A technique to measure the ability of the human nose to warm and humidify air.

To assess the ability of the nose to warm and humidify inhaled air, we developed a nasopharyngeal probe and measured the temperature and humidity of air exiting the nasal cavity. We delivered cold, dry air (19-1 degrees C, <10% relative humidity) or hot, humid air (37 degrees C, >90% relative humidity) to the nose via a nasal mask at flow rates of 5, 10, and 20 l/min. We used a water gradient across the nose (water content in nasopharynx minus water content of delivered air) to assess nasal function. We studied the characteristics of nasal air conditioning in 22 asymptomatic, seasonally allergic subjects (out of their allergy season) and 11 nonallergic normal subjects. Inhalation of hot, humid air at increasingly higher flow rates had little effect on both the relative humidity and the temperature of air in the nasopharynx. In both groups, increasing the flow of cold, dry air lowered both the temperature and the water content of the inspired air measured in the nasopharynx, although the relative humidity remained at 100%. Water gradient values obtained during cold dry air challenges on separate days showed reproducibility in both allergic and nonallergic subjects. After exposure to cold, dry air, the water gradient was significantly lower in allergic than in nonallergic subjects (1,430 +/- 45 vs. 1,718 +/- 141 mg; P = 0.02), suggesting an impairment in their ability to warm and humidify inhaled air.

Endoscopic management of foreign bodies in the tracheobronchial tree: predictive factors for complications.

We reviewed the records of 504 patients admitted to the American University of Beirut Medical Center during a 10-year period for treatment of aspiration of a foreign body into the tracheobronchial tree. All underwent rigid fiberoptic bronchoscopy for removal of the foreign body. Complications occurred in 42 patients (8%) and were classified as intraoperative (7 patients), postoperative (25 patients), and failure to retrieve the foreign body by bronchoscopy (9 patients). These complications included respiratory distress necessitating tracheotomy and/or assisted ventilation, bronchial pneumonia, pneumothorax, bradycardia, and cardiac arrest. Variables that were examined were the age and sex of the patient, history of multiple previous bronchoscopies, delay in diagnosis and/or treatment, duration of the procedure, type and location of the foreign body, and use of corticosteroids during surgery. The most important variables that were of value in predicting the occurrence of complications were the history of previous bronchoscopy, the duration of the procedure, and the type of foreign body. Age, sex, delay in diagnosis and treatment, and intraoperative use of corticosteroids, while important, had no predictive value. Detailed results with guidelines for prevention and management are presented.

Ipratropium bromide increases the ability of the nose to warm and humidify air.

We have developed a method for measuring the temperature and relative humidity of air prior to and after nasal conditioning and used it to study the effect of treatment with ipratropium bromide on the ability of the nose to condition cold, dry air. We performed randomized, double-blind, placebo-controlled, two-way crossover studies and an open study in nonallergic subjects. The subjects were treated with ipratropium bromide (84 microgram) or normal saline solution sprayed into the nasal cavity 15 min before the measurement of nasal conditioning capacity. Cold, dry air was delivered to the nose via a nasal mask, and the temperature and humidity of air were measured before entering and after exiting the nasal cavity. The total water gradient across the nose was calculated and represents nasal conditioning capacity. Ipratropium bromide treatment significantly increased nasal conditioning capacity when compared with saline. Ipratropium bromide led to less reduction in the cold, dry air-induced decrease in the nasal volume (p < 0.05) without affecting the decrease in nasal surface temperature during cold, dry air exposure (p = 0.3). Our data show that ipratropium bromide increases the ability of the nose to condition cold, dry air. Thus, treating rhinitis with ipratropium bromide should not increase the burden for inspired air conditioning on the conducting pulmonary airways.

Intranasal beclomethasone reduces allergen-induced symptoms and superficial mucosal eosinophilia without affecting submucosal inflammation.

Previous investigations have suggested that nasal secretions, obtained by lavage or scraping, and the nasal submucosa, sampled by biopsy, are two distinct compartments. We investigated the effect of intranasal corticosteroids on antigen-induced eosinophil influx into both compartments. We performed a double-blind, placebo-controlled study in 15 patients with seasonal allergic rhinitis. Beclomethasone dipropionate, 84 microg twice a day, was delivered to one nostril while the other nostril received placebo for 1 wk. Subjects were then challenged with grass or ragweed extracts on each inferior turbinate. Nasal scrapings from both inferior turbinates were obtained before and 24 h after challenge, and bilateral inferior turbinate biopsies were obtained 24 h after challenge, with the subjects still receiving treatment. Intranasal steroids led to a significant reduction in sneezes and eosinophil influx in nasal secretions without affecting the number of eosinophils in the submucosa. Furthermore, intranasal steroids had no effect on the numbers of submucosal EG2+ (activated eosinophils) or CD25+ (IL-2-receptor-bearing) cells, nor did they decrease the endothelial expression of vascular cell adhesion molecule-1 (VCAM-1). These data show that pretreatment with intranasal steroids successfully inhibited the clinical response to allergen and reduced eosinophils in the superficial compartment of the nasal mucosa, but it had no effect on inflammation in the deeper compartment. This might be related to a different distribution of the active medication and antigen into the nasal mucosa or to a specific effect of the active medication on the epithelium resulting in inhibited migration of eosinophils across this layer.