ABSTRACT
OBJECTIVE: Tracheostomy is performed for various indications ranging from prolonged ventilation to airway obstruction. Many factors may play a role in the incidence of complications in the immediate post-operative period including patient-related factors. Chronic obstructive pulmonary disease and asthma are some of the most common pulmonary pathologies in the United States. The relationship between obstructive pulmonary diseases and acute post-tracheostomy complications has been incompletely studied. DESIGN: A retrospective chart review was designed in order to answer these objectives. Medical records were reviewed for the technique used, complications, and contributing patient factors. Post-operative complications were defined as any tracheostomy-related adverse event occurring within 14 days. SETTING: The study took place at an academic comprehensive cancer. PARTICIPANTS: Inclusion criteria included patients from January 2017 through December 2018 who underwent a tracheostomy. Exclusion criteria included presence of stomaplasty, total laryngectomy, and tracheostomies performed at outside hospitals. MAIN OUTCOME MEASURES: Patient factors examined included demographics, comorbidities, and body mass index with the primary outcome measured being the rate of tracheostomy complications. RESULTS: The most common indication for tracheostomy among the 321 patients that met inclusion criteria was airway obstruction or a head and neck cancer surgical procedure. Obstructive sleep apnea was associated with acute complications in bivariate analysis (29.4% complications, p = .003). Chronic obstructive pulmonary disease and asthma were not associated with acute complications in bivariate analysis (11.6% complications, p = .302). Among the secondary outcomes measured, radiation was associated with early complications occurring in post-operative days 0-6 (1.1%, p = .029). CONCLUSION: Patients with obstructive sleep apnea may have a higher risk of acute post-tracheostomy complications that might be due to the patient population at risk for obstructive sleep apnea. Patients with obstructive pulmonary pathologies such as asthma or chronic obstructive pulmonary disorder did not have an elevated risk of complications which is clinically significant when considering the utility of ventilation and tracheostomy in the management of acute respiratory failure secondary to these conditions.
Subject(s)
Airway Obstruction , Asthma , Pulmonary Disease, Chronic Obstructive , Sleep Apnea, Obstructive , Humans , Retrospective Studies , Tracheostomy/adverse effects , Tracheostomy/methods , Sleep Apnea, Obstructive/surgery , Airway Obstruction/etiology , Risk Factors , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Postoperative Complications/surgery , Pulmonary Disease, Chronic Obstructive/complications , Asthma/complications , Asthma/epidemiologyABSTRACT
Asthma is a chronic inflammatory disease of the airway that leads to airway obstruction via bronchoconstriction, edema, and mucus hypersecretion. The National Asthma Education and Prevention Program has outlined evidence-based guidelines to standardize asthma therapy and improve outcomes. The initial recommendation of choice for persistent asthmatic patients is an inhaled corticosteroid (ICS). Long-acting beta-2 agonists in combination with ICS, oral corticosteroids, leukotriene modifiers, and anti-IgE therapeutic options can be considered for patients with persistent or worsening symptoms. Many novel therapies are being developed, with an emphasis on anti-inflammatory mechanisms, gene expression, and cytokine modification.
Subject(s)
Adrenal Cortex Hormones/administration & dosage , Adrenergic beta-2 Receptor Agonists/administration & dosage , Anti-Asthmatic Agents/administration & dosage , Asthma/diagnosis , Asthma/drug therapy , Administration, Inhalation , Administration, Oral , Drug Therapy, Combination , Evidence-Based Medicine , Female , Humans , Immunotherapy/methods , Male , Practice Guidelines as Topic , Prognosis , Severity of Illness Index , Treatment OutcomeABSTRACT
PURPOSE: The increasing incidence of IgE-mediated food allergy has led to further study of this atopic disease. RECENT FINDINGS: Food allergy represents a failure to attain oral tolerance marked by a pronounced Th2 versus T-regulatory cell response. The gold standard for the diagnosis of food allergy is a double-blind, placebo-controlled food challenge. Evidence supports breastfeeding to prevent certain atopic diseases but there is no support for delayed food introduction or maternal diet restrictions during pregnancy or lactation. There is no cure for food allergies. The mainstay of therapy is avoidance and management of severe reactions with self-injectable epinephrine. Other promising therapies include oral immunotherapy and sublingual immunotherapy. SUMMARY: The mechanism of IgE-mediated food allergy is better understood but further research is needed to prevent and treat food allergies.
