Resp Care
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Comparative Study
Detection of upper airway obstruction with spirometry results and the flow-volume loop: a comparison of quantitative and visual inspection criteria.
There are important gaps in our understanding of the epidemiology and diagnosis of upper-airway obstruction. ⋯ The prevalence of reported upper-airway obstruction was 7.5%. The quantitative criteria showed low sensitivity for detecting upper-airway obstruction but exceeded that of visual criteria. The aggregate criterion increased the sensitivity to 69.4%, which suggests the need for additional criteria to help predict upper-airway obstruction.
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Practice Guideline
Cystic fibrosis pulmonary guidelines: airway clearance therapies.
Cystic fibrosis (CF) is a genetic disease characterized by dehydration of airway surface liquid and impaired mucociliary clearance. As a result, there is difficulty clearing pathogens from the lung, and patients experience chronic pulmonary infections and inflammation. Clearance of airway secretions has been a primary therapy for those with CF, and a variety of airway clearance therapies (ACTs) have been developed. ⋯ The committee recommends airway clearance be performed on a regular basis in all patients. There are no ACTs demonstrated to be superior to others, so the prescription of ACTs should be individualized. Aerobic exercise is recommended as an adjunctive therapy for airway clearance and for its additional benefits to overall health.
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Post-traumatic pulmonary pseudocyst is an uncommon cavitary lesion of the lung, which generally develops after blunt chest trauma. We saw a 22-year-old man with chest trauma, hemopneumothorax, and hemoptysis, on the day he fell from an electrical pylon. Intubation in the emergency department was followed by 4 days of mechanical ventilation. ⋯ On hospital day 6 he developed pneumonia, which we treated with ceftazidime plus gentamycin. He was discharged on hospital day 20, and a month later the pseudocyst had resolved without complications. Diagnosis of post-traumatic pulmonary pseudocyst may require computed tomography, and some complicated cases may require surgery.
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Vocal cord dysfunction (VCD) is difficult to diagnose. Laryngoscopy while the patient is symptomatic is the accepted standard method to establish a diagnosis of VCD, but patient characteristics and spirometry values are thought to be useful for predicting VCD. We sought to identify clinical and spirometric variables that suggest VCD. ⋯ VCD remains difficult to predict with spirometry or flow-volume loops. If VCD is suspected, normal flow-volume loop patterns should not influence the decision to perform laryngoscopy.