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Query: UMLS:C0010200 (cough)
 23,843 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In a series of 2150 patients subjected to bronchoscopy 94 (4.5%) were found to have tracheobronchomalacia. Tracheomalacia alone was diagnosed in 21 patients (22%), tracheobronchomalacia in 59 (63%) and bronchomalacia alone in 14 (15%). Mild malacic changes were noted in 44 patients (47%), moderate in 38 (40.5%) and severe in 12 (12.5%). The main symptoms were dyspnoea (63%), chronic cough with expectoration (49%) and haemoptysis (33%), and the most frequent concurrent diseases chronic bronchitis (53%), bronchial cancer (27.5%) and pulmonary tuberculosis (19%). Bronchoscopy performed under local anaesthesia enabled the dynamics of the tracea and bronchi to be observed during spontaneous breathing and during coughing, and it is the best available diagnostic procedure. Histologically the number of longitudinal elastic fibres in the pars membranacea was clearly reduced throughout the whole tracheal area in one patient with tracheomalacia but no differences were found in the amount of collagen, mucopolysaccharides and elastin in the cartilages of trachea and bronchi. This disease seems to be associated with chronic obstructive pulmonary diseases such as chronic bronchitis, and it apparently shares the same aetiological factors.
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PMID:Acquired tracheobronchomalacia. 88 58

A case of Saber-sheath type tracheo-bronchomalacia complicating bronchial asthma was treated by external fixation of Marlex mesh, and good results were obtained. The patient was a 43-year-old male who had been treated for bronchial asthma for over nearly 20 years. Since 4 years ago, dyspnea and a feeling of obstruction of the larynx developed and gradually aggravated. He lost consciousness twice and was hospitalized on an emergency basis. Pulmonary function tests performed during remission of asthma attacks revealed an obstructive disorder: FEV1.0% was 30.5% and peak flow was 4.11 L/sec. Bronchoscopy and tracheo-bronchography revealed Saber-sheath type tracheo-bronchomalacia in the trachea and the right main bronchus. The severity of the obstruction was, in terms of Johnson's classification, II. for the trachea and I. for the right main bronchus. In accordance with the method reported by Hanawa and Ikeda, external fixation was applied to the trachea and the right main bronchus; that is, Marlex mesh was applied around to the trachea and the right main bronchus, and additional Lyodura was applied over the Marlex mesh. The postoperative course was satisfactory. Both FEV1.0% and the peak flow improved, and constriction of the trachea and the right main bronchus at the time of coughing was also reduced.
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PMID:[A case of Saber-sheath type tracheo-bronchomalacia]. 148 47

The long-term functional results of splinting a collapsing major airway with a silastic Marlex mesh prosthesis were assessed. Six patients in whom follow-up has been longer than 4 years (mean 5.3 years) were studied. The prosthetic semirigid splints had been implanted in five children with tracheomalacia and one with bronchomalacia. Mean age at the time of airway splinting was 4 years (range 6 months to 8 years). At their last clinical evaluation, all six children were leading normal active lives. Three had mild respiratory symptoms not related to the splinting. The only long-term complication was a serous effusion that developed around the splint and compressed the trachea in one child 2 years postoperatively. Tracheal fluoroscopy, barium swallow, and computed tomography scans of the trachea in five patients demonstrated satisfactory tracheal caliber without airway collapse during expiration and coughing. Pulmonary function testing showed a mild increase in airway resistance in one child who had had a tracheostomy. These results demonstrate that the application of composite synthetic graft to a segment of a malacic airway in young patients can provide long-term relief from airway collapse without compromising airway growth.
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PMID:Long-term functional results of prosthetic airway splinting in tracheomalacia and bronchomalacia. 381 91

Laryngomalacia, bronchomalacia, and tracheomalacia are commonly seen in pediatric respiratory medicine, yet their patterns and associations with other conditions are not well-understood. We prospectively video-recorded bronchoscopic data and clinical information from referred patients over a 10-year period and defined aspects of interrelationships and associations. Two hundred and ninety-nine cases of malacia disorders (34%) were observed in 885 bronchoscopic procedures. Cough, wheeze, stridor, and radiological changes were the most common symptoms and signs. The lesions were most often found in males (2:1) and on the left side (1.6:1). Concomitant malacia lesions ranged from 24% for laryngotracheobronchomalacia to 47% for tracheobronchomalacia. The lesions were found in association with other disorders such as congenital heart disorders (13.7%), tracheo-esophageal fistula (9.6%), and various syndromes (8%). Even though the understanding of these disorders is in its infancy, pediatricians should maintain a level of awareness for malacia lesions and consider the possibility of multiple lesions being present, even when one symptom predominates or occurs alone.
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PMID:Series of laryngomalacia, tracheomalacia, and bronchomalacia disorders and their associations with other conditions in children. 1220 47

Although asthma is the most common cause of cough, wheeze, and dyspnea in children and adults, asthma is often attributed inappropriately to symptoms from other causes. Cough that is misdiagnosed as asthma can occur with pertussis, cystic fibrosis, primary ciliary dyskinesia, airway abnormalities such as tracheomalacia and bronchomalacia, chronic purulent or suppurative bronchitis in young children, and habit-cough syndrome. The respiratory sounds that occur with the upper airway obstruction caused by the various manifestations of the vocal cord dysfunction syndrome or the less common exercise-induced laryngomalacia are often mischaracterized as wheezing and attributed to asthma. The perception of dyspnea is a prominent symptom of hyperventilation attacks. This can occur in those with or without asthma, and patients with asthma may not readily distinguish the perceived dyspnea of a hyperventilation attack from the acute airway obstruction of asthma. Dyspnea on exertion, in the absence of other symptoms of asthma or an unequivocal response to albuterol, is most likely a result of other causes. Most common is the dyspnea associated with normal exercise limitation, but causes of dyspnea on exertion can include other physiologic abnormalities including exercise-induced vocal cord dysfunction, exercise-induced laryngomalacia, exercise-induced hyperventilation, and exercise-induced supraventricular tachycardia. A careful history, attention to the nature of the respiratory sounds that are present, spirometry, exercise testing, and blood-gas measurement provide useful data to sort out the various causes and avoid inappropriate treatment of these pseudo-asthma clinical manifestations.
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PMID:Pseudo-asthma: when cough, wheezing, and dyspnea are not asthma. 1816 77

Bronchomalacia in adults is rare. A case is reported here of a 65-year-old man with severe cough and mucostasis, caused by a benign bronchomalacia of the ventral wall of the left main bronchus. This was treated successfully with the insertion of a silicone Dumon stent as an alternative to surgical bronchoplasty.
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PMID:Severe bronchomalacia in a 65-year-old man treated with stent insertion instead of surgical bronchoplasty. 1849 70

A laryngo-tracheo-esophageal cleft (LC) is a congenital malformation characterized by an abnormal, posterior, sagittal communication between the larynx and the pharynx, possibly extending downward between the trachea and the esophagus. The estimated annual incidence of LC is 1/10,000 to 1/20,000 live births, accounting for 0.2% to 1.5% of congenital malformations of the larynx. These incidence rates may however be underestimated due to difficulty in diagnosing minor forms and a high mortality rate in severe forms. A slightly higher incidence has been reported in boys than in girls. No specific geographic distribution has been found. Depending on the severity of the malformation, patients may present with stridor, hoarse cry, swallowing difficulties, aspirations, cough, dyspnea and cyanosis through to early respiratory distress. Five types of laryngo-tracheo-esophageal cleft have been described based on the downward extension of the cleft, which typically correlates with the severity of symptoms: Type 0 laryngo-tracheo-esophageal cleft to Type 4 laryngo-tracheo-esophageal cleft. LC is often associated with other congenital abnormalities/anomalies (16% to 68%), mainly involving the gastro-intestinal tract, which include laryngomalacia, tracheo-bronchial dyskinesia, tracheo-bronchomalacia (mostly in types 3 and 4), and gastro-esophageal reflux disease (GERD). The syndromes most frequently associated with an LC are Opitz/BBB syndrome, Pallister Hall syndrome, VACTERL/VATER association, and CHARGE syndrome. Laryngeal clefts result from failure of fusion of the posterior cricoid lamina and abnormal development of the tracheo-esophageal septum. The causes of the embryological developmental anomalies leading to LC are not known but are thought to be multifactorial. LC appears to be mostly sporadic although some familial cases with suspected autosomal dominant transmission have been reported. The age of diagnosis depends mainly on the severity of the clinical symptoms and therefore on the extent of the LC. Diagnosis is made either based on clinical manifestations or on investigations, such as endoscopy, X-ray, CT scan, performed for other conditions. Differential diagnoses include tracheo-bronchial fistula, gastro-esophageal reflux disease and neurological swallowing disorders, as well as laryngomalacia and laryngeal palsy. Prenatal diagnosis of LC has never been reported, although associated anomalies may be detected on fetal ultrasonography. Once the cleft is diagnosed, it is essential to determine its length to orient the management and treatment approach. Management involves maintenance of satisfactory ventilation, prevention of secondary pulmonary complications as a result of repeated aspirations, and adequate feeding. Endotracheal intubation may be required for respiratory distress in severe cases. Treatment requires endoscopic or external surgery to close the cleft. Surgery should be performed as early as possible to avoid complications related to aspiration and gastric reflux, except in type 0 and type 1 cases in which conservative measures must first be attempted. The prognosis is variable depending on the severity of the LC and associated malformations. Early diagnosis and appropriate treatment and management help to reduce mortality and morbidity.
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PMID:Laryngo-tracheo-oesophageal clefts. 2215 99

Tracheal and airway collapse (bronchomalacia) are common causes of chronic cough in middle-aged to older dogs where weakening of cartilage within the respiratory system leads to narrowing of airways, coughing, wheezing, and other secondary effects. Successful treatment involves correct identification of the problem, recognition of concurrent problems, and appropriate medical therapy. Surgical and noninvasive treatment options are becoming readily available, and it is important to understand indications for such procedures.
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PMID:Tracheal and airway collapse in dogs. 2426 37

A 13-year-old neutered male Maltese was referred for paroxysms of coughing and cyanosis, with radiographic evidence of bronchial disease and cardiomegaly. Investigation with echocardiography, bronchoscopy, fluoroscopy and bronchoalveolar lavage led to a diagnosis of myxomatous mitral valve degeneration with insufficiency, ISACHC class II heart failure and bronchomalacia with severe left mainstem bronchial collapse. Persistence of intractable cough despite medical therapy prompted placement of a stent in the left mainstem bronchus. Immediately after stent placement, severe pulmonary oedema developed, thought to be due to compression of the left atrium by the stent or acute lung injury related to stent placement. The dog recovered over a 3-day period with diuretic therapy and positive end expiratory pressure ventilation. Subsequently, the dog died from congestive heart failure 102 days after stent placement, during which time occasional, self limiting coughing episodes occurred.
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PMID:Bronchial stent placement in a dog with bronchomalacia and left atrial enlargement. 2463 79

The patients suffering of trachea bronchial dyskinesia in a context of trachea bronchomalacia present an important decrease of the expiratory flow during the Forced Expiration Techniques, and during the cough, returning difficult mucus clearance. The use of CPAP for these patients as a pneumatic prothesis can bring a considerable help during the chest physiotherapy techniques, avoiding the tracheobronchial collapse. The objectivation of the efficiency of this technique through a clinical case, its ease of application and control, allows us to propose the attempt of this additive help when the indication and the contraindications are clearly defined.
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PMID:[CPAP interest in help of mucus clearance in tracheo-bronchomalacia outpatients]. 2756 81


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