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Associa??o entre hipertrofia adenotonsilar, tonsilites e crises álgicas na anemia falciforme
Salles, Cristina;Ramos, Regina Terse T.;Daltro, Carla;Nascimento, Valma Maria;Matos, Marcos Almeida;
Jornal de Pediatria , 2009, DOI: 10.1590/S0021-75572009000300011
Abstract: objectives: to determine the prevalence of obstructive adenotonsillar hypertrophy in children and adolescents with sickle cell anemia; to investigate possible association between the presence of more than five episodes of tonsillitis in the last 12 months and episodes of painful crises in the same period; and to compare the mean annual hemoglobin level in children and adolescents with and without obstructive adenotonsillar hypertrophy. methods: prospective, observational, cross-sectional study involving 85 children and adolescents with sickle cell anemia. all patients answered a questionnaire and underwent a standard otolaryngology examination, including endoscopic endonasal approach. the diagnosis of obstructive adenotonsillar hypertrophy was made according to the brodsky scale. results: the prevalence of obstructive adenotonsillar hypertrophy was 55.3%. obstructive adenotonsillar hypertrophy was associated with history of difficulty in eating (76.7 vs. 23.5%, p = 0.003), presence of more than five episodes of tonsillitis in the last 12 months (70.6 vs. 29.4%, p = 0.021), loud snoring (73.0 vs. 27.0%, p = 0.004), and sleep apnea (71.8 vs. 28.2%, p = 0.005). patients with obstructive adenotonsillar hypertrophy had more episodes of recurrent upper airway tract infection (62.5 vs. 37.5; p = 0.010). the presence of more than five episodes of tonsillitis in the last 12 months was associated with episodes of painful crises (median = 12 vs. 2, p = 0.017). there was no significant difference between mean annual hemoglobin levels of patients with obstructive adenotonsilar hypertrophy vs. nonobstructive adenotonsillar hypertrophy: 7.6 vs. 8.2 g/dl, p = 0.199. conclusion: the prevalence of obstructive adenotonsillar hypertrophy was 55.3% in children and adolescents with sickle cell anemia; the presence of more than five episodes of tonsillitis in the last 12 months was associated with episodes of painful crises in the same period; and there was no difference in the mean annua
The role of small airways in obstructive airway diseases  [cached]
P-R. Burgel
European Respiratory Review , 2011,
Abstract: This review article is a summary of a seminar organised by the European Respiratory Society on “The role of small airways in obstructive airway diseases” which was held in October 2010 in Amsterdam, the Netherlands. The aims of the seminar were to identify important questions related to small airways involvement in asthma and chronic obstructive pulmonary disease (COPD), and to discuss future approaches based on current and evolving knowledge. Data obtained by pathological and physiological measurements in small airways and their relevance to clinical manifestations and therapeutics in asthma and COPD were reviewed. It was concluded that our knowledge on the roles of small airways in asthma and COPD is limited. Studies of large numbers of well-characterised subjects using multiple methods (genetic characterisation, cell biology and physiology, imaging) and integration of the data using mathematical models are suggested to be of interest. The availability of these techniques coupled with our ability to better target inhaled molecules to small airways provide a unique opportunity for a reappraisal of the relevance of small airways in chronic airway diseases.
Obese obstructive sleep apnea patients with tonsil hypertrophy submitted to tonsillectomy
Martinho, F.L.;Zonato, A.I.;Bittencourt, L.R.A.;Soares, M.C.M.;Silva, R.F.N.;Gregório, L.C.;Tufik, S.;
Brazilian Journal of Medical and Biological Research , 2006, DOI: 10.1590/S0100-879X2006000800017
Abstract: the physiopathology of obstructive sleep apnea-hypopnea syndrome (osahs) is multifactorial and obesity has been shown to be one of the main factors correlated with its occurrence. in obese patients with anatomical alterations of the upper airways it is often difficult to predict success for surgical correction since obesity is a limiting factor. therefore, the aim of the present study was to evaluate the results of tonsillectomy in a specific group of patients, i.e., obese osahs patients with tonsil hypertrophy. seven osahs patients with moderate obesity with obstructive palatine tonsil hypertrophy were submitted to tonsillectomy. all patients were submitted to pre- and postoperative appraisal of body mass index, otorhinolaryngology examination and polysomnography. patients' average age was 36.4 ± 10.3 years and average preoperative body mass index was 36.6 ± 6.3 kg/m2. postoperative weight did not differ significantly from preoperative weight (p = 0.27). average preoperative apnea and hypopnea index (ahi) was 81 ± 26/h and postoperative ahi was 23 ± 18/h (p = 0.0005). average preoperative minimum oxyhemoglobin saturation (sao2 min) was 69 ± 14% and the postoperative value was 83 ± 3% (p = 0.038). in relation to ahi, 6 (86%) of the 7 patients studied showed a reduction of 50% in relation to preoperative level and of these, 4 (57%) presented ahi of less than 20%. only one patient presented a reduction of less than 50% in ahi, but even so showed improved sao2 min. tonsillectomy treatment for osahs in obese patients with obstructive palatine tonsil hypertrophy caused a significant reduction in ahi, with improvement in sao2 min. this procedure could be eventually considered as an option of treatment for obese osahs patients with significant tonsil hypertrophy when continuous positive air pressure therapy is not possible as the first choice of treatment.
Polysomnographic findings of obstructive sleep apnea in children with adenotonsillar hypertrophy  [PDF]
érico Campos Moreira Silva, Vinícius S. Moraes, Helena Protetti, Silke T. Weber
Health (Health) , 2013, DOI: 10.4236/health.2013.58A2007
Abstract:

Serous Background: There are few studies assessing the clinical manifestations of sleep breathing disorders and polysomnograms in several pediatric age ranges. This studied aimed to assess polysomnography results such as apnea-hypopnea index, mean oxygen saturation and sleep efficiency in children presenting with airway obstruction and adenotonsillar hypertrophy complaints, and to establish whether they are correlated to age and sex. Methods: A retrospective study with children of both sexes, aged between 2 and 12 years, with clinically suspected obstructive sleep apnea syndrome and adenotonsillar hypertrophy, who underwent polysomnography before surgery. The children were allocated to groups according to their age range (Group I: 2 to 4 years old; Group II: 5 to 8 years old; Group III: 9 to 12 years old). Apnea-hypopnea index, mean oxygen saturation and sleep efficiency data were compared between sexes and among the three groups (Student’s t test, p < 0.05). Results: Of 167 children studied by polysomnography, 76.6% were of school age and 67% were male. For all studied age ranges, there was no difference between sexes for the investigated parameters (body mass index, apnea-hypopnea index, mean oxygen saturation and sleep efficiency). As regards mean oxygen saturation, Group I showed the lowest value (89.9 ± 6.2). Apnea-hypopnea indexes were higher in male children aged between 2 and 4 years (9.9 ± 5.2). Group III had the lowest sleep efficiency (84.1 ± 9.2). Conclusion: There was a predilection of more severe cases of obstructive sleep apnea syndrome for children younger than four years, shown by higher apnea-hypopnea index per hour and lower mean oxygen saturation in this age range.

Haemophilus influenzae and smoking-related obstructive airways disease
Otczyk DC, Clancy RL, Cripps AW
International Journal of Chronic Obstructive Pulmonary Disease , 2011, DOI: http://dx.doi.org/10.2147/COPD.S19359
Abstract: emophilus influenzae and smoking-related obstructive airways disease Original Research (3546) Total Article Views Authors: Otczyk DC, Clancy RL, Cripps AW Published Date June 2011 Volume 2011:6 Pages 345 - 351 DOI: http://dx.doi.org/10.2147/COPD.S19359 Diana C Otczyk1, Robert L Clancy2, Allan W Cripps1 1School of Medicine, Griffith Health Institute, Griffith Health, Griffith University, Gold Coast, Queensland, Australia; 2Immunology Unit, Hunter Area Pathology Service and University of Newcastle, Newcastle, New South Wales, Australia Background: Intralumenal bacteria play a critical role in the pathogenesis of acute infective episodes and airway inflammation. Antigens from colonizing bacteria such as nontypeable Haemophilus influenzae (NTHi) may contribute to chronic lung disease through an immediate hypersensitivity response. The objective of this study was to determine the presence of specific NTHi-IgE antibodies in subjects with chronic bronchitis (CB) and COPD who had smoked. Methods: Serum, sputum, and saliva samples were collected from subjects with CB and moderate–severe COPD and healthy aged-matched controls. Total IgE and specific NTHi IgE were measured by enzyme linked immmunosorbent assay. Throat swabs were examined for the presence of NTHi. Results: The results demonstrate that: i) specific NTHi IgE antibodies occur at a low level in healthy subjects; ii) those with both CB and moderate–severe COPD have elevated specific NTHi IgE antibody compared with healthy controls, with higher levels in those with most severe disease; iii) IgE levels are greater in those with moderate–severe COPD than in those with CB. They demonstrate specific NTHi IgE antibody is regularly found at higher than normal levels in COPD. Conclusion: The detection of IgE antibody to colonizing bacteria in all subjects with CB or moderate–severe COPD identifies a possible mechanism of bronchospasm in these subjects amenable to specific intervention therapy.
Solid fuel smoke exposure and risk of obstructive airways disease  [cached]
Qorbani Mostafa,Yunesian Masud
Iranian Journal of Environmental Health Science & Engineering , 2012, DOI: 10.1186/1735-2746-9-8
Abstract: This study was designed to investigate whether there is an association between Obstructive Airways Disease (OAD) and indoor exposure to baking home-made bread smoke (BHBS) in ground oven at home. In this hospital-based case–control study, 83 patients with OAD (cases) were compared with 72 patients without any known pulmonary diseases from the surgical ward (controls) who were frequently matched with cases on age. The interview was performed using the modified questionnaire recommended by the "American Thoracic Society". The questionnaire comprised of demographic information, occupational history, cigarette smoking and indoor exposure to BHBS in ground oven at home. The exposure to BHBS was considered both as a dichotomous and quantitative variable (number of years being exposed to smoke) and the population attributable fraction (PAF) was estimated due to BHBS exposure. The percentage of indoor exposure to BHBS was measured as 51.8% and 30.6% in the cases and the controls, respectively. The average years of exposure to BHBS was 20.46 years (SD: 11.60) for the cases and 15.38 years (SD: 13.20) for the controls. The univariate analysis comparing the cases and the controls showed that exposure to BHBS (as a binary variable) and occupational exposure to dust was significantly associated with OAD. In the multivariate model, only exposure to BHBS was associated with OAD (OR=2.22, 95%CI = 1.14-4.35). Duration of exposure to BHBS (as a quantitative variable) was significantly associated with OAD in the univariate model. In the multivariate model, only the duration of exposure to BHBS (years) showed a significant association with OAD (OR=1.04, 95% CI=1.01-1.08). Population attributable risk due to BHBS exposure was equal to 28.5%.
Solid Fuel Smoke Exposure and Risk of Obstructive Airways Disease  [PDF]
Mostafa Qorbani,Masud Yunesian
Iranian Journal of Environmental Health Science & Engineering , 2012,
Abstract: This study was designed to investigate whether there is an association between Obstructive Airways Disease (OAD) and indoor exposure to baking home-made bread smoke (BHBS) in ground oven at home. In this hospital-based case–control study, 83 patients with OAD (cases)were compared with 72 patients without any known pulmonary diseases from the surgical ward (controls) who were frequently matched with cases on age. The interview wasperformed using the modified questionnaire recommended by the "American Thoracic Society". The questionnaire comprised of demographic information, occupational history,cigarette smoking and indoor exposure to BHBS in ground oven at home. The exposure toBHBS was considered both as a dichotomous and quantitative variable (number of years being exposed to smoke) and the population attributable fraction (PAF) was estimated due to BHBS exposure. The percentage of indoor exposure to BHBS was measured as 51.8% and30.6% in the cases and the controls, respectively. The average years of exposure to BHBS was 20.46 years (SD: 11.60) for the cases and 15.38 years (SD: 13.20) for the controls. The univariate analysis comparing the cases and the controls showed that exposure to BHBS (as a binary variable) and occupational exposure to dust was significantly associated with OAD. In the multivariate model, only exposure to BHBS was associated with OAD (OR=2.22, 95%CI= 1.14-4.35). Duration of exposure to BHBS (as a quantitative variable) was significantly associated with OAD in the univariate model. In the multivariate model, only the duration of exposure to BHBS (years) showed a significant association with OAD (OR=1.04, 95% CI=1.01-1.08). Population attributable risk due to BHBS exposure was equal to 28.5%.
Associations between Adenotonsillar Hypertrophy, Age, and Obesity in Children with Obstructive Sleep Apnea  [PDF]
Kun-Tai Kang, Chen-Han Chou, Wen-Chin Weng, Pei-Lin Lee, Wei-Chung Hsu
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0078666
Abstract: Objective To investigate the contributions of adenoid and tonsil size to childhood obstructive sleep apnea (OSA) and the interactions between adenotonsillar hypertrophy, age, and obesity in children with OSA. Methods In total, 495 symptomatic patients were recruited. The patients were assigned to four groups according to age:toddler (age 1-3, n=42), preschool (age 3-6, n=164), school (age 6-12, n=200), and adolescence (age 12-18, n=89). All subjects had tonsil size graded by otolaryngologists, adenoid size determined on lateral radiographs (Fujioka method), and a full-night polysomnography. The apnea-hypopnea index (AHI), adenoid size, and tonsil size were compared in obese and non-obese children in the four age groups. Adjusted odds ratios (ORs) and 95% confidence interval (CI) of adenotonsillar hypertrophy and OSA risk were estimated by multi-logistic regression. Results The AHI was positively related to tonsil grade (r=0.33, p <0.001) and adenoid size (r=0.24, p <0.01) in all patients. Tonsil grade was positively related to AHI in all four age groups. Adenoid size was positively related to AHI in the toddler, preschool, school groups, but not in the adolescent group (r=0.11, p=0.37). Tonsil grade and adenoid size were both positively related to AHI in obese and non-obese children. In the regression model, obesity (OR=2.89; 95% CI 1.47-5.68), tonsillar hypertrophy (OR=3.15; 95% CI 2.04-4.88), and adenoidal hypertrophy (OR=1.89; 95% CI 1.19-3.00) significantly increased OSA risk. Conclusions Adenotonsillar hypertrophy and obesity are the major determinants of OSA in children. However, the influence of adenoid size decreases in adolescence.
Haemophilus influenzae and smoking-related obstructive airways disease  [cached]
Otczyk DC,Clancy RL,Cripps AW
International Journal of COPD , 2011,
Abstract: Diana C Otczyk1, Robert L Clancy2, Allan W Cripps11School of Medicine, Griffith Health Institute, Griffith Health, Griffith University, Gold Coast, Queensland, Australia; 2Immunology Unit, Hunter Area Pathology Service and University of Newcastle, Newcastle, New South Wales, AustraliaBackground: Intralumenal bacteria play a critical role in the pathogenesis of acute infective episodes and airway inflammation. Antigens from colonizing bacteria such as nontypeable Haemophilus influenzae (NTHi) may contribute to chronic lung disease through an immediate hypersensitivity response. The objective of this study was to determine the presence of specific NTHi-IgE antibodies in subjects with chronic bronchitis (CB) and COPD who had smoked.Methods: Serum, sputum, and saliva samples were collected from subjects with CB and moderate–severe COPD and healthy aged-matched controls. Total IgE and specific NTHi IgE were measured by enzyme linked immmunosorbent assay. Throat swabs were examined for the presence of NTHi.Results: The results demonstrate that: i) specific NTHi IgE antibodies occur at a low level in healthy subjects; ii) those with both CB and moderate–severe COPD have elevated specific NTHi IgE antibody compared with healthy controls, with higher levels in those with most severe disease; iii) IgE levels are greater in those with moderate–severe COPD than in those with CB. They demonstrate specific NTHi IgE antibody is regularly found at higher than normal levels in COPD.Conclusion: The detection of IgE antibody to colonizing bacteria in all subjects with CB or moderate–severe COPD identifies a possible mechanism of bronchospasm in these subjects amenable to specific intervention therapy.Keywords: nontypeable Haemophilus influenza, chronic bronchitis, chronic obstructive pulmonary disease, IgE, smoking
Identification of adults with symptoms suggestive of obstructive airways disease: Validation of a postal respiratory questionnaire
Timothy L Frank, Peter I Frank, Jennifer A Cropper, Michelle L Hazell, Philip C Hannaford, Roseanne R McNamee, Sybil Hirsch, Charles AC Pickering
BMC Family Practice , 2003, DOI: 10.1186/1471-2296-4-5
Abstract: A two-stage design was used. All adults in two practice populations were sent the questionnaire and a stratified random sample of respondents was selected to undergo full clinical evaluation. Three respiratory physicians reviewed the results of each evaluation. A majority decision was reached as to whether the subject merited a trial of obstructive airways disease medication. This clinical decision was compared with two scoring systems based on the questionnaire in order to determine their positive predictive value, sensitivity and specificity.The PPV (positive predictive value) of the first scoring system was 75.1% (95% CI 68.6–82.3), whilst that of the second system was 82.3% (95% CI 75.9–89.2). The more stringent second system had the greater specificity, 97.1% (95% CI 96.0–98.2) versus 95.3% (95% CI 94.0–96.7), but poorer sensitivity 46.9% (95% CI 33.0–66.8) versus 50.3% (95% CI 35.3–71.6).This scoring system based on the number of symptoms/risk factors reported via a postal questionnaire could be used to identify adults who would benefit from a trial of treatment for obstructive airways disease.The aim of the study was to validate two simple scoring systems for a self-completed postal questionnaire designed to identify adult patients likely to have asthma/COPD (obstructive airways disease).It has been reported that asthma is under-diagnosed and under-treated in adults [1,2]. In the short term this probably leads to increased morbidity for sufferers, and in the long term it may have a detrimental effect on their lung function and clinical state [3]. Chronic obstructive pulmonary disease is also thought to be under-diagnosed in adults [4]. This may lead to increased morbidity and the loss of an effective opportunity for giving smoking cessation advice. There may be clinical benefits to the individual and health economic benefits to society from identifying and treating patients who have asthma or COPD and who are unknown to the medical services. Before this hypot
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