Upper airway syndrome

In humans, four clinical syndromes (three of which are associated with immunologic reactions) are induced by inhalation of TMAN dust and furne. The first is a direct irritant syndrome characterized by cough and upper airway irritation related to the irritant properties of the anhydride at high-dose exposures. 

Guilleminault C, Black J, Palombini L, Ohayon M. Clinical investigation of obstructive sleep apnea syndrome and upper airway resistance syndrome patients. Sleep Med 2000 1 51-56. 

Guilleminault C, Stoohs R, Clerk A, Cetel M, Maistros P. A cause of excessive daytime sleepiness the upper airway resistance syndrome. Chest 1993 104 781-787. 

Black JE, Guilleminault C, Colrain IM, Carillo O. Upper airway resistance syndrome central EEG power and changes in breathing effort. Am J Respir Crit Care Med 2000 162 406-411. 

Guilleminault C, Kim YD, Chowdhuri S, Horita M, Ohayon M Kushida C. Sleep and daytime sleepiness in upper airway resistance syndrome compared to obstructive sleep apnea syndrome. Eur Respir J 2001 17 1-10. 

Gold AR, Dipalo F, Gold MS, O Heam D. Symptoms and signs of upper airway resistance syndrome a link to the functional somatic syndromes. Chest 2003. In press. 

Kirkness JP, Madronio M, Stavrinou R, Wheatley JR, Amis TC (2003) Relationship between surface tension of upper airway lining liquid and upper airway collapsibility during sleep in obstructive sleep apnea hypopnea syndrome. J Appl Physiol 95 1761— 1766... 

Poe RH, Harder RV, Israel RH, KaUay MC (1989) Chronic persistent cough. Experience in diagnosis and outcome using an anatomic diagnostic protocol. Chest 95 723-728 Pratter MR (2006) Chronic upper airway cough syndrome secondary to rhinosinus diseases (previously referred to as postnasal drip syndrome) ACCP evidence-based clinical practice guidelines. Chest 129 63S-71S... 

A unique presentation of airway obstruction in RA is due to cricoarytenoid arthritis. The cricoarytenoid joint is the only true joint in the larynx that can be involved with RA. When the vocal cords are unable to adduct because of arthritis, severe inspiratory stridor develops with a flow volume loop typical of variable extrathoracic upper airway obstruction. Cricoarytenoid arthritis is also seen in gout, systemic lupus erythematosus (SLE), and Reiter s syndrome but is more common in RA. The symptoms of cricoarytenoid arthritis may be subtle... 

Upper airway obstruction Epiglottitis and laryngitis Cricoar5ftenoid arthritis Bronchiectasis Bronchiolitis obliterans Shrinking lung syndrome Diaphragmatic dysfunction Pulmonary vascular disease Thromboembolic disease Pulmonary arterial hypertension Mediastinal and axillary lymphadenopathy... 

Abbreviations WTC, world trade center FDNY, Fire Department of the city of New York FEVi, forced expiratory volume in one second FVC, forced vital capacity MFEF, maximum forced expiratory flow RUDS, reactive upper airway dysfunction syndrome ESU, emergency service rmit GERD, gastroesophageal reflux dysfunction LLN, lower Umits of normal SLGPD, sarcoid-Uke granulomatous pulmonary disease NYC, New York City. 

III. Chronic Rhinosinusitis and Reactive Upper Airways Dysfunction Syndrome... 

Phillipson EA. Control of breathing during sleep. Am Rev Respir Dis 1978 118 909-939. Oren J. Control of the upper airways during sleep and the hypersomnia-sleep apnea syndrome. In Oren J, Barnes CD, eds. Physiology in Sleep. New York Academic Press, 1980 273-313. Bach JR, Tilton MC. Life satisfaction and well being measures in ventilator assisted individuals with traumatic tetraplegia. Arch Phys Med Rehab 1994 75 626-632. 

OHS, previously called the Pickwickian syndrome (6), is defined as the association of obesity, sleep-disordered breathing (SDB) with daytime h)q)ersomnolence, and hypercapnia (Pacc>2 > 45 mmHg) in the absence of any other respiratory disease (Fig. 1). SDB can present as obstructive apneas and hypopneas, obstructive hypoventilation due to increased upper airway resistance, and/or central hypoventilation (7). The prevalence of OHS is 36% in patients with BMI between 35 and 40 kg/m, and 48%, if BMI equals or exceeds 50 (8). Without adequate treatment, patients with OHS develop cor pulmonale and recurrent episodes of hypercapnic respiratory failure, and loss of survival (Fig. 2). OHS is one of the many etiologies of CRF and has become a growing indication to initiate longterm noninvasive ventilation (NIV) in most European countries (9,10). 

Breathing during sleep is also modified by obesity and may present with different patterns, e.g., no hypoxemia and (heavy) snoring, with possible upper airway resistance syndrome periodic hypoxemia with hypopneas periodic hypoxemia and sleep apneas, and continuous hypoxemia, with or without long periods of hypoventilation (13). 

Infants and children may require long-term ventilatory support due to three categories of diseases that may impair the ventilatory balance increased respiratory load (due to intrinsic cardiopulmonary disorders, upper airway abnormalities, or skeletal deformities), ventilatory muscle weakness [due to neuromuscular diseases (NMD) or spinal cord injury], or failure of neurological control of ventilation (with central hypoventilation syndrome being the most common presentation) (Fig. 1). 

Obstruction of the upper or lower airways may cause an increase in respiratory load. Obstructive sleep apnea (OSA) is less common in children than in adults. In this age group, enlarged tonsils and adenoids play a predominant role (3). Noninvasive continuous positive airway pressure (CPAP) ventilation has proved its efficacy and is proposed as a first therapeutic option if tonsillectomy and adenoidectomy are not able to relieve upper airway obstruction (4,5). Congenital abnormalities of the upper airways, such as laryngomalacia, tracheomalacia, or Pierre Robin syndrome, may also cause severe upper airway obstruction (6). Even in young infants, noninvasive CPAP may correct the alveolar hypoventilation (7). 

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