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Evaluation of the Pulmonary System

  • Jeremy E. OrrEmail author
  • Lisa F. Wolfe
Chapter
  • 45 Downloads

Abstract

Neurological conditions affecting the larynx often coincide with respiratory issues, highlighting the importance of multispecialty care of these patients that includes pulmonologists. In this chapter, we provide a background on pulmonary evaluation and discuss several potential issues: Laryngeal dysfunction may mimic respiratory disease, with symptoms such as shortness of breath and abnormal airway sounds. In many diseases of the larynx, laryngeal dysfunction leads to a risk of pulmonary aspiration and pneumonia. In neuromuscular conditions, concurrent respiratory muscle weakness must be recognized for proper comprehensive care and perioperative evaluation. Increasingly, patients with respiratory muscle weakness are managed with noninvasive respiratory support including noninvasive ventilation and airway clearance modalities. In patients with severe laryngeal dysfunction, treatment including tracheostomy and possible mechanical ventilation (e.g., invasive approach) may still be warranted but should be evaluated with consideration of the patient’s values and preferences.

Keywords

Lung Pulmonary function testing Restrictive lung disease Respiratory muscle weakness Respiratory failure 

References

  1. 1.
    Wanger JS, Culver BH. Quality standards in pulmonary function testing: past, present, future. Ann Am Thorac Soc. 2016;13(9):1435–6.CrossRefGoogle Scholar
  2. 2.
    Pellegrino R, Viegi G, Brusasco V, Crapo RO, Burgos F, Casaburi R, et al. Interpretative strategies for lung function tests. Eur Respir J. 2005;26(5):948–68.CrossRefGoogle Scholar
  3. 3.
    Lutfi MF. The physiological basis and clinical significance of lung volume measurements. Multidiscip Respir Med. 2017;12(1):3.CrossRefGoogle Scholar
  4. 4.
    Braun NM, Arora NS, Rochester DF. Respiratory muscle and pulmonary function in polymyositis and other proximal myopathies. Thorax. 1983;38(8):616–23.CrossRefGoogle Scholar
  5. 5.
    Serisier DE, Mastaglia FL, Gibson GJ. Respiratory muscle function and ventilatory control. I n patients with motor neurone disease. II n patients with myotonic dystrophy. Q J Med. 1982;51(2):205–26.PubMedGoogle Scholar
  6. 6.
    Black LF, Hyatt RE. Maximal static respiratory pressures in generalized neuromuscular disease. Am Rev Respir Dis. 1971;103(5):641–50.PubMedGoogle Scholar
  7. 7.
    Kuzniar TJ, Morgenthaler TI, Prakash UB, Pallanch JF, Silber MH, Tippmann-Peikert M. Effects of continuous positive airway pressure on stridor in multiple system atrophy-sleep laryngoscopy. J Clin Sleep Med. 2009;5(1):65–7.CrossRefGoogle Scholar
  8. 8.
    Miller RD, Hyatt RE. Evaluation of obstructing lesions of the trachea and larynx by flow-volume loops. Am Rev Respir Dis. 1973;108(3):475–81.PubMedGoogle Scholar
  9. 9.
    Rotman HH, Liss HP, Weg JG. Diagnosis of upper airway obstruction by pulmonary function testing. Chest. 1975;68(6):796–9.CrossRefGoogle Scholar
  10. 10.
    Murry T, Cukier-Blaj S, Kelleher A, Malki KH. Laryngeal and respiratory patterns in patients with paradoxical vocal fold motion. Respir Med. 2011;105(12):1891–5.CrossRefGoogle Scholar
  11. 11.
    Perkins MAJPJ, Morris LTCMJ. Vocal cord dysfunction induced by methacholine challenge testing. Chest. 2002;122(6):1988–93.CrossRefGoogle Scholar
  12. 12.
    Guss J, Mirza N. Methacholine challenge testing in the diagnosis of paradoxical vocal fold motion. Laryngoscope. 2006;116(9):1558–61.CrossRefGoogle Scholar
  13. 13.
    Christensen PM, Maltbaek N, Jorgensen IM, Nielsen KG. Can flow-volume loops be used to diagnose exercise induced laryngeal obstructions? A comparison study examining the accuracy and inter-rater agreement of flow volume loops as a diagnostic tool. Prim Care Respir J. 2013;22(3):306–11.CrossRefGoogle Scholar
  14. 14.
    Marik PE. Aspiration pneumonitis and aspiration pneumonia. N Engl J Med. 2001;344(9):665–71.CrossRefGoogle Scholar
  15. 15.
    Lee JS, Collard HR, Raghu G, Sweet MP, Hays SR, Campos GM, et al. Does chronic microaspiration cause idiopathic pulmonary fibrosis? Am J Med. 2010;123(4):304–11.CrossRefGoogle Scholar
  16. 16.
    van der Graaff MM, Grolman W, Westermann EJ, Boogaardt HC, Koelman H, van der Kooi AJ, et al. Vocal cord dysfunction in amyotrophic lateral sclerosis: four cases and a review of the literaturevocal cord dysfunction in amyotrophic lateral sclerosis. Arch Neurol. 2009;66(11):1329–33.PubMedGoogle Scholar
  17. 17.
    Steier J, Kaul S, Seymour J, Jolley C, Rafferty G, Man W, et al. The value of multiple tests of respiratory muscle strength. Thorax. 2007;62(11):975–80.CrossRefGoogle Scholar
  18. 18.
    Bach JR, Ishikawa Y, Kim H. Prevention of pulmonary morbidity for patients with Duchenne muscular dystrophy. Chest. 1997;112(4):1024–8.CrossRefGoogle Scholar
  19. 19.
    Bach JR. Amyotrophic lateral sclerosis: predictors for prolongation of life by noninvasive respiratory aids. Arch Phys Med Rehabil. 1995;76(9):828–32.CrossRefGoogle Scholar
  20. 20.
    Bach JR, Saporito LR. Criteria for extubation and tracheostomy tube removal for patients with ventilatory failure: a different approach to weaning. Chest. 1996;110(6):1566–71.CrossRefGoogle Scholar
  21. 21.
    Finder JD, Birnkrant D, Carl J, Farber HJ, Gozal D, Iannaccone ST, et al. Respiratory care of the patient with Duchenne muscular dystrophy: ATS consensus statement. Am J Respir Crit Care Med. 2004;170(4):456–65.CrossRefGoogle Scholar
  22. 22.
    Bourke SC, Tomlinson M, Williams TL, Bullock RE, Shaw PJ, Gibson GJ. Effects of non-invasive ventilation on survival and quality of life in patients with amyotrophic lateral sclerosis: a randomised controlled trial. Lancet Neurol. 2006;5(2):140–7.CrossRefGoogle Scholar
  23. 23.
    Annane D, Orlikowski D, Chevret S. Nocturnal mechanical ventilation for chronic hypoventilation in patients with neuromuscular and chest wall disorders. Cochrane Database Syst Rev. 2014;12Google Scholar
  24. 24.
    Ishikawa Y, Miura T, Ishikawa Y, Aoyagi T, Ogata H, Hamada S, et al. Duchenne muscular dystrophy: survival by cardio-respiratory interventions. Neuromuscul Disord. 2011;21(1):47–51.CrossRefGoogle Scholar
  25. 25.
    Ward S, Chatwin M, Heather S, Simonds AK. Randomised controlled trial of non-invasive ventilation (NIV) for nocturnal hypoventilation in neuromuscular and chest wall disease patients with daytime normocapnia. Thorax. 2005;60(12):1019–24.CrossRefGoogle Scholar
  26. 26.
    Andersen T, Sandnes A, Brekka AK, Hilland M, Clemm H, Fondenes O, et al. Laryngeal response patterns influence the efficacy of mechanical assisted cough in amyotrophic lateral sclerosis. Thorax. 2017;72(3):221–9.CrossRefGoogle Scholar
  27. 27.
    Marchese S, Lo Coco D, Lo Coco A. Outcome and attitudes toward home tracheostomy ventilation of consecutive patients: a 10-year experience. Respir Med. 2008;102(3):430–6.CrossRefGoogle Scholar
  28. 28.
    Bach JR. A comparison of long-term ventilatory support alternatives from the perspective of the patient and care giver. Chest. 1993;104(6):1702–6.CrossRefGoogle Scholar
  29. 29.
    Bach JR, Tran J, Durante S. Cost and physician effort analysis of invasive vs. noninvasive respiratory management of Duchenne muscular dystrophy. Am J Phys Med Rehabil. 2015;94(6):474–82.CrossRefGoogle Scholar
  30. 30.
    Rabkin J, Ogino M, Goetz R, McElhiney M, Marziliano A, Imai T, et al. Tracheostomy with invasive ventilation for ALS patients: neurologists’ roles in the US and Japan. Amyotroph Lateral Scler Frontotemporal Degener. 2013;14(2):116–23.CrossRefGoogle Scholar
  31. 31.
    Birnkrant DJ. The American College of Chest Physicians consensus statement on the respiratory and related management of patients with Duchenne muscular dystrophy undergoing anesthesia or sedation. Pediatrics. 2009;123(Suppl 4):S242–4.CrossRefGoogle Scholar
  32. 32.
    Gupta H, Gupta PK, Fang X, Miller WJ, Cemaj S, Forse RA, et al. Development and validation of a risk calculator predicting postoperative respiratory failure. Chest. 2011;140(5):1207–15.CrossRefGoogle Scholar
  33. 33.
    Arozullah AM, Daley J, Henderson WG, Khuri SF. Multifactorial risk index for predicting postoperative respiratory failure in men after major noncardiac surgery. The National Veterans Administration Surgical Quality Improvement Program. Ann Surg. 2000;232(2):242–53.CrossRefGoogle Scholar
  34. 34.
    Canet J, Gallart L, Gomar C, Paluzie G, Vallès J, Castillo J, et al. ARISCAT Group.Prediction of postoperative pulmonary complications in a population-based surgical cohort. Anesthesiology. 2010;113(6):1338–50.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Division of Pulmonary, Critical Care, and Sleep Medicine, Department of MedicineUniversity of California–San DiegoSan DiegoUSA
  2. 2.Division of Pulmonary and Critical Care Medicine, Department of Medicine, The Ken and Ruth Davee Department of Neurology and Clinical Neurological SciencesNorthwestern University Feinberg School of MedicineChicagoUSA

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