humans; Hypercapnia; Male; Middle Aged; Noninvasive Ventilation; Nose; Partial Pressure; Prospective Studies; Pulmonary Disease, Chronic Obstructive

Dynamic hyperinflation is an important target in the treatment of COPD. There is increasing evidence that positive expiratory pressure (PEP) could reduce dynamic hyperinflation during exercise. PEP application through a nasal mask and a flow resistance device might have the potential to be used during daily physical activities as an auxiliary strategy of ventilatory assistance. The aim of this study was to determine the effects of nasal PEP on lung volumes during physical exercise in patients with COPD.. Twenty subjects (mean ± SD age 69.4 ± 6.4 years) with stable mild-to-severe COPD were randomized to undergo physical exercise with nasal PEP breathing, followed by physical exercise with habitual breathing, or vice versa. Physical exercise was induced by a standard 6-min walk test (6 MWT) protocol. PEP was applied by means of a silicone nasal mask loaded with a fixed-orifice flow resistor. Body plethysmography was performed immediately pre-exercise and post-exercise.. Differences in mean pre- to post-exercise changes in total lung capacity (-0.63 ± 0.80 L, P = .002), functional residual capacity (-0.48 ± 0.86 L, P = .021), residual volume (-0.56 ± 0.75 L, P = .004), S(pO2) (-1.7 ± 3.4%, P = .041), and 6 MWT distance (-30.8 ± 30.0 m, P = .001) were statistically significant between the experimental and the control interventions.. The use of flow-dependent expiratory pressure, applied with a nasal mask and a PEP device, might promote significant reduction of dynamic hyperinflation during walking exercise. Further studies are warranted addressing improvements in endurance performance under regular application of nasal PEP during physical activities.

Topics: Aged; Cross-Over Studies; Exercise Test; Female; Humans; Male; Masks; Middle Aged; Nose; Oxygen; Plethysmography, Whole Body; Positive-Pressure Respiration; Pulmonary Disease, Chronic Obstructive; Residual Volume; Walking

The interrupter technique, the simplest method for measuring airflow resistance (R(int)) is particularly valuable under field conditions. We investigate whether during tidal breathing, variations in the flow at which interruption occurs contribute to variability of results. Using a portable device with mouthpiece, sets of 10 measurements of R(int) (R(int,mo)) were made in inspiration and expiration at 0.05 l s(-1) intervals from 0.1 up to 0.9 l s(-1) flow in 22 normal adults, 11 children (5-9 years) and 12 COPD patients. R(int) was also measured via nasal-mask in normal adults (R(int,na)). Intra-subject coefficient of variation was obtained at each flow and flow-dependence of R(int) was assessed. In normal subjects, R(int)-flow relationships were consistent, with a narrow range of absolute values. R(int,na), but not R(int,mo), rose with increasing flow, especially >0.4 l s(-1). Repeatability was poor at flows <0.3 l s(-1) but improved with increasing flow and was better in inspiration than expiration. In children, repeatability was better than in adults and R(int,mo) was not flow dependent at < or =0.4 l s(-1). By contrast, in COPD patients repeatability was less good and R(int,mo) increased with increasing flows. R(int,mo) and R(int,na) should be measured at fixed inspiratory flows. The best signal-to-noise ratios were obtained at 0.4 l s(-1) for R(int) in normal adults and COPD patients and at 0.3 l s(-1) in children.

Topics: Adult; Airway Resistance; Equipment Failure Analysis; Female; Forced Expiratory Flow Rates; Humans; Lung; Male; Middle Aged; Nose; Pulmonary Disease, Chronic Obstructive; Reproducibility of Results; Respiratory Function Tests; Sensitivity and Specificity

Chronically ill older adults constitute a population vulnerable for complications associated with influenza. Study of their immunity to influenza virus may help design better strategies to stimulate protective immune responses.. Immunogenicity of influenza vaccines and immune protection from natural influenza were assessed in older adults with chronic obstructive pulmonary disease as part of a vaccine efficacy trial. Subjects received either trivalent inactivated influenza virus vaccine (TVV) intramuscularly and trivalent live cold-adapted influenza virus vaccine (CAIV-T; n=1107) intranasally (inl) or TVV and placebo inl (P; n=1108).. In the subsets of study subjects assessed, serum hemagglutination inhibition (HAI) and nasal-wash antihemagglutinin (HA) immunoglobulin (Ig) A and IgG antibody levels and anti-influenza virus CD8(+) cytotoxic T lymphocyte activity increased after immunization. Mean postimmunization nasal-wash IgA antibody levels to influenza A H3/HA and B HA were statistically higher in the TVV+CAIV-T group (n=957) than in the TVV+P group (n=951). Postimmunization serum HAI and nasal-wash IgA antibodies to influenza A/H3N2 and B viruses were associated with a reduced relative risk for natural influenza infection.. TVV+CAIV-T appeared more immunogenic than TVV+P, but the observed difference may be clinically unimportant. Anti-influenza serum and nasal-wash antibodies were associated with immune protection.

Topics: Administration, Intranasal; Adult; Aged; Antibodies, Viral; Humans; Influenza A virus; Influenza B virus; Influenza Vaccines; Influenza, Human; Injections, Intramuscular; Nose; Pulmonary Disease, Chronic Obstructive; T-Lymphocytes, Cytotoxic; Treatment Outcome; Vaccination; Vaccines, Combined; Vaccines, Inactivated

The nasal airflow in chronic obstructive pulmonary disease (COPD) is poorly characterized. Peak nasal inspiratory flow (PNIF) is a valuable instrument for assessing nasal airflow and the effect of pulmonary pathology such as COPD on PNIF remains unknown. To test the hypothesis that nasal airflow is reduced in COPD, we assessed airflow using PNIF in COPD and a control group. We also explored whether there is an association between COPD, chronic rhinosinusitis without nasal polyps (CRSsNP), and other predefined covariates with PNIF.. Ninety patients with COPD and 67 controls underwent PNIF and spirometry. The associations between PNIF and COPD and pre-bronchodilator forced expiratory volume in the first second (FEV1) (% predicted) were assessed by multivariable linear regression in two separate models.. PNIF was significantly lower in the COPD group than in the control group. Multivariable linear regression showed that COPD and pre-bronchodilator FEV1 (% predicted) were significantly associated with lower PNIF after adjustment for age, sex, CRSsNP, weight and height. CRSsNP was not associated with PNIF in either of the adjusted regression analyses.. PNIF is lower in COPD than in a control group. The finding of a low PNIF in the absence of disease in the upper airways may be due to obstructive lower airways diseases and special care should be taken when interpreting PNIF values in patients with COPD or reduced FEV1.

Topics: Bronchodilator Agents; Chronic Disease; Humans; Nasal Polyps; Nose; Pulmonary Disease, Chronic Obstructive; Respiratory Function Tests; Sinusitis; Spirometry

Frequent asthma exacerbators, defined as those experiencing more than 1 hospitalization in a year for an asthma exacerbation, represent an important subgroup of individuals with asthma. However, this group remains poorly defined and understudied in children.. Our aim was to determine the molecular mechanisms underlying asthma pathogenesis and exacerbation frequency.. We performed RNA sequencing of upper airway cells from both frequent and nonfrequent exacerbators enrolled in the Ohio Pediatric Asthma Repository.. Through molecular network analysis, we found that nonfrequent exacerbators display an increase in modules enriched for immune system processes, including type 2 inflammation and response to infection. In contrast, frequent exacerbators showed expression of modules enriched for nervous system processes, such as synaptic formation and axonal outgrowth.. These data suggest that the upper airway of frequent exacerbators undergoes peripheral nervous system remodeling, representing a novel mechanism underlying pediatric asthma exacerbation.

Topics: Asthma; Child; Disease Progression; Humans; Inflammation; Nose; Pulmonary Disease, Chronic Obstructive; Transcriptome

Chronic exposures to tobacco and biomass smoke are the most prevalent risk factors for COPD development. Although microbial diversity in tobacco smoke-associated COPD (TSCOPD) has been investigated, microbiota in biomass smoke-associated COPD (BMSCOPD) is still unexplored. We aimed to compare the nasal and oral microbiota between healthy, TSCOPD, and BMSCOPD subjects from a rural population in India. Nasal swabs and oral washings were collected from healthy (n = 10), TSCOPD (n = 11), and BMSCOPD (n = 10) subjects. The downstream analysis was performed using QIIME pipeline (v1.9). In nasal and oral microbiota no overall differences were noted, but there were key taxa that had differential abundance in either Healthy vs COPD and/or TSCOPD vs. BMSCOPD. Genera such as Actinomyces, Actinobacillus, Megasphaera, Selenomonas, and Corynebacterium were significantly higher in COPD subjects. This study suggests that microbial community undergoes dysbiosis which may further contribute to the progression of disease. Thus, it is important to identify etiological agents for such a polymicrobial alterations which contribute highly to the disease manifestation.

Topics: Adult; Aged; Dysbiosis; Humans; India; Male; Microbiota; Middle Aged; Nose; Pulmonary Disease, Chronic Obstructive; Risk Factors; Smoke; Tobacco Smoke Pollution

Chronic obstructive pulmonary disease (COPD) is characterized by a progressive and abnormal inflammatory response in the lungs, mainly caused by cigarette smoking. Animal models exposed to cigarette smoke (CS) are used to mimic human COPD but the use of different CS protocols makes it difficult to compare the immunological and structural consequences of using a nose-only or whole-body CS exposure system. We hypothesized that when using a standardized CS exposure protocol based on particle density and CO (carbon monoxide) levels, the whole-body CS exposure system would generate a more severe inflammatory response than the nose-only system, due to possible sensitization by uptake of CS-components through the skin or via grooming.. In this study focusing on early COPD, mice were exposed twice daily 5 days a week to CS either with a nose-only or whole-body exposure system for 14 weeks to assess lung function, remodeling and inflammation.. At sacrifice, serum cotinine levels were significantly higher in the whole-body (5.3 (2.3-6.9) ng/ml) compared to the nose-only ((2.0 (1.8-2.5) ng/ml) exposure system and controls (1.0 (0.9-1.0) ng/ml). Both CS exposure systems induced a similar degree of lung function impairment, while inflammation was more severe in whole body exposure system. Slightly more bronchial epithelial damage, mucus and airspace enlargement were observed with the nose-only exposure system. More lymphocytes were present in the bronchoalveolar lavage (BAL) and lymph nodes of the whole-body exposure system while enhanced IgA and IgG production was found in BAL and to a lesser extent in serum with the nose-only exposure system.. The current standardized CS-exposure protocol resulted in a higher internal load of serum cotinine in the whole-body exposure system, which was associated with more inflammation. However, both exposure systems resulted in a similar lung function impairment. Data also highlighted differences between the two models in terms of lung inflammation and remodelling, and potential sensitization to CS. Researchers should be aware of these differences when designing their future studies for an early intervention in COPD.

Topics: Animals; Biomarkers; Bronchoalveolar Lavage Fluid; Cotinine; Cytokines; Disease Models, Animal; Immunity, Humoral; Immunoglobulin A; Immunoglobulin G; Inflammation Mediators; Inhalation Exposure; Lung; Lymphoid Tissue; Male; Mice, Inbred C57BL; Nose; Pneumonia; Pulmonary Disease, Chronic Obstructive; Smoke; Time Factors; Tobacco Products

Topics: Humans; Hypercapnia; Noninvasive Ventilation; Nose; Pulmonary Disease, Chronic Obstructive; Respiratory Insufficiency

Topics: Humans; Hypercapnia; Noninvasive Ventilation; Nose; Pulmonary Disease, Chronic Obstructive; Respiratory Insufficiency

Oral taxa are often found in the chronic obstructive pulmonary disease (COPD) lung microbiota, but it is not clear if this is due to a physiologic process such as aspiration or experimental contamination at the time of specimen collection.. Microbiota samples were obtained from nine subjects with mild or moderate COPD by swabbing lung tissue and upper airway sites during lung lobectomy. Lung specimens were not contaminated with upper airway taxa since they were obtained surgically. The microbiota were analyzed with 16S rRNA gene qPCR and 16S rRNA gene hypervariable region 3 (V3) sequencing. Data analyses were performed using QIIME, SourceTracker, and R.. Streptococcus was the most common genus in the oral, bronchial, and lung tissue samples, and multiple other taxa were present in both the upper and lower airways. Each subject's own bronchial and lung tissue microbiota were more similar to each other than were the bronchial and lung tissue microbiota of two different subjects (permutation test, p = 0.0139), indicating more within-subject similarity than between-subject similarity at these two lung sites. Principal coordinate analysis of all subject samples revealed clustering by anatomic sampling site (PERMANOVA, p = 0.001), but not by subject. SourceTracker analysis found that the sources of the lung tissue microbiota were 21.1% (mean) oral microbiota, 8.7% nasal microbiota, and 70.1% unknown. An analysis using the neutral theory of community ecology revealed that the lung tissue microbiota closely reflects the bronchial, oral, and nasal microbiota (immigration parameter estimates 0.69, 0.62, and 0.74, respectively), with some evidence of ecologic drift occurring in the lung tissue.. This is the first study to evaluate the mild-moderate COPD lung tissue microbiota without potential for upper airway contamination of the lung samples. In our small study of subjects with COPD, we found oral and nasal bacteria in the lung tissue microbiota, confirming that aspiration is a source of the COPD lung microbiota.

Topics: Aged; Aged, 80 and over; Animals; Bacteria; DNA, Bacterial; DNA, Ribosomal; Female; Humans; Lung; Male; Microbiota; Middle Aged; Moths; Nose; Pulmonary Disease, Chronic Obstructive; RNA, Ribosomal, 16S; Sequence Analysis, DNA

Topics: Aged; Anti-Arrhythmia Agents; Anti-Bacterial Agents; Cheek; Diagnosis, Differential; Digoxin; Diuretics; Exanthema; Female; Humans; Hypertension, Pulmonary; Nose; Oxygen; Pulmonary Disease, Chronic Obstructive

Portable oxygen concentrators (POCs) typically include pulse flow (PF) modes to conserve oxygen. The primary aims of this study were to develop a predictive in vitro model for inhaled oxygen delivery using a set of realistic airway replicas, and to compare PF for a commercial POC with steady flow (SF) from a compressed oxygen cylinder.. Experiments were carried out using a stationary compressed oxygen cylinder, a POC, and 15 adult nasal airway replicas based on airway geometries derived from medical images. Oxygen delivery via nasal cannula was tested at PF settings of 2.0 and 6.0, and SF rates of 2.0 and 6.0 L/min. A test lung simulated three breathing patterns representative of a chronic obstructive pulmonary disease patient at rest, during exercise, and while asleep. Volume-averaged fraction of inhaled oxygen (F. Relative volume-averaged F. For the POC tested, PF delivered similar, though consistently lower, volume-averaged F

Topics: Adult; Aged; Cannula; Equipment Design; Exercise; Female; Humans; Lung; Magnetic Resonance Imaging; Male; Middle Aged; Models, Anatomic; Nose; Oxygen Inhalation Therapy; Pulmonary Disease, Chronic Obstructive; Respiratory Mechanics; Rest; Retrospective Studies; Sleep; Time Factors; Tomography, X-Ray Computed

Chronic obstructive pulmonary disease (COPD) is a chronic airway disease with increased airway resistance. This study investigated the common characteristics of electrocardiographic (ECG) and nostril airflow signals in COPD patients using cross-spectral analysis. Heart rate variability (HRV) measures and cross-spectral (cs) measures of ECG and nostril airflow were compared in COPD patients and normal subjects, and correlated with their clinical characteristics. We found that cross-spectral analysis can lead to a significant increase in normalized high-frequency power (nHFPcs) and a significant decrease in normalized very low-frequency power (nVLFPcs), normalized low-frequency power (nLFPcs), and low-/high-frequency power ratio (LHRcs) in both normal subjects and COPD patients, as compared with their corresponding HRV measures. Further analysis showed that the percentage increase in nHFP (%nHFP) and the percentage decrease in LHR (%LHR) due to cross-spectral analysis in COPD patients were significantly smaller than those of normal subjects. All cross-spectral measures of ECG and nostril airflow in COPD patients did not significantly correlate with their pulmonary function characteristics. However, the nHFPcs correlated significantly and negatively with body mass index (BMI) in both normal subjects and COPD patients, and the %nHFP correlated significantly and negatively with BMI in COPD patients. We conclude that cross-spectral analysis of ECG and nostril airflow signals could lead to reduced enhancement in the high-frequency component in the cross spectrum of COPD patients. The magnitude of reduced enhancement in the high-frequency component in the cross-spectrum was related to the BMI of the patients. Cross-spectral analysis of ECG and nostril airflow might be used to assess the cardiovascular-related functions of COPD patients.

Topics: Aged; Aged, 80 and over; Airway Resistance; Case-Control Studies; Electrocardiography; Female; Forced Expiratory Volume; Fourier Analysis; Heart Rate; Humans; Male; Nose; Predictive Value of Tests; Prospective Studies; Pulmonary Disease, Chronic Obstructive; Respiration; Respiratory Rate; Signal Processing, Computer-Assisted; Time Factors; Vital Capacity

Inhaled drugs can only be effective if they reach the middle and small airways. This study introduces a system that combines a trans-nasal application of aerosols with noninvasive pressure support ventilation.. In a pilot study, 7 COPD patients with GOLD stages II and III inhaled a radiolabeled marker dissolved in water via a trans-nasal route. The mean aerosol particle size was 5.5 µm. Each patient took part in two inhalation sessions that included two application methods and were at least 70 hours apart. During the first session ("passive method"), the patient inhaled the aerosol through an open tube system. The second session ("active method") included pressure support ventilation during the inhalation process. A gamma camera and planar scintigraphy was used to determine the distribution of aerosol particles in the patient's body and lung.. The pressure supported inhalation ("active method") results in an increased aerosol lung deposition compared to the passive method. Above all, we could demonstrate deposition in the lung periphery with relatively large aerosol particles (5.5 µm).. The results prove that the combination of trans-nasal inhalation with noninvasive pressure support ventilation leads to significantly increased particle deposition in the lung.

Topics: Administration, Inhalation; Aerosols; Aged; Female; Humans; Lung; Male; Middle Aged; Nose; Particle Size; Pilot Projects; Positive-Pressure Respiration; Pulmonary Disease, Chronic Obstructive; Radioisotopes; Tissue Distribution

To establish a mouse model of chronic obstructive pulmonary disease (COPD) and associated pulmonary hypertension (COPD-PH) induced by nose-only cigarette smoking exposure plus airway lipopolysaccharide (LPS) inhalation.. There were 24 male C57B6 mice divided into a control group and a model group at random. The model group was given LPS by intranasal inhalation on day 1 and day 14 and exposed to the cigarette smoke in a nose-only exposure system, while the control group was given physiological saline and exposed to normal air. The model establishment was evaluated according the following parameters: the lung function and the right heart pressure, the total and differential cell numbers in bronchial alveolar lavage fluid (BALF), and the pathological changes of lung tissues.. The functional residual capacity data of the model group and the control group were (0.402 ± 0.057) and (0.243 ± 0.064) ml respectively (P<0.05). The inspiratory resistance data of the model group and the control group were (1.056 ± 0.121) and (0.789 ± 0.063) cmH(2)O · ml(-1) · s(-1) (1 cmH(2)O=0.098 kPa) respectively (P<0.05). The static lung compliance data of the model group and the control group were (0.084 ± 0 .007) and (0.056 ± 0.004) cmH(2)O/ml respectively (P<0.05). The right ventricular mean pressure of the model group and the control group were (11.3 ± 1.3) and (7.9 ± 1.1) mmHg (1 mmHg=0.133 kPa) respectively (P<0.05), while the right ventricular hypertrophy index of the model group and the control group were (0.267 ± 0.019) and (0.195 ± 0.023) respectively (P<0.05). Moreover, the histological staining showed that goblet cell hyperplasia, lung inflammation and thickening of smooth muscle layers of bronchial and pulmonary small vessels occurred in the model group, which indicated ongoing airway and blood vessel remodeling.. A COPD-PH mouse model was established by nose-only cigarette smoking exposure plus airway LPS inhalation in a short period of time, and this method was more similar to the smoking behavior of human.

Topics: Administration, Inhalation; Animals; Bronchoalveolar Lavage Fluid; Disease Models, Animal; Hypertension, Pulmonary; Lipopolysaccharides; Lung; Male; Mice; Mice, Inbred C57BL; Nicotiana; Nose; Pneumonia; Pulmonary Disease, Chronic Obstructive; Respiratory Function Tests; Smoking

Topics: Chronic Disease; Cytokines; Eosinophils; Humans; Nasal Decongestants; Nose; Pulmonary Disease, Chronic Obstructive; Pulmonary Ventilation; Rhinitis; Sinusitis

Sleep-related hypoventilation should be considered in patients with chronic obstructive pulmonary disease, because appropriate respiratory management during sleep is important for preventing elevation of PaCO2 levels. A nasal high-flow oxygen therapy system using a special nasal cannula can deliver suitably heated and humidified oxygen at up to 60 L/min. Since the oxygen concentration remains a constant independent of minute ventilation, this system is particularly useful in patients with chronic obstructive pulmonary disease who have hypercapnia. This is the first report of sleep-related hypoventilation with chronic obstructive pulmonary disease improving using a nasal high-flow oxygen therapy system.. We report the case of a 73-year-old Japanese female who started noninvasive positive-pressure ventilation for acute exacerbation of chronic obstructive pulmonary disease and CO2 narcosis due to respiratory infection. Since she became agitated as her level of consciousness improved, she was switched to a nasal high-flow oxygen therapy system. When a repeat polysomnography was performed while using the nasal high-flow oxygen therapy system, the Apnea Hypopnea Index was 3.7 times/h, her mean SpO2 had increased from 89 to 93%, percentage time with SpO2 ≤ 90% had decreased dramatically from 30.8 to 2.5%, and sleep stage 4 was now detected for 38.5 minutes. As these findings indicated marked improvements in sleep-related hypoventilation, nasal high-flow oxygen therapy was continued at home. She has since experienced no recurrences of CO2 narcosis and has been able to continue home treatment.. Use of a nasal high-flow oxygen therapy system proved effective in delivering a prescribed concentration of oxygen from the time of acute exacerbation until returning home in a patient with chronic obstructive pulmonary disease, dementia and sleep-related hypoventilation. The nasal high-flow oxygen therapy system is currently used as a device to administer high concentrations of oxygen in many patients with type I respiratory failure, but may also be useful instead of a Venturi mask in patients like ours with type II respiratory failure, additionally providing some positive end-expiratory pressure.

Topics: Aged; Female; Humans; Hypoventilation; Nose; Oxygen Inhalation Therapy; Pulmonary Disease, Chronic Obstructive

For in vitro studies of airway pathophysiology, primary epithelial cells have many advantages over immortalised cell lines. Nasal epithelial cells are easier to obtain than bronchial epithelial cells and can be used as an alternative for in vitro studies. Our objective was to compare nasal and bronchial epithelial cells from subjects with COPD to establish if these cells respond similarly to pro-inflammatory stimuli. Cell cultures from paired nasal and bronchial brushings (21 subjects) were incubated with cigarette smoke extract (CSE) prior to stimulation with Pseudomonas aeruginosa lipopolysaccharide. IL-6 and IL-8 were measured by ELISA and Toll-like receptor 4 (TLR-4) message and expression by RT-PCR and FACS respectively. IL-8 release correlated significantly between the two cell types. IL-6 secretion was significantly less from bronchial compared to nasal epithelial cells and secreted concentrations did not correlate. A 4 h CSE incubation was immunosuppressive for both nasal and bronchial cells, however prolonged incubation for 24 h was pro-inflammatory solely for the nasal cells. CSE reduced TLR-4 expression in bronchial cells only after 24 h, and was without effect on mRNA expression. In subjects with COPD, nasal epithelial cells cannot substitute for in vitro bronchial epithelial cells in airway inflammation studies.

Topics: Aged; Aged, 80 and over; Bronchi; Cells, Cultured; Cytokines; Epithelial Cells; Female; Humans; Inflammation Mediators; Lipopolysaccharides; Male; Middle Aged; Nasal Mucosa; Nose; Pulmonary Disease, Chronic Obstructive; Respiratory Mucosa; RNA, Messenger; Tobacco Smoke Pollution; Toll-Like Receptor 4

Associations between nasal and bronchial impairment have been repeatedly described in chronic obstructive pulmonary disease (COPD), whereas nasal mucociliary clearance (MCC) in COPD patients is not yet fully understood. We studied nasal MCC parameters in COPD patients and compared them with healthy adults (HA) and with cystic fibrosis (CF) patients with compromised MCC.. An observational study of 98 COPD ex-smokers and subjects from control groups evaluated for nasal MCC time (NMCCt) and by digital video microscopy of nasal mucosa recording ciliary beat frequency (CBF) and ciliary beat pattern.. The NMCCt was decreased in HA compared to those with COPD and decreased in those with COPD compared to those with CF. CBF in COPD was lower compared to HA. The index of ciliary dyskinesia in COPD patients differed from HA. We detected higher NMCCt and lower nasal CBF in patients with chronic bronchitis phenotype (CB) compared to non-CB patients.. We confirmed the presence of impaired nasal MCC in COPD ex-smokers. These impairments were apparent predominantly in the CB phenotype.

Topics: Aged; Bronchitis; Cilia; Ciliary Motility Disorders; Female; Humans; Male; Middle Aged; Mucociliary Clearance; Nose; Phenotype; Pulmonary Disease, Chronic Obstructive; Respiratory Function Tests; Smoking

Topics: Burns; Humans; Lip; Male; Middle Aged; Nose; Oxygen Inhalation Therapy; Pulmonary Disease, Chronic Obstructive; Risk Factors; Smoking

Topics: Aged, 80 and over; Amiodarone; Anti-Arrhythmia Agents; Cheek; Dermatitis, Phototoxic; Diagnosis, Differential; Humans; Male; Nose; Pulmonary Disease, Chronic Obstructive; Skin; Tachycardia

The nasal septal deviation is a common cause of nasal obstruction. On the other hand, many septal deviations are asymptomatic. It seems a physiological adaptation occurs on both sides. Septal deviation leads to internal nasal asymmetry, which in turn causes compensatory change in turbinate morphology (e.g. turbinate hypertrophy respectively hypotrophy). This mechanism is investigated with the help of fluid dynamic experiments and functional rhinologic diagnostics.. Functional models of the nose (modified Mink's boxes) were used and assessment was made by acoustic rhinometry and rhinoresistometry, followed by flow dynamic investigations. Septal deviations of varying position, together with turbinates of differing grades of hypertrophy, were simulated and assessed.. We observed in models of septal deviation an increase in flow resistance on the ipsilateral side as a result of friction of flow particles in the narrowing. Furthermore, on the opposite side of the deviation, the enlargement of the stream channel did not generally lead to a reduction in flow resistance, but rather to a 'dead space', where only a slow-circling eddy was observed. This eddy causes an increase in turbulence. In vivo turbinate hypertrophy occurs to fill this dead space, thereby reducing turbulent flow without a significant increase in resistance. In cases of moderate septal deviation, compensatory mechanisms of the turbinates can lead to a normalization of nasal airflow and surgical therapy would not be indicated. Deviations in the anterior part of the septum seem to be more symptomatic, because the mechanism is missing and due to the physiological narrowing of the nasal isthmus. To differ between physiologic and pathologic deviation, functional diagnostics are needed.

Topics: Computer Simulation; Humans; Hypertrophy; Models, Biological; Nasal Septum; Nose; Pulmonary Disease, Chronic Obstructive; Rhinomanometry; Rhinometry, Acoustic; Tomography, X-Ray Computed; Turbinates

The sniff nasal inspiratory pressure (SNIP) consists in the measurement of pressure through an occluded nostril during sniffs performed through the controlateral nostril. It is an accurate and noninvasive approximation of esophageal pressure swing during sniff maneuvers. However SNIP can underestimate esophageal pressure swing in subjects with nasal obstruction, patients with chronic obstructive pulmonary disease and severe neuromuscular patients. Nevertheless, since SNIP maneuver has predicted normal values, is noninvasive and is easier to perform than maximal inspiratory pressure (MIP) maneuver, it could be considered as the first simple test to use in order to assess inspiratory muscle weakness. In addition, because it is as reproducible as MIP, it can be suitable to follow inspiratory muscle function in chronic neuromuscular patients. Because, of the important limit of agreement between SNIP and MIP, these two methods are not interchangeable but complementary.

Topics: Forced Expiratory Volume; Humans; Inhalation; Neuromuscular Diseases; Nose; Predictive Value of Tests; Pulmonary Disease, Chronic Obstructive

To observe and describe normal and abnormal inspiratory nasal flow-volume patterns.. In this observational case series, individuals with and without nasal symptoms underwent forced inspiratory nasal flow-volume (FINFV) curve measurements. The participants were volunteer adults from the staff and patients of a pulmonary subspecialty private practice office. To examine the flow patterns from the FINFV curves, definitions of normal and abnormal were established. Normal curves were defined as those from participants who had no nasal symptoms and a peak inspiratory nasal flow greater than 2.5 L/s. Abnormal curves were defined as those from participants who had 1 or more nasal symptoms, a peak inspiratory nasal flow lower than 2.5 L/s, and normal oral inspiratory flow.. Study participants consisted of 10 staff and 58 patients. Fourteen individuals (21%) met the definition of normal and had FINFV curves that mimicked the shapes of normal oral flow-volume curves; 39 (57%) met the definition of abnormal and had FINFV curves that mimicked the patterns of abnormal oral flow-volume curves. The abnormal curves showed both fixed (33/39 [85%]) and variable (6/39 [15%]) patterns of obstruction. Fifteen participants (22%) did not meet either established definition.. Forced inspiratory nasal flow-volume curves are a potentially useful clinical tool to measure nasal airflow. Normal and abnormal flow patterns are easily identifiable.

Topics: Adult; Aged; Aged, 80 and over; Airway Resistance; Female; Humans; Inspiratory Capacity; Male; Middle Aged; Nasal Obstruction; Nose; Pulmonary Disease, Chronic Obstructive; Respiratory Physiological Phenomena