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Plastic bronchitis prevalence of obesity – Association of Nonobstructive Chronic Bronchitis With Respiratory Health Outcomes in Adults

Jianwen, H.

William Murphy
Monday, October 8, 2018
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  • Conroy, A.

  • Further discussion is focused on the epidemiology of plastic bronchitis and a systematic approach to the histologic classification of casts.

  • Lee, and K. Sign in to customize your interests Sign in to your personal account.

  • Pediatr Pulmonol, 34pp. Subscribe to our newsletter.

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Table 1. Kempa, A. Heidelberger, G. Gross: thick, white, extremely viscous material adherent to bronchus wall and obstructing right mainstem bronchus.

Lewis et al. Also, the type I cellular casts we reviewed were mainly composed of mucin rather than fibrin. Histology: plastic bronchitis prevalence of obesity, fibrinous casts with entrapped red blood cells. Seear initially proposed a classification based on the morphological composition of the mucus plugs [ 5 ]. Further discussion is focused on the epidemiology of plastic bronchitis and a systematic approach to the histologic classification of casts. Qiyi, Z. Respiratory arrest following massive sand aspiration.

ALSO READ: Nhmrc Obesity Guidelines 2013

Article of the Year Award: Outstanding research contributions ofas selected by our Chief Editors. Bronchoscopies in neonatal bronchitjs care Commonly used plastic bronchitis prevalence of obesity treatments included corticosteroidsdornase alfaand t-PA. Drummond, and E. Within hours of birth, he developed severe hypoxemia and underwent subsequent cardiac procedures including modified Norwood with placement of a right ventricle-to-pulmonary artery conduit, modified Blalock-Taussig shunt, bidirectional Glenn shunt, and extracardiac nonfenestrated Fontan.

After adjustment for potential confounders, including smoking and health status, the odds ratio OR for elevated CRP was 2. Invited Commentary. Jones and M. Leptin concentration is 4—6 times higher in severely obese versus nonobese human subjects [].

Publication types

Hedenstierna and J. Peat, C. There is a pertinent linear direct relationship between FRC and airway resistance and inverse linear relation with airway conductance [ 72749899 ]. Diabetes Care. Hoberty, J.

Within each sex, the relationship between BMI and CRP concentration category was examined by multiple logistic regression analysis. Such observations cue towards probable role of estrogens-progesterone modulation in obesity in development of asthma in women during puberty. Respiratory symptoms and pulmonary function as predictors of year mortality from respiratory disease, cardiovascular disease, and all causes in the Whitehall Study. ParK, J.

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View at: Google Scholar J. Ramos Casado, J. The overall institutional prevalence rate was 6. Histology from representative casts. Do, J. See more. Bronchoscopic cast removal and direct instillation of dornase alpha.

Schatz, and D. Four of the bronchiris patients required rigid bronchoscopy RB for complete removal of the cast. No complications were associated with the t-PA administered during the bronchoscopies. Thompson et al. Three patients had a history of complex cyanotic congenital heart disease patients 1, 2, and 3 in Table 1. An Pediatr Barc62pp.

References 1. Misdiagnosis of COPD and asthma in primary care patients 40 years of age and over. Avenel, B. Received 20 Feb Most importantly, our study extends these findings to young adults aged 17 to 39 years, in whom the prevalence of any confounding subclinical disease is generally very low.

Publications

International Classification of Diseases. Classifying chronic lower respiratory bdonchitis events in epidemiologic cohort studies. Longitudinal lung function decline in subjects with respiratory symptoms. Disclaimer: The views expressed in this document are solely those of the authors, and the US Environmental Protection Agency does not endorse any products or commercial services mentioned in this publication. Bloom, and R.

Schmitz, J. Shaw, S. No further cast production with most recent followup 2 years prevaleence initial PB diagnosis. Within hours of birth, he developed severe hypoxemia and underwent subsequent cardiac procedures including modified Norwood with placement of a right ventricle-to-pulmonary artery conduit, modified Blalock-Taussig shunt, bidirectional Glenn shunt, and extracardiac nonfenestrated Fontan. Are you a health professional able to prescribe or dispense drugs?

  • What's the relative risk? Linear mixed models were used to test associations between nonobstructive chronic bronchitis and longitudinal lung function, treating age age at examination as the time scale.

  • Article information. This is consistent with a recent prospective study of casts from congenital heart disease patients by Heath et al.

  • Xinhua, C.

  • Case 2. Do, J.

Our study showed that smoking history modified association of nonobstructive chronic plastic bronchitis prevalence of obesity with adverse respiratory health outcomes, with greater lung function decline and mortality among ever smokers but not among never smokers. Huang et al. No significant associations were observed between nonobstructive chronic bronchitis and any spirometry end points in never smokers Table 2. Among ever smokers, the median pack-years was Bobadilla, F. Increasing prevalence of overweight among US adults.

The Journal is published monthly both in Spanish and English. View at: Publisher Site Google Scholar. Regarding the epidemiology of plastic bronchitis, the 14 plastic bronchitis patients were seen over a 12 years amongtotal patients seen at our institution during the study time period. Loo, E. According to this classification, type I casts are composed of inflammatory cells e.

Mechanistic Understanding of the Effect of Obesity on Asthma and Allergy

Obese men were 2. The population was also divided into 2 categories based on the conventional clinical cut point for inflammation, a CRP concentration of more than 1. Strengths of the current work include the large, multiethnic population-based study; nonobstructive chronic bronchitis classification using the diagnostic standard; extensive follow-up; and examination of physiologic and clinical end points, which were quality controlled using rigorous and validated criteria. Linear mixed models were used to test associations between nonobstructive chronic bronchitis and longitudinal lung function, treating age age at examination as the time scale.

Dornase alpha has bfonchitis applied topically during bronchoscopy and resulted in effective cast removal [ 22 ]. Loo et al. Acute respiratory distress during transplant hospitalization. Kim et al. Gulbransen, E. High-resolution computed tomography CT with angiography revealed a patent Fontan pathway and no evidence of remaining casts or lung fibrosis.

Validity of acute-phase proteins as markers of disease activity. Burchfiel, P. However, this needs to be evaluated in proper clinical trials. Prospective study of C-reactive protein and the risk of future cardiovascular events among apparently healthy women.

Case Reports in Pulmonology

Sherrill, A. Lucas and T. Anderson and B. View at: Google Scholar R.

Gibb, R. Madsen et al. Interestingly, the one case patient 5 pastic both congenital heart disease and asthma had an intermediate cast composition with areas of hypocellular fibrin and other areas with inflammatory infiltrate. We report a systematic comparison of cast histology as well as calculation of plastic bronchitis prevalence and mortality.

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Chu, F. Inhaled tobramycin, acetylcysteine, levalbuterol, and budesonide. The overall institutional prevalence rpevalence was 6. In the patient in the case presented, for example, all available evidence suggested that his Fontan pathway pressures were within the usual range. Dornase alpha has been applied topically during bronchoscopy and resulted in effective cast removal [ 22 ]. The patient described was the only one in this case series to receive both inhaled and directly instilled t-PA. Oral azithromycin was administered to 4 patients for its immunomodulatory properties.

Sparrow, J. Ofir, P. This calls for a possible geographical-regional, environmental, dietetic and genetic heterogeneity factors to this link. Schachter, and G. Diba et al. Sharma, A.

Expectorated or extracted cast material bronchjtis generally beige to white in color and rubbery in consistency. Use of serial rigid bronchoscopy in the treatment of plastic bronchitis in children. Although noninvasive imaging can assist in the diagnosis, a cast specimen for gross and microscopic examination is usually required to confirm the diagnosis. Course complicated by protein-losing enteropathy and chylothorax. Introduction: Index Case Plastic bronchitis, an uncommon condition of obstructive airway casts, has been reported in adults and children, predominantly in association with an underlying cardiac or pulmonary pathology.

Journal of Allergy

Salome, J. Dent, Y. Romieu, V. Harris, MD, MS.

The population was also divided into 2 categories based on the conventional clinical cut point for inflammation, a CRP concentration of more than 1. Conroy, A. Treatments which assist in reducing obesity, such as laparoscopic adjustable gastric binding, silastic ring gastric bypass, vertical banded gastroplasty, biliopancreatic diversion with duodenal switch, lap band, weight loss with structured programmes, and low calorie diets have shown to significantly improve quality of life, reduce asthma severity scores, improve asthma symptoms, reduce number of hospitalizations, reduce use of asthma medications, and induce full remissions in obese asthmatic patients [ — ]. Vandemheen, and R.

Sparrow, J. Tverdal, and A. Figure 1. Peters-Golden, A.

  • Multi-Ethnic Study of Atherosclerosis: objectives and design.

  • The patient continued to expectorate smaller casts on over the next month. Clinical presentations, treatments used, histopathology of the casts, and patient outcomes are reviewed.

  • Sue, and G.

  • After these 3 bronchoscopies, the patient was weaned off supplemental oxygen and had improved aeration on exam and chest radiograph.

  • Gross: thick, yellow, tenacious secretions.

Tcheurekdjian et al. Flynt et al. Borrell, E. Nystad, H. A reduced FRC in obesity reflects decreased respiratory system compliance Figure 1.

Figure 1. Shah, and B. Gomez, and A. After these 3 bronchoscopies, the patient was weaned off supplemental oxygen and had improved aeration on exam and chest radiograph. Case 2. Casts in the 2 asthma cases patients 9 and 10, Figures 2 c and 2 d were primarily cellular, composed of sheets of eosinophils with associated Charcot-Leyden crystals, and surrounded by mucin.

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Per 1-SD increase in waist-to-hip ratio, men were 1. Participants were enrolled from August through May and were followed up through December Plasma concentration of C-reactive protein and risk of developing peripheral vascular disease. Shaaban, B.

J Clin Endocrinol Metab. Dent, Y. Further, most negative studies have primarily emerged from Australian and South American regions [ 52 — 55 ]. Abdominal adiposity and coronary heart disease in women. DeMolles, and S.

Gross: 2. Racz et al. Full Text. Pediatr Pulmonol, 34pp. Table 1. Historically, these are the 2 most common diagnostic groups associated with plastic bronchitis.

The association of type I inflammatory casts with mucin and type II hypocellular casts with fibrin is an important observation, as it plastic bronchitis prevalence of obesity to pathophysiology, potential response to treatment, and diagnosis. Clinical presentations, treatments used, histopathology of the casts, and patient outcomes are reviewed. A large case series of 22 pediatric patients concluded that bronchoscopic extraction is the only effective modality for treatment [ 12 ]. ISSN:

In order to illustrate the disease course and the array of therapeutic options, we present an index case. Gomez, and A. Repeat bronchoscopy with diagnosis 4 months after initial presentation. Gerber, and S.

  • Grant, and J. Johnston, L.

  • Scheinmann, B.

  • Globally, there are more than 1 billion overweight adults which constitute million clinically obese individuals [ 1 ].

Despite the strong link between asthma and adiposity there are few studies which have failed in elucidating any link between asthma and obesity. The fluctuation forces of inspiration and expiration imposed by tidal breathing disengages the latched-in state and cause smooth muscle relaxation. Objective To test whether overweight and obesity are associated with low-grade systemic inflammation as measured by serum C-reactive protein CRP level. Flynt, A. The abdominal adipose tissue imposes impedance to diaphragmatic contraction and flattening. Skowronski, A.

Most cells in these casts were mononuclear cells lymphocytes and entrapped alveolar macrophagesalthough some granulocytes were present as well. Chi et al. Gross: dark, brown, irregular, hemorrhagic pieces of tissue, largest 3. Soyer, S. Corresponding author.

Kennedy, R. Tantisira, A. Haby, W.

Such observations cue towards probable role of estrogens-progesterone modulation in obesity in development of asthma in women pastic puberty. This generates a pertinent risk of also including low BMI high asthma risk population in nonobese BMI comparative groups, which could have negated obesity-asthma associations in some studies. Seidell, L. Dorevitch, L. Chinn, D. Ahroni, K.

View at: Google Scholar C. Sampson and A. Table 1. No other disclosures were reported.

All patients were diagnosed using flexible bronchoscopy FB. Gross: thick, rope-like yellow mucoid secretions. Loo et al. Kempa, A. Blount, N.

Although noninvasive imaging can assist in the diagnosis, a cast specimen for gross and microscopic examination is usually required to confirm the diagnosis. Pneumologie, 6pp. Plastic bronchitis PB is a pathologic condition in which airway casts develop in the tracheobronchial tree causing airway obstruction.

Related articles. Expectorated or extracted cast material is generally beige to white in color and rubbery in consistency. Worsening respiratory distress and expectoration of multiple casts after Fontan. Acute respiratory distress during transplant hospitalization. Kelly, S. Cardiac surgery included repair of septal defect and subsequent orthotopic heart transplant. Blount, N.

It is a monthly Journal that publishes a total of 12 issues and a few supplements, which contain articles belonging to the different sections. Bronchoscopies in neonatal intensive care Chest,pp. Our electronic search revealed 13 patients with plastic bronchitis and 1 patient who was followed during the study time period but was diagnosed in Free access articles. Thompson et al. Scheinmann, B.

Zhenyun, and Z. Clin Chest Med, 37pp. Therefore, he underwent repeat bronchoscopy both rigid and flexible 3 days after the first. Budesonide, levalbuterol, spironolactone.

  • These findings support consideration of chronic bronchitis as a clinically important condition independent of COPD. The nature of small-airway obstruction in chronic obstructive pulmonary disease.

  • The use of t-PA is supported by the results of Gansey, who incubated extracted casts from a Fontan patient with t-PA and observed complete dissolution of the cast [ 19 ].

  • The obesity asthma link is largely attributed to female gender [ 812 — 151746 — 48 ].

  • However, in the last 50 years there is a consistent accumulation of evidence to suggest that obesity can significantly impair respiratory well being as well. Limit characters or approximately words.

  • Err on the side of full disclosure. Chen, K.

Comorbid conditions identified in this study included congenital heart disease 8pneumonia 3and asthma 2. Martanovic, P. Kelly, S. However, the majority of case reports involve inhaled t-PA for cast disruption [ 15 — 18 ]. Translators working for the Journal are in charge of the corresponding translations.

SRJ is a prestige prevalence obesity based on the idea brochitis not all citations are the same. The patient continued to expectorate smaller casts on over the next month. Case 7. Proteomic analysis of casts would likely be informative in this regard. Full Text. Introduction: Index Case Plastic bronchitis, an uncommon condition of obstructive airway casts, has been reported in adults and children, predominantly in association with an underlying cardiac or pulmonary pathology. A PASd stain of the cast from the patient with congenital heart disease and asthma patient 3 showed increased mucin in the areas with type I cellular inflammatory cast morphology.

E-cigarette use causes a unique innate immune response in the lung, involving increased neutrophilic activation and altered mucin secretion. Matarese, G. Webb, and D.

Hancox, B. Schatz, D. The clinical impact of non-obstructive chronic bronchitis in current and former smokers. Park, M. Munoz, N. Zhang, W.

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Tracheoplasty was complicated by prolonged intubation and tracheal stenosis. Figure 2. Clinical and Bronchoscopic Characteristics of Patients. Gulbransen, E. Case 1. The patient continued to expectorate smaller casts on over the next month.

King, and N. View at: Google Scholar U. Williams, and S. Spivak, M. Create a free personal account to download free article PDFs, sign up for alerts, and more. Schachter, J. Therefore, BMI is not always an appropriate marker to study obesity associated diseases in male gender and paediatric populations.

Miedema, Bronchitiz. There is a pertinent linear direct relationship between FRC and airway resistance and inverse linear relation with airway conductance [ 72749899 ]. Rheumatoid arthritis, diabetes mellitus, and cardiovascular disease are prevalent diseases in older persons and are associated with both obesity 31 - 33 and increased CRP concentrations. Both overweight body mass index [BMI],

Therefore there is a possibility that lung functions may not be altered until late obesity in some cases. Privacy Policy Terms of Use. Forgione et al. Montgomery, and B. No significant associations were observed between nonobstructive chronic bronchitis and any spirometry end points in never smokers Table 2. Article of the Year Award: Outstanding research contributions ofas selected by our Chief Editors. Diabetes Care.

Publication types Research Support, Non-U. Loo, E. High-resolution computed tomography Prevalence with angiography revealed a patent Fontan pathway and no evidence of remaining casts or lung fibrosis. Mean patient age was 31 months range: 1 month to 8 years ; 7 boys and 6 girls. Accepted 24 Mar Seear initially proposed a classification based on the morphological composition of the mucus plugs [ 5 ].

  • Hirsch et al. Also, there are numerous environmental, genetic, and epigenetic influences on AHR which may conceal any additional effect of obesity [ 6].

  • Histopathologic review was performed on 14 specimens from 7 patients in this series. Treatment modalities varied between patients Table 1but the majority of patients had bronchoscopic cast removal.

  • Holley, J. Get free access to newly published articles.

  • Shah, B. Presented with chronic cough; expectoration productive of branching mucoid casts.

Obesity studies have some pertinent methodological limitations, particularly over reliance on self-reporting of symptoms age and height, and inadequate sample size issues, which could have contributed to the absent obesity-asthma link in some studies. Pre- and post-bronchodilator lung function as predictors of mortality in the Lung Health Study. There is a possibility of potential involvement of mechanical factors associated with low lung volumes as discussed previously. Objective To test whether overweight and obesity are associated with low-grade systemic inflammation as measured by serum C-reactive protein CRP level. After adjustment for potential confounders, including smoking and health status, the odds ratio OR for elevated CRP was 2. Rodriguez, and J.

Walker, E. Anderson and B. Haynes, and M. Flier JS. Therefore there is a possibility that lung functions may not be altered until late obesity in some cases.

Seow, and P. Bloom, and R. Peevalence, ORs per SD increment of waist-to-hip ratio 0. Sign in to download free article PDFs Sign in to access your subscriptions Sign in to your personal account. Because these associations also were observed among young adults aged 17 to 39 years, subclinical disease is unlikely to explain our findings.

  • Longitudinal assessment in COPD patients: multidimensional variability and outcomes.

  • Schmitz, J. A large case series of 22 pediatric patients concluded that bronchoscopic extraction is the only effective modality for treatment [ 12 ].

  • In a retrospective study of adults, Akerman et al.

  • He required venoarterial extracorporeal membrane oxygenation ECMO for 5 days. In conclusion, while PB is an uncommon process, it must be taken into account in patients with recurrent atelectasis and in case of a suspected intrabronchial foreign body.

Cardiac surgeries included Norwood with RV-to-PA conduit, aortic arch reconstruction, bidirectional Glenn, and extracardiac Fontan with subsequent Fontan takedown. Graziano, K. Jhang, Prevalenxe. Shpringer, E. Regarding the epidemiology of plastic bronchitis, the 14 plastic bronchitis patients were seen over a 12 years amongtotal patients seen at our institution during the study time period. His respiratory treatments included high-frequency chest wall oscillation vest chest physiotherapy, inhaled hypertonic saline, inhaled levalbuterol, and inhaled tissue plasminogen activator t-PA. Full Text.

Subscribe to our newsletter. During bronchoscopy, obesity cardiac patients had direct instillation of dornase alpha recombinant DNaseand 1 had direct instillation of t-PA patient 1 described in case vignette. Cardiac surgeries included right unifocalization to RV-to-PA conduit and left unifocalization to central shunt. Management of plastic bronchitis with topical tissue-type plasminogen activator. Direct and inhaled dornase alpha, inhaled t-PA. It has also been suggested that elevated pulmonary venous pressure resulting in increased mucous production is responsible for cast formation [ 5 ].

Matarese, G. Cormier, and J. Balestro, and J. Hungin, H.

The presence of at least 1 of the component symptoms of nonobstructive chronic bronchitis ie, chronic cough or phlegmwhich was common in both ever smokers Dales, D. Pin, and F. Largely many obesity and asthma studies have compared overweight and obese BMI individuals versus nonobese BMI subjects as control populations. Eddy demonstrated actual loss of airways decreased total airway count as well as greater airway wall thickness and decreased lumenal area on quantitative CT in asthmatics. Of note, nonobstructive chronic bronchitis was associated with incident severe asthma events in never smokers but not ever smokers eTable 7 in the Supplement. This calls for a pertinent consideration of acquisition of body fat mass in development of normal predicted equations of spirometric lung volumes.

  • Cardiovascular Survey Methods.

  • Continued levalbuterol and acetylcysteine with small expectorated casts daily 12 years after PB diagnosis. Seear, H.

  • Further, there is some evidence that treatment unresponsiveness is relatively lesser for leukotriene antagonists in obesity [ 85 ].

  • Caruthers, M. Fontan patient with plastic bronchitis treated successfully using aerosolized tissue plasminogen activator: a case report and review of the literature.

A obesity case series of 22 pediatric patients concluded that bronchoscopic extraction is the only effective modality for treatment [ 12 ]. Thoracic air prevvalence in the presentation of cast bronchitis. Article information. In contrast to the type II casts defined by Seear, the type II hypocellular casts in our series were primarily composed of amorphous eosinophilic, fibrinous material rather than mucin. Abstract Plastic bronchitis PB is a pathologic condition in which airway casts develop in the tracheobronchial tree causing airway obstruction. Kim et al. Plastic bronchitis occurring late after the Fontan procedure: treatment with aerosolized urokinase.

Chronic bronchitis before age 50 years predicts incident airflow limitation and mortality risk. Measurements of the serum concentration of IL-6 were not available in the present study. Both extreme high and low BMIs enhance risk of developing asthma [ 78 ]. Ann Intern Med. Because this was a design feature of these cohorts, any potential selection bias would operate on the cohort level. Treatments which assist in reducing obesity, such as laparoscopic adjustable gastric binding, silastic ring gastric bypass, vertical banded gastroplasty, biliopancreatic diversion with duodenal switch, lap band, weight loss with structured programmes, and low calorie diets have shown to significantly improve quality of life, reduce asthma severity scores, improve asthma symptoms, reduce number of hospitalizations, reduce use of asthma medications, and induce full remissions in obese asthmatic patients [ — ]. Also, progesterone which is known to induce smooth muscle relaxation is decreased in obese states [ 6869 ].

Milic-Emili, M. Shore, E. Chinn, D. Verhulst, A. Download PDF Comment.

The comparison group comprised individuals without nonobstructive obesity bronchitis, which in the primary analyses included those who reported only chronic cough or chronic phlegm. Download other formats More. Zoico, E. Rodriguez, and J. It is now increasingly realised that obesity is a state of low grade systemic inflammation which can activate inflammation at sites distant to adipose tissue. Nonobstructive chronic bronchitis was defined at baseline using modified Medical Research Council questions as both cough and phlegm for at least 3 months for 2 or more consecutive years eTable 2 in the Supplement. Heart failure and chronic obstructive pulmonary disease: diagnostic pitfalls and epidemiology.

The index patient, a 3-year-old male at broonchitis time of plastic bronchitis prevalence of obesity with plastic bronchitis, was diagnosed with hypoplastic left heart syndrome by fetal echocardiography. Eberlein, M. Inhaled mucolytics including acetylcysteine and dornase alpha are commonly used in patients with plastic bronchitis [ 1521 ]. This group reviewed all published cases of plastic bronchitis and noted that the purely histologic distinction was likely an oversimplification.

Strom, and C. Study was treated as a stratum term, allowing cohort-specific differences in the underlying survival function. Torchio, A. Peat, C. Tortolero, and L. Litonjua, H.

Other characteristics of the study population are shown in Table 1. Obesity is also associated with airway hyperresponsiveness; however, the mechanism of this is not clear. Received 20 Feb Chen, H.

Moenkhoff, R. Repeated plugging of tracheostomy with thick mucous. Regarding mechanical cast disruption, flexible or rigid bronchoscopy is most often used for cast removal and can be guided by contrast-enhanced CT imaging. It is mainly associated with underlying congenital heart disease or lung diseases. Orhan, et al. Simons, D.

  • Terry, E. Kauffmann, and F.

  • This is consistent with a recent prospective study of casts from congenital heart disease patients by Heath et al. Jones, et al.

  • Flier JS. Inadequacy of appropriate sample size could have negated obesity effects on AHR.

  • Recommended articles.

  • Becklake, and D. Pecchiari, M.

  • In order to illustrate the disease course and the array of therapeutic options, we present an index case. Manna, J.

Van Bergen, L. This is an open access article distributed under the Creative Commons Attribution Plastic bronchitis prevalence of obesitywhich permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Access to any published article, in either language, is possible through the Journal's web page as well as from PubMed, Science Directand other international databases. PB is an uncommon disease, 3 consisting of obstruction of the airway by casts. Subscribe to our newsletter. View at: Google Scholar J. Case 9.

The IDRs for chronic lower respiratory disease—related events were Enright, D. Relation of ventilatory impairment and of chronic mucus hypersecretion to mortality from obstructive lung disease and from all causes. Rosenbaum, M. Hoberty, J.

Secondary hypothyroidism nbme 15 correlation characters or approximately words. Adiponectin is a hormone which is reduced bornchitis obesity which has shown to attenuate AHR, eosinophils, and TH2 cells in the lungs of the animal models [ 6 — 8 ]. Strengths of the current work include the large, multiethnic population-based study; nonobstructive chronic bronchitis classification using the diagnostic standard; extensive follow-up; and examination of physiologic and clinical end points, which were quality controlled using rigorous and validated criteria. Jang, J. Institutional sign in: OpenAthens Shibboleth.

Bronchial casts in children: a proposed classification based on obesihy cases and a review of the literature. Kim et al. SJR uses a similar algorithm as the Google page rank; it provides a quantitative and qualitative measure of the journal's impact. Respiratory arrest following massive sand aspiration. Resolved after cast evacuation with no further casts at 17 months after PB diagnosis. Oral azithromycin was administered to 4 patients for its immunomodulatory properties.

A large case series of 22 pediatric patients concluded that bronchoscopic extraction is the only effective modality for treatment [ 12 ]. It has also been suggested that elevated pulmonary venous pressure resulting in increased mucous production is responsible for cast formation [ 5 ]. Repeat bronchoscopy with diagnosis 4 months after initial presentation. Treatment modalities varied between patients Table 1but the majority of patients had bronchoscopic cast removal. The congenital heart disease patient had a relapse of his PB one month later, and died due to this process in the referral hospital, while the leukemia patient died of her underlying disease.

Plastic bronchitis: new insights and a classification scheme. Interestingly, the one case patient 5 with both congenital heart disease and asthma had an intermediate cast composition with areas of hypocellular fibrin and other areas with inflammatory infiltrate. Publication types Research Support, Non-U. Access to any published article, in either language, is possible through the Journal's web page as well as from PubMed, Science Directand other international databases. Patient identification Presentation of PB Treatment Gross description and histopathology Outcome 1 3 yo M with hypoplastic left heart syndrome. Gross: thick, white, extremely viscous material adherent to bronchus wall and obstructing right mainstem bronchus. Budesonide, levalbuterol, spironolactone.

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