Obstructive Lung Disease

Relationship Between Various Obstructive Lung Diseases

  • Key Points
    • Classical Obstructive Lung Diseases, Such as Chronic Obstructive Pulmonary Disease and Asthma, May or May Not Demonstrate Obstruction
    • Obstruction (with Wheezing, etc) Can Also Be Variably Present in Other Airway and Lung Diseases

Upper Airway Obstruction

Bilateral Vocal Fold Immobility (BVFI) (see Bilateral Vocal Fold Immobility)

Cricoarytenoid Arthritis (see Cricoarytenoid Arthritis)

  • Primary Rheumatologic Disease
  • Other
    • Cricoarytenoid Joint Ankylosis Due to Prior Streptococcal Infection (see Streptococcus)
    • Crohn’s Disease (see Crohn’s Disease)
    • External Trauma to Cricoarytenoid Joint
    • Internal Trauma Due to Endotracheal Tube-Related Injury to Cricoarytenoid Joint: includes posterior or anterior arytenoid displacement, posterior dislocation resulting from extubation with a partially inflated endotracheal tube cuff, arytenoid chondritis secondary to prolonged endotracheal intubation
    • Mumps-Associated Laryngeal Arthritis (see Mumps Virus)
    • Radiation Therapy Injury to Cricoarytenoid Joint (see Radiation Therapy)
    • Tietze’s Syndrome

Laryngeal Inflammation

Laryngospasm (see Laryngospasm)

Neurologic Disease/Dysfunction Involving the Vocal Folds

  • Alport Syndrome (see Alport Syndrome): case report invoved a patient with chronic kidney disease, post-op from surgery with high amount of blood loss and possible impaired perfusion to recurrent laryngeal nerves (with ischemic injury) during the case
  • Altered Mental Status with Inability to Protect Upper Airway
    • Physiology
      • Airway Obstruction Occurs Due to Tongue Prolapse into the Posterior Pharynx and/or Decreased Soft Palate Muscular Tone (Anaesth Intensive Care, 1994) [MEDLINE] (Anesthesiology, 1996) [MEDLINE]
    • Clinical: typically acute
  • Amyotrophic Lateral Sclerosis (ALS) (see Amyotrophic Lateral Sclerosis)
  • Arnold-Chiari Malformation
  • Charcot-Marie-Tooth Disease
  • Creutzfeldt-Jakob Disease (CJD) (see Creutzfeldt-Jakob Disease)
  • Diabetes Mellitus (DM) (see Diabetes Mellitus)
    • Physiology: neuropathy involving the laryngeal nerves
  • Dystonic Reaction of Pharyngeal and Laryngeal Muscles (see Dystonic Reaction of Pharyngeal+Laryngeal Muscles): typically acute
  • Essential Tremor (see Essential Tremor): typically mild upper airway obstruction
  • Hydrocephalus (see Hydrocephalus)
  • Hypocalcemia (see Hypocalcemia)
  • Hypokalemia (see Hypokalemia)
  • Hypokalemic Periodic Paralysis (see Hypokalemic Periodic Paralysis)
  • Idiopathic Bilateral Vocal Cord Paralysis
  • Laryngeal/Tracheal Fracture (see Tracheobronchial Fracture): with recurrent laryngeal nerve injury
  • Lyme Disease (see Lyme Disease)
    • Physiology: neuropathy involving the laryngeal nerves
  • Mediastinal Mass/Lymphadenopathy (see Mediastinal Mass): in cases where large mass or nodes impact the recurrent laryngeal nerves
  • Meningomyelocele
  • Mobius Syndrome
  • Myasthenia Gravis (see Myasthenia Gravis)
  • Paclitaxel (Taxol) (see Paclitaxel)
    • Physiology: neuropathy involving the laryngeal nerves
  • Paradoxical Vocal Fold Motion (Vocal Cord Dysfunction) (see Paradoxical Vocal Fold Motion): typically acute
  • Parkinson’s Disease (see Parkinson’s Disease): may be acute (particularly in the post-operative setting) or progressive
  • Postpolio Syndrome (see Poliomyelitis)
  • Rheumatoid Arthritis (RA) (see Rheumatoid Arthritis)
    • Physiology: arteritis of vasa vasorum of recurrent laryngeal (and vagus) nerves
  • Shy-Drager Syndrome
  • Synkinesis of the Recurrent Laryngeal Nerve
  • Systemic Lupus Erythematosus (SLE) (see Systemic Lupus Erythematosus)
    • Physiology: neuropathy involving the laryngeal nerves
  • Vincristine (see Vincristine)
    • Physiology: neuropathy involving the laryngeal nerves

Developmental Abnormality or Neoplasm the Involving Vocal Folds

Intubation Injury to Vocal Folds (see Endotracheal Tube-Associated Laryngeal Injury)

  • Acute
    • Arytenoid Dislocation
    • Excessive Endotracheal Cuff Pressure with Compression of Recurrent Laryngeal Nerve Where It Enters the Larynx
    • Hyperextension of Neck with Vagus Nerve Injury
    • Larygneal Mask Airway (LMA)-Related Injury
    • Recurrent Laryngeal Nerve Injury Due to Anterior Thyroid Cartilage Displacement (Relative to the Cricoid Cartilage)
  • Chronic
    • Excessive Endotracheal Tube Cuff Pressure with Compression of Recurrent Laryngeal Nerve Where It Enters the Larynx
    • Posterior Glottic Stenosis (PGS): due to prolonged or traumatic intubation
    • Vocal Cord Granuloma

Mechanical/Iatrogenic Injury to Vocal Folds

  • Nasogastric Tube Syndrome (see Nasogastric Tube Syndrome): first reported in 1981, it is believed to be due to paresis of the posterior cricoarytenoid muscles secondary to ulceration and infection over the posterior lamina of the cricoid
    • Risk Group: diabetic renal transplant patients (due to prolonged gastroparesis and requirement for nasogastric tube drainage)
  • Proximal Esophageal Stent Placement (see Esophageal Stent)

Radiation Injury to Vocal Folds (see Radiation Therapy)

  • Radiation-Induced Chondronecrosis of Larynx
  • Radiation-Induced Fibrosis of the Cricoarytenoid Joint and/or Vocal Cords
  • Radiation-Induced Injury to Cricoarytenoid Joint: see Cricoarytenoid Arthritis above
  • Radiation Injury to Vocal Cords

Surgical Injury to Vocal Folds

  • Anterior Cervical Disk Surgery
    • Epidemiology
      • Typically Results in Unilateral Injury (Which May Compromise the Upper Airway if Contralateral Side was Previously Injured)
  • Brainstem Surgery
    • Epidemiology
      • May Result in Bilateral Injury
  • Cardiac Surgery
  • Carotid Endarterectomy
    • Epidemiology
      • Typically Results in Unilateral Injury (Which May Compromise the Upper Airway if Contralateral Side was Previously Injured)
  • Endolaryngeal Surgery (Using Carbon Dioxide Laser)
    • Epidemiology
      • May Damage the Posterior Glottis
  • Esophageal Surgery
    • Epidemiology
      • May Result in Bilateral Injury
  • Thyroid Surgery
    • Epidemiology
      • Accounts for 48% of All Surgical Cases
      • May Result in Bilateral Injury
  • Parathyroid Surgery
    • Epidemiology
      • May Result in Bilateral Injury
  • Tracheal Surgery
    • Epidemiology
      • May Result in Bilateral Injury

Other Upper Airway Disease

Infection

Miscellaneous

  • Ammonia Inhalation (see Ammonia): typically acute
  • Anaphylaxis (see Anaphylaxis): typically acute
  • Angioedema (see Angioedema): typically acute
  • Congenital Small Cricoid Cartilage: typically progressive
  • Esophageal Foreign Body: extrinsic compression of upper airway, typically progressive
  • Langerhans Cell Histiocytosis (see Langerhans Cell Histiocytosis): typically mild upper airway obstruction
  • Laryngeal Cyst/Laryngocele: typically mild upper airway obstruction
  • Laryngeal Rheumatoid Nodule (see Rheumatoid Arthritis): typically progressive
  • Macroglossia: typically mild upper airway obstruction
  • Nasal Polyps (see Nasal Polyps): typically mild upper airway obstruction
  • Obstructive Sleep Apnea (see Obstructive Sleep Apnea): typically acute
    • Particularly in post-op setting, etc
  • Strangulation/Near Hanging (see Near Hanging): non-judicial hangings (where drop is <6.5-7.5 ft) do not fracture dens off, they result in death most commonly due to pulmonary complications
  • Thermal Injury/Burns of Upper Airway (see Smoke Inhalation): may be acute
    • Thermal injury is usually supraglottic (typically, laryngeal injury)
  • Thyromegaly/Goiter (see Goiter): typically progressive
  • Tracheal Cyst: typically progressive
  • Tracheomalacia (see Tracheobronchomalacia): typically progressive
  • Tonsillar/Adenoid Enlargement: typically progressive
  • Unilateral Vocal Cord Paralysis (see Unilateral Vocal Fold Immobility): typically mild upper airway obstruction
  • Upper Airway Foreign Body (see Airway Foreign Body): typically acute

Tracheobronchial/Central Airway Obstruction (see Central Airway Obstruction)

Tracheobronchial Infection

Tracheobronchial Neoplasm

Primary Tracheobronchial Tumor

Endobronchial Metastases (see also Lung Metastases-Endobronchial)

Extrinsic Tracheobronchial Compression

  • Enlarged Pulmonary Artery: extrinsic compression of tracheobronchial airways
    • Tetralogy of Fallot (see Tetralogy of Fallot): in infants and children
    • Transposition of Great Vessles with Ventricular Septal Defect: in infants and children
  • Granulomatous Mediastinitis and Fibrosing Mediastinitis (see Granulomatous Mediastinitis and Fibrosing Mediastinitis])
    • Physiology: extrinsic compression of tracheobronchial airways
  • Mediastinal Mass (see Mediastinal Mass): extrinsic compression of tracheobronchial airways
    • Bulky Mediastinal or Peribronchial Lymphadenopathy
    • Mediastinal Tumor
  • Thoracic Aortic Aneurysm (TAA) (see Thoracic Aortic Aneurysm): extrinsic compression of tracheobronchial airways
  • Thyroid Cancer/Thyromegaly/Goiter (see Goiter and Thyroid Cancer)
    • Physiology: extrinsic compression of trachea

Other Tracheobronchial Obstructive Process

Other Airway Obstruction

Infection

  • Scombroid (see Scombroid)
    • Physiology
      • Ingestion of Histamine-Contaminated Fish (or Swiss Cheese)
    • Clinical
      • Bronchospasm (Cough, Dyspnea, Wheezing) May Be Severe in Patients with Underlying Lung Disease
  • Herpes Simplex Virus (HSV) Tracheobronchitis (see Herpes Simplex Virus)
  • Chlamydophila Pneumoniae (see Chlamydophila Pneumoniae)

Drug

Toxin

Pulmonary Infiltrates with Eosinophilia (PIE) Syndrome (see Pulmonary Infiltrates with Eosinophilia)

Bronchiolitis Syndrome

Other

Clinical Manifestations

Pulmonary Manifestations

  • Cough (see Cough)
    • Epidemiology: common
  • Dyspnea (see Dyspnea)
    • Epidemiology: common
  • Wheezing (see Wheezing)
    • Epidemiology: common

References

Etiology

  • Assessment of upper airway anatomy in awake, sedated and anaesthetised patients using magnetic resonance imaging. Anaesth Intensive Care. 1994;22(2):165 [MEDLINE]
  • Magnetic resonance imaging of the upper airway. Effects of propofol anesthesia and nasal continuous positive airway pressure in humans. Anesthesiology. 1996;84(2):273 [MEDLINE]