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At Aircare, we perform in-office pulmonary function testing, and rhinoscopy for evaluation of the upper airway is also offered in-office.
The Respiratory System
The respiratory system is comprised of the nose and throat (naso-pharynx), vocal cords and epiglottis, the windpipe (trachea), the lungs, the diaphragm and the rib cage. The lungs are further comprised of tubes (bronchi) that end in tiny sacs (alveoli), when we inhale the air travels from the nose or mouth through the vocal chords and down the windpipe to the lungs where it is distributed by the bronchi to the alveoli. The alveoli absorb oxygen from the air and remove carbon dioxide from the blood. The diaphragm allows the lungs to inflate and deflate while the ribs serve a protective purpose to the respiratory system.
The Unified Airway:
The unified airway theory states, "that airway respiratory disease is usually reflected throughout the airway or respiratory system even though symptoms appear confined to a specific or isolated segment". This means that symptoms in the upper airway or nose represent disease throughout the respiratory system even though symptoms seem localized to the nose. It appears that over time symptoms will eventually manifest throughout the respiratory system. This has become apparent from longitudinal population studies like those done in Tuscon, Arizona by Fernando Martinez. In these studies upper airway or nasal disease predated and increased the risk for subsequent development of asthma or lower airway disease for both allergic and non-allergic disease states.
Non-Allergic Respiratory Disorders
Samter's Triad - Aspirin Sensitivity, Nasal Polyposis, and Asthma
Patients with Samter's Triad represent a clinical phenotype with exaggerated leukotriene production. Leukotrienes are released along with histamine in a typical allergic response to environmental allergens and result in many of the symptoms associated with nasal allergies and asthma. Patients with Samter's Triad release leukotrienes to a variety of environmental triggers whether they are allergic to those triggers or not. Allergy often times is a significant factor for these patients but is not necessary, As significant respiratory disease can result even in the absence of allergy. Respiratory disease often predates the sensitivity to aspirin and other non-steroidal anti-inflammatory drugs (advil, ibuprofen, aleve, naprosyn, and many others) that may not manifest until later in life (fourth or fifth decades). Patients with Samter's Triad often have significant sinus disease. Chronic sinusitis and recurrent nasal polyps may be more problematic than the asthma symptoms.
Treatment has been greatly facilitated by the introduction of specific leukotriene blocking drugs such as Singulair and Accolate. Aspirin desensitization has also shown benefit in reducing clinical symptoms associated with this disease entity.
Gastro-esophageal-reflux disease (GERD) occurs when stomach acids rise or reflux into the esophagus causing symptoms of heartburn or a bitter taste in the throat. Most people experience reflux symptoms at some point in their lives without significant impact, but when reflux occurs regularly it can disrupt daily routine and most importantly result in chronic respiratory disease. Young children and even some adults may not experience typical stomach symptoms completely. It is possible for the only manifestation of GERD to be chronic respiratory disease such as asthma or chronic sinusitis. GERD is caused by the dysfunction of a small muscle at the bottom of the esophagus. This muscle, known as the lower esophageal sphincter (LES) closes sealing the stomach after swallowing. The LES of a GERD sufferer has difficulty closing. This allows acids from the stomach to rise up into the esophagus, trachea and even into the naso-pharynx/sinus area. The most important predictor of respiratory disease is not the frequency of reflux episodes, but how high the acid refluxes. Respiratory symptoms associated with GERD include:
Treatment: Lifestyle changes may help alleviate GERD. Avoid acidic drinks(fruit juice and coffee) and fatty or spicy foods. Avoid eating less than two hours before bed, try eating smaller meals and elevate the head and shoulders above the stomach during sleep.Your doctor may also prescribe medication that lowers the acid content of the stomach. These acid lowering medications can significantly improve stomach and respiratory symptoms associated with GERD.
Vocal Cord Dysfunction
Vocal cord dysfunction or "VCD" mimics asthma with symptoms of wheezing and shortness of breath. In VCD the vocal cords appose or come together when a patient is trying to breathe. The vocal cords normally appose during speech to produce vibrations and sound. When the vocal cords come together during breathing the result is obstruction to airflow. Obstructed airflow also occurs in asthma, though the obstruction is secondary to inflammation within the bronchial airways. Thus, VCD as a clinical entity is almost indistinguishable from asthma. The diagnosis can be made through diagnostic procedures (Rhinolaryngoscopy or pulmonary function testing) that reveal signs of abnormal vocal cord apposition . VCD often manifests in young adults around the time of puberty, though it can appear at any age.VCD can be aggravated and even result from chronic irritation of the vocal chords that may occur in gastro-esophageal reflux disease or from chronic post-nasal drainage.
Treatment is aimed at measures that control vocal cord function such as speech therapy and bio-feedback, and also eliminating any causes of chronic vocal cord irritation.
Occasionally food, drink, vomit or mouth secretions get into the lungs.When this happens, the lungs become inflamed and asthma or infection (pneumonia) may develop.Among other things, age, dental issues, gastrointestinal reflux, swallowing disorders and certain neurologic disorders can result in chronic aspiration.
Symptoms include weight loss, loss of appetite, fever, cough, wheezing, fatigue and bluish skin undertone from lack of oxygen.
Treatment is aimed at dealing with the underlying cause of aspiration such as a swallowing dysfunction if it is present.
Cystic fibrosis is an autosomal recessive genetic disorder. It is the most common genetic cause of a lethal pulmonary disease in persons of Caucasian descent. The mutation affects the cystic fibrosis trans-membrane conductance regulator gene, that encodes a channel with chloride activity in epithelial cells. Loss of function in this chloride channel affects the properties of mucous in the airways and results in both desiccated secretions and recurrent secondary infections. The end result is chronic airway obstruction and loss of lung function that in its early stages may resemble asthma.
Treatment: The primary goal of treatment is to improve mucous flow and viscosity and aggressively treat infections when they occur. Currently there are clinical trials underway investigating the feasibility of gene transfer to correct the underlying defect.
At Aircare, we offer diagnostic testing, in-office pulmonary function testing, and rhinoscopy for evaluation of the upper airway.