Age differences in inducible laryngeal obstruction in adult populations.

BACKGROUND: Whereas differences in inducible laryngeal obstruction (ILO) presentation on the basis of age have been observed within pediatric populations, age-based differences in adult populations are lacking. OBJECTIVE: To describe differences in ILO on the basis of age in adults. METHODS: Patients aged older than 16 years with confirmed ILO (vocal cord adduction > 50% during inspiration) by means of provocation-challenge rhinolaryngoscopy by their treating allergist were included. An investigator-designed questionnaire was administered using Research Electronic Data Capture with corresponding medical data collection. χ2 tests, Student's t tests, analysis of variance, Cochran-Armitage test for trend, and Fisher's exact test were used. RESULTS: The median age of the 67 patients was 50 years. P values less than .05 were considered significant. Those aged younger than 50 years (n = 31; mean age 35.6 years) reported more symptoms vs age 50 years and older (n = 36; mean age 61.8 years), including shortness of breath at rest and exertion (84% vs 39%, 94% vs 72%), throat tightness (81% vs 50%), chest tightness (81% vs 47%), and difficulty getting air in (81% vs 56%). Those aged younger than 50 years had an increased history of anxiety (68% vs 33%), asthma (55% vs 31%), positive methacholine challenge (52% vs 22%), increasing triggers with time (87% vs 43%), higher Pittsburgh Vocal Cord Dysfunction Index Scores (6.9 vs 5.5), and inspiratory curve flattening (48% vs 24%). Additional age-based subdivisions confirmed significant trends with the lowest reported ILO characteristics and symptoms in those aged 65 years and older. CONCLUSION: A high index of suspicion for ILO should be maintained in older adults since they may report less typical ILO symptoms and anxiety associations that prompt ILO evaluation.

Extreme Weather Events and Asthma.

The objective of this article is to review recent literature on the implications of extreme weather events such as thunderstorms, wildfires, tropical cyclones, freshwater flooding, and temperature extremes in relationship to asthma symptoms. Several studies have shown worsening of asthma symptoms with thunderstorms, wildfires, tropical cyclones, freshwater flooding, and temperature extremes. In particular, thunderstorm asthma can be exacerbated by certain factors such as temperature, precipitation, and allergen sensitization. Therefore, it is imperative that the allergy and immunology community be aware of the health effects associated with these extreme weather events in order to educate patients and engage in mitigation strategies.

Influence of Rural Environmental Factors in Asthma.

PURPOSE: The objective of this article is to review recent literature on the implications of agricultural factors including pesticides, animal/livestock production facilities, agricultural dust, endotoxin, biomass/crop burning, and nutritional factors with respiratory health. METHODS: PubMed, Embase, and CINAHL literature searches for the years 2016 to 2021 were conducted with librarian assistance. RESULTS: Several studies suggest increased risk for asthma or wheeze with certain rural exposures, particularly for pesticides, livestock production facilities, agricultural dust, and biomass and crop burning. CONCLUSION: A complex network of environmental factors exists, which may have detrimental effects on the respiratory health of rural residents.