Respiratory problems in children with esophageal atresia and tracheoesophageal fistula

Published: 5 September 2017

This is very long, and I found interesting, so if you have the time id click on the link below and read on. 

There are about 3 Studies, Graphs, and much data 



Children with congenital esophageal atresia (EA) and tracheoesophageal fistula (TEF) have chronic respiratory symptoms including recurrent pneumonia, wheezing and persistent cough. The aim of this study is to describe the clinical findings of a large group of children with EA and TEF surgically corrected and the instrumental investigation to which they have undergone in order to better understand the patient’s needs and harmonize the care.


A retrospective data collection was performed on 105 children with EA and TEF followed at Department of Pediatric Medicine of Bambino Gesù Children’s Hospital (Rome, Italy) between 2010 and 2015.


69/105 (66%) children reported lower respiratory symptoms with a mean age onset of 2.2 ± 2.5 years and only 63/69 (91%) performed a specialist assessment at Respiratory Unit. Recurrent pneumonia (33%) and wheezing (31%) were the most reported symptoms. The first respiratory evaluation was performed after surgically correction of gastroesophageal reflux (GER) at mean age of 3.9 ± 4.2 years. Twenty-nine patients have undergone to chest CT with contrast enhancement detecting localized atelectasis (41%), residual tracheal diverticulum (34%), bronchiectasis (31%), tracheal vascular compression (21%), tracheomalacia (17%) and esophageal diverticulum (14%). Fifty-three patients have undergone to airways endoscopy detecting tracheomalacia (66%), residual tracheal diverticulum (26%), recurrent tracheoesophageal fistula (19%) and vocal cord paralysis (11%).


Our study confirms that respiratory symptoms often complicate EA and TEF; their persistence despite medical and surgical treatment of GER means that other etiological hypothesis must be examined and that a complete respiratory diagnostic work-up must be considered.


Airway Defects

Can bioprosthetics work for large airway defects?

Publish date: November 30, 2016

By: Richard Mark Kirkner  Frontline Medical News

Key clinical point: Bioprosthetic materials show progress for reconstruction of large airway defects.

Major finding: Airway defects were successfully closed in all patients, with no postoperative deaths or recurrence of airway defect.

Data source: Eight patients who underwent closure of complex central airway defects with bioprosthetic materials between 2008 and 2015.

Disclosures: Dr Udelsman and coauthors reported having no relevant financial disclosures.


Large and complex airway defects that primary repair cannot fully close require alternative surgical approaches and techniques that are far more difficult to perform, but bioprosthetic materials may be an option to repair large tracheal and bronchial defects that have achieved good results, without postoperative death or defect recurrence, in a small cohort of patients at Massachusetts General Hospital, in Boston. Although our results are derived from a limited number of heterogeneous patients, they suggest that closure of noncircumferential large airway defects with bioprosthetic materials is feasible, safe and reliable,” These complex defects typically exceed 5 cm and can involve communication with the oesophagus. For repair of smaller defects, surgeons can use a more conventional approach that involves neck flexion, laryngeal release, airway mobilisation, and hilar release, but in larger defects, these techniques increase the risk of too much tension on the anastomosis and dehiscence along with airway failure. Large and complex defects occur in patients who have had a previous airway operation or radiation exposure, requiring alternative strategies, the researchers wrote. “Patients in this rare category should be referred to a high-volume centre for careful evaluation by a surgeon experienced in complex airway reconstruction before the decision to abandon primary repair is made.

Read the Full report here.


Modelling COPD and asthma in a human small airway-on-a-chip

Date: Dec 21, 2015

A microfluidic model of human lung inflammatory disorders provides a new and systematic way to analyse disease mechanisms and test new drug candidates

(BOSTON) — A research team at the Wyss Institute for Biologically Inspired Engineering at Harvard University leveraged its organ-on-a-chip technology to develop a model of the human small airway in which lung inflammatory diseases, such as chronic obstructive pulmonary disease (COPD), the third leading cause of mortality worldwide, and asthma can be studied outside the human body. As reported advanced online on December 21 in Nature Methods, the platform allows researchers to gain new insights into the disease mechanisms, identify novel biomarkers and test new drug candidates.

COPD and asthma are inflammatory reactions in the lung which can be dramatically exacerbated by viral and bacterial infections, as well as smoking. It is known that many of the associated disease processes occur in the conducting airway sections of the lung that shuttle air to and from the alveoli or air sacs. However, much less is known about how inflammation induces distinct pathological processes such as the recruitment of circulating white blood cells and the buildup of mucus, which compromise the lungs of these patients, or how clinical exacerbations are triggered.

“Inspired by our past work using the organ-on-a-chip approach to model the lung alveolus, we created a new microfluidic model of the lung small airway that recapitulates critical features of asthma and COPD with unprecedented fidelity and detail. Now with this micro-engineered human lung small airway, we can study lung inflammatory diseases over several weeks in chips lined by cells from both normal donors and diseased patients to gain better insight into disease mechanisms, as well as screen for new therapeutics,” said Donald Ingber, M.D., Ph.D., the senior author on this work who is leading a multidisciplinary team of Wyss scientists that has been at the forefront of organ-on-chip technology. He is also the Wyss Institute’s Founding Director, the Judah Folkman Professor of Vascular Biology at Harvard Medical School and Boston Children’s Hospital, and Professor of Bioengineering at the Harvard John A. Paulson School of Engineering and Applied Sciences.

Demand for such opportunities is especially high since small airway inflammation cannot be adequately studied in human patients or animal models and, to date, there are no effective therapies that can stop or reverse the complex and widespread inflammation-driven processes.

“To closely mimic the complex 3D cellular architecture of actual human small airways, we designed a microfluidic device that contains a fully matured human small airway epithelium with different specialised cell types exposed to air in one of its two parallel microchannels. The second channel is lined by a human vascular endothelium in which we flow medium containing white blood cells and nutrients so that the living microsystem can be maintained over weeks. We then modelled inflammatory asthma and COPD conditions by adding an asthma-inducing immune factor or by setting up the system with lung epithelial cells obtained from patients with COPD,” said Remi Villenave, Ph.D., a former postdoctoral fellow in Ingber’s group and the co-first author on the publication. In both cases, the team was not only able to observe highly disease- and cell type-specific changes but could also exacerbate them with agents simulating viral or bacterial infection.  CONT….

READ and Watch Video


Infant Apnea Prevention

In the United States, about 500,000 babies, or one in eight, are born prematurely each year. Many of them suffer from apnea of prematurity — a condition in which babies stop breathing for at least 10 seconds as they sleep — and related complications such as hypoxia, which causes insufficient oxygen supply to their tissues. Apnea and hypoxia in premature infants can cause multi-organ damage, developmental delay, and lifelong cognitive deficits, and they represent a major public-health problem. Current apnea and hypoxia therapies, such as caffeine treatment and vigorous manual stimulation, are not always effective. A reliable medical device is badly needed to address these problems.


A multi-disciplinary team of scientists, clinicians and engineers at the University of Massachusetts Medical School, Boston University and the Wyss Institute have developed a versatile, intelligent technology that can inhibit and possibly prevent infant apnea in Neonatal Intensive Care Units (NICUs) and, in the future, for infants at home. The technology consists of an active mattress that senses the cardio-respiratory function of the infant and hardware and software that can help predict when apnea or hypoxia may occur.

The mattress is based on the principle of “stochastic resonance” (SR). This is a counterintuitive phenomenon in which the application of a small amount of “noise” to a complex biological system, such as the human body, increases the sensitivity of that system. In this case, the mattress provides gentle vibration to the baby’s body (well below the baby’s head). This has been shown to promote stable respiration without changing sleep state or waking the infant and can prevent dangerous apneic and hypoxic events from occurring.


What is already here … Newish

Fluoroscopy Procedure

What is fluoroscopy?

Fluoroscopy is a study of moving body structures. It’s much like an X-ray “movie” and is often done while a contrast dye moves through the part of the body being examined. A continuous X-ray beam is passed through the body part and transmitted to a video monitor so that the body part and its motion can be seen in detail. Fluoroscopy, as an imaging tool, allows doctors to look at many body systems, including the skeletal, digestive, urinary, respiratory, and reproductive systems.Fluoroscopy may be used to evaluate specific areas of the body, including the bones, muscles, and joints, as well as solid organs, such as the heart, lung, or kidneys.

Neues Durchleuchtungssystem Luminos Agile von Siemens erhöht de

Why might I need fluoroscopy?

Fluoroscopy is used in many types of exams and procedures including:

Barium X-rays

In barium X-rays, fluoroscopy used alone allows the doctor to see the movement of the intestines as the barium moves through them.

Fluoroscopy x-ray photo barurm

Cardiac catheterization

In cardiac catheterization, fluoroscopy is used to help the doctor see the flow of blood through the coronary arteries to check for arterial blockages.


X-ray to view a joint or joints.

Placement of intravenous (IV) catheters (thin, hollow tubes put into veins or arteries)

For IV catheter insertion, fluoroscopy is used to guide the catheter into a specific location inside the body.

Fluoroscopy x-ray photo

Intravenous pyelogram (IVP)

X-ray of the kidneys, bladder, and ureters.


X-ray of the uterus and fallopian tubes.

Percutaneous vertebroplasty

A procedure used to treat compression fractures of the vertebrae (bones) of the spine.


Fluoroscopy is also used for:

Lumbar puncture


Locating foreign bodies

Guided injections into joints or the spine

Fluoroscopy may be used alone or may be used along with other diagnostic procedures. There may be other reasons for your doctor to recommend fluoroscopy.,P07662#sthash.EMkaGNoN.dpuf


About older x-ray machines


What does a chest x-ray show

Chest X-rays are used to determine the cause of symptoms such as chest pain, trouble breathing, persistent coughing and coughing up blood, reports MedlinePlus. They are also used to diagnose or rule out conditions such as lung disease and tuberculosis. There are many causes of an abnormal chest X-ray. A physician is able to diagnose pneumonia, lung tumours, collapsed the lung, scarring of the lung tissue and other respiratory problems using this test. If the heart is an abnormal size or shape, a physician is able to see the abnormality on a chest film. Chest X-rays also show problems with the position and shape of the large arteries. Because the ribs and spine are visible on a chest film, this type of X-ray is also used to diagnose osteoporosis, rib fractures and spine fractures.

Chest X-rays use a small amount of radiation. In fact, a person receives a similar amount of radiation from a chest X-ray as he would from 10 days of natural radiation exposure. 

X-ray machines are designed to permeate the surfaces of lighter objects and materials, such as skin and soft tissues. While beams pass easily through these body parts, they are not absorbed by denser materials, such as bone. The reflection of X-ray beams from dense objects appears as light areas on X-ray films, which identify bone structures and illuminate the skeleton.


This process starts with the generation of electricity, which happens when the machine is turned on. Electrical energy is then carried through a compressed X-ray tube, which transforms energy into multiple X-ray beams. These beams are highly concentrated and exist in various levels of energy. Beams with low energy are blocked, while high-energy beams pass through dense surfaces to provide technicians with a clear image of the skeleton.

breath in

BREATHING look here too on a different page


Sleep Study

Is ideal if you don’t have a prescription for CPAP or haven’t been diagnosed yet with sleep apnoea. These affordable and discreet, in-home sleep studies can offer a fast-track route to CPAP therapy.

Sleep Studies in Children: What to Expect During Your Child’s Sleep Study

Why Would a Doctor Order a Sleep Study Test?

 There are several obvious reasons a child’s doctor may order a sleep study (polysomnogram) for a child: some kids have problems like night terrors, frequent waking, loud snoring, or sleepwalking. There are several less obvious reasons a doctor might order a sleep study: an Ear, Nose, and Throat (ENT) doctor may notice enlarged tonsils and prescribe a sleep study. Persistent bedwetting and some cases of Attention Deficit/Hyperactivity Disorder have been linked to children’s sleep disorders.

sleep study

 Why Our Son’s Sleep Study was Ordered: Our Personal Experience

Our son had constant ear infections and was due to have his third set of ventilation tubes placed (these are also known as grommets, or “ear tubes”). It is standard practice to remove the adenoids when the third set of tubes are placed, as enlarged adenoids can contribute to middle ear fluid. Our ENT wanted to determine if we should remove our son’s tonsils at the same time: to determine if his tonsils were posing any difficulties, she ordered a sleep study. In this case, our son did not present with any obvious sleep disorder (though he had never slept through the night, at two years old this is not an uncommon occurrence). The paediatric sleep study was simply ordered to determine whether he needed a tonsillectomy and adenoidectomy.

How is a Sleep Study Test Performed?

A sleep study test is an overnight procedure. An impressive amount of monitoring equipment will be attached to the child during the sleep study. It is a good idea to prepare your child for a lot of “stickers” and “strings” (the patches and leads that will be attached). Fortunately, no part of a sleep study causes pain: a child can be reassured that there will be no “ouchies” during the test. The most difficult part of a sleep study (for most children) is the placement of a nasal cannula in a child who has never worn one. This is a small tube that runs under the nose, with two small prongs that fit into the nostrils. This is usually placed at the end of the sleep study set-up.

(Watch Viedo’s of a sleep study on link under this photo)

sleep study 2

CPAP Humidifiers

Sleep Disorders

Sleep apnea in infancy and childhood.

Episodic apnea leading to asphyxia is a relatively common disorder of young children. Important apnea syndromes include apnea of prematurity, “narrow upper airway syndrome,” congenital hypoventilation syndrome, breath-holding spells, and “near-miss” sudden infant death syndrome. More recently described syndromes include apnea associated with feedings, regurgitation or gastroesophageal reflux and apnea initiated by epileptic seizures. Apnea occurring during wakefulness is common and may be related to that occurring during sleep. Knowledge of the clinical features and pathophysiology of these various kinds of apnea is important in their management.

What Is Sleep Apnea?

Sleep apnea (AP-ne-ah) is a common disorder in which you have one or more pauses in breathing or shallow breaths while you sleep. Breathing pauses can last from a few seconds to minutes. They may occur 30 times or more an hour. Typically, normal breathing then starts again, sometimes with a loud snort or choking sound.

Sleep apnea usually is a chronic (ongoing) condition that disrupts your sleep. When your breathing pauses or becomes shallow, you’ll often move out of deep sleep and into a light sleep. As a result, the quality of your sleep is poor, which makes you tired during the day. Sleep apnea is a leading cause of excessive daytime sleepiness.


Sleep apnea often goes undiagnosed. Doctors usually can’t detect the condition during routine office visits. Also, no blood test can help diagnose the condition. Most people who have sleep apnea don’t know they have it because it only occurs during sleep. A family member or bed partner might be the first to notice signs of sleep apnea. The most common type of sleep apnea is obstructive sleep apnea. In this condition, the airway collapses or becomes blocked during sleep. This causes shallow breathing or breathing pauses.

However, CPAP therapy is designed to manage apnea, not to cure it. The machine must be worn throughout each night to provide maximal benefit.

Children and C-Pap: Adjusting to Continuous Positive Airway Pressure

Why a Child Would Need C-Pap

 What is obstructive sleep apnea? Obstructive sleep apnea is when there is a physical obstruction preventing a breath, or causing a shallow breath (hypopnea) to occur. For the vast majority of children, the cause is enlarged tonsils, which can be surgically removed. In rarer circumstances, children have obstructions caused by floppy airway tissue, neuromuscular weakness, or other physiologic causes which cannot be surgically corrected.

Children with persistent obstructive sleep apnea (and sometimes central sleep apnea) that cannot be surgically corrected may be prescribed a CPAP machine. A CPAP provides a continuous stream of air to splint open the airway while the child is sleeping: this prevents the apneas and hypopneas which cause obstructive sleep apnea. Some children do not tolerate CPAP and must use a bi-level system (BiPAP) or an automatically adjusting airflow system (APAP) for proper breath support and carbon dioxide clearance.

My own son has persistent obstructive sleep apnea, caused by a floppy airway (a condition known as laryngomalacia). Despite surgery, the obstructive apnea could not be helped: he now uses a CPAP machine to help him breathe at night.

The C-Pap Titration: Sleep Study with C-Pap

 It is extremely helpful if the parents have access to a CPAP mask prior to the sleep study test. This will help lessen anxiety about the process once the child arrives at the sleep lab/hospital for the sleep study. Let the child play with the mask, and have them wear it while watching TV or playing quiet games. This is called “desensitisation” and is an important step in getting a child to accept CPAP therapy.

Once the child’s sleep neurologist or pulmonologist feels that CPAP is a necessary treatment, a CPAP titration will be ordered. This is a sleep study where the CPAP pressure is adjusted to the point where almost all apneas and hypopneas disappear.

The sleep study (polysomnogram) is very similar to ones the child has had prior to the CPAP titration. The technologist will monitor EEG patterns, EKG tracings, leg movement, carbon dioxide levels, oxygen saturation levels, chest wall movements, eye movements, and mouth movements. In addition to the normal polysomnogram equipment, a CPAP mask will be used throughout the study. This will be placed over the nasal cannula which measures respiratory rate and carbon dioxide output.

The technologist will slowly increase the CPAP air pressure until the hypopneas and apneas disappear – the aim is to find the least amount of pressure that will eliminate the obstructive sleep apnea. This information is sent to the sleep neurologist or the pulmonologist, who will then forward the prescription information to a Home Healthcare Company.

In my son’s case, there was no mask available prior to the sleep study. This meant he had to adjust to wearing the mask and the new sensation of blowing air while going through the sleep study test. While he managed to make it through the night and sleep enough to determine the necessary air pressure, it was a difficult night for all involved. Several children’s hospitals have recognised the unique needs of children adjusting to CPAP and provide behavioural therapy prior to the CPAP titration. It is wise to determine if this service is available in a local children’s hospital, as it can make the testing process easier on everyone.

Why is it Important to Treat Pediatric Sleep Apnea?

The vast majority of children will not have sleep apnea or will have sleep apnea which is correctable via a tonsillectomy. Some children will require support with a C-Pap (or BiPAP) machine. Why must sleep apnea in kids be treated? Paediatric sleep apnea has been indicated in a wide variety of childhood conditions.

Bringing the C-Pap Home (Loads more to read on this visit the site)


 A Basic Understanding of the Trachea.

The trachea, commonly known as the windpipe, is a tube about 4 inches long and less than an inch in diameter in most people. The trachea begins just under the larynx (voice box) and runs down behind the breastbone (sternum). The trachea then divides into two smaller tubes called bronchi: one bronchus for each lung. The trachea is composed of about 20 rings of tough cartilage. The back part of each ring is made of muscle and connective tissue. Moist, smooth tissue called mucosa lines the inside of the trachea. The trachea widens and lengthens slightly with each breath in, returning to its resting size with each breath out.


Chest infections are very common, especially in autumn and winter. Chest infections can be serious and need urgent treatment. However, many chest infections in otherwise healthy people do not need antibiotic medicines and get better quite quickly. If you feel very unwell then you should see a doctor urgently to see what treatment you need.


Tracheomalacia is a weakness of the walls of the windpipe, or trachea. The resulting respiratory problems range from mild to severe.


Tracheomalacia is a very rare condition that occurs when the cartilage that forms the walls of the windpipe, which is normally rigid, becomes weak and floppy. The condition is usually congenital, appearing at birth because the cartilage has not developed properly. In some cases, it is acquired when the weakening develops after birth. It causes a variety of respiratory complications and, left untreated, the breathing difficulties can increase to the point of requiring urgent or emergency care. Often, tracheomalacia is associated with oesophagal atresia (a blockage of the oesophagus) and tracheoesophageal fistula (an opening between the trachea and the oesophagus) but may occur without other conditions. Patients with tracheomalacia who develop respiratory infections should be monitored closely by their healthcare provider.

What Causes Tracheomalacia?

Some babies are born with the cartilage of the trachea being weak, known as congenital tracheomalacia. A breakdown of the windpipe cartilage after birth is referred to as acquired, or secondary, tracheomalacia. It may occur as a result of large blood vessels putting pressure on the airway, complications from surgery for tracheal-esophageal fistula or oesophagal atresia, or from extended use of a breathing tube.

Symptoms and Signs of Tracheomalacia

The symptoms of tracheomalacia vary from mild to severe breathing difficulties. Problems occur because the weakened walls of the trachea are not rigid enough to keep the windpipe properly open.

Signs of tracheomalacia include:

  • Noisy or rattling breaths
  • High-pitched breathing
  • Breathing noises during sleep that can change as position changes and improve while sleeping
  • Breathing problems made worse during feeding and by coughing, crying and upper respiratory infections

The types of symptoms are the same for both congenital tracheomalacia and acquired tracheomalacia. Newborns with tracheomalacia may also exhibit the symptoms of other disorders such as gastroesophageal reflux, heart defects and delayed development.

Survivability of Tracheomalacia

The prognosis for tracheomalacia is generally good, with most cases resolving naturally as cartilage in the windpipe grows stronger over time. Breathing noises and respiratory problems usually improve gradually and stop by the time a child reaches the age of two. However, other more serious congenital abnormalities related to tracheomalacia, such as heart defects, may be present.

Additional risks from tracheomalacia include aspiration pneumonia, a potentially fatal complication caused by inhaling food. Upper respiratory infections require that a person with tracheomalacia be monitored closely and receive follow-up care by an ear, nose and throat health care provider. Adults with tracheomalacia caused by being on a breathing machine often develop serious lung problems.

Acquired tracheomalacia occurs after birth. It can be the result of abnormal blood vessels which put pressure on the trachea and cause it to break down, as well as infections of the trachea. Prolonged use of a ventilator can also contribute to the development of tracheomalacia, as can certain surgeries, which may cause cartilage breakdowns as a complication. Since this condition is a known risk of certain standards of care and medical procedures, patients at risk may be monitored and screened for any signs of tracheomalacia.


There are two main types of chest infection: Acute bronchitis is an infection of the large airways in the lungs (bronchi). Acute bronchitis is common and is often due to a viral infection. Infection with a germ (bacterium) is a less common cause. See the separate article called Acute Bronchitis. What is acute bronchitis and what are the symptoms?

broncites breathing

x ray broncitis 

Pneumonia is an inflammation of the lung tissue. It is usually due to infection. Pneumonia tends to be more serious than bronchitis. See the separate PAGE.

Bronchitis is an inflammation or infection of the large airways.



Long-term respiratory complications of congenital oesophagal atresia with or without tracheoesophageal fistula: an update.

Despite early surgical repair, congenital oesophagal atresia with or without tracheoesophageal fistula (EA ± TEF) has long-term effects on respiratory and gastrointestinal function. This review update summarises research published since 2003 on long-term respiratory complications in patients with a history of EA ± TEF. Pulmonary hypoplasia appears to not be rare in patients with EA ± TEF. Tracheomalacia is common and is associated with respiratory symptoms in childhood. Aspiration, associated with oesophagal dysmotility and/or gastroesophageal reflux, may lead to reduced pulmonary function and bronchiectasis. Pulmonary function is generally normal, although lower than in control patients, and restrictive defects tend to be commoner than obstructive defects. Abnormal airway reactivity is common and, along with respiratory symptoms, is associated with atopy. However, the inflammatory profile in EA ± TEF patients based on bronchial biopsies and exhaled nitric oxide differs from typical allergic asthma. Recent studies suggest that in older patients, respiratory symptoms tend to be associated with atopy, but abnormal lung function tends to be associated with gastroesophageal reflux and with chest wall abnormalities. Early detection and management of aspiration may be important to help prevent decrements in pulmonary function and serious long-term complications in EA ± TEF patients.


It’s often advisable to have a team of doctors following someone with Tof or Ea-Tef. For children, the team may include a paediatric surgeon, a paediatric respirologist lung specialist, or a stomach specialist which is a paediatric gastroenterologist.


Asthma and wheezing

Roughly a quarter to a third of people with EA are diagnosed with asthma. Asthma is tricky to diagnose in EA patients, as both tracheomalacia and aspiration can cause narrowing of the bronchi and wheezing. These conditions should be ruled out before a diagnosis of asthma is made, as persistent aspiration can lead to lung damage. An important clue that wheezing in an EA patient isn’t due to asthma is those bronchodilator inhalers (such as salbutamol) rapidly improve wheezing in people with asthma, but have no effect in people with tracheomalacia – or make the wheezing worse. In people with EA, breathing tests can be performed in individuals 6 years of age and older, to evaluate these issues further.


Why EA patients may be more prone to asthma is an area of controversy. Some studies suggest that asthma in EA patients is linked to allergies, just like in other people with asthma. On the other hand, many experts believe that increased bronchial inflammation early in life, due to repeated aspiration, increases the risk of persistently inflamed airways later in life, resulting in asthma.


Given the many issues that can harm the lungs early in life in EA patients, many studies have looked at lung function in older EA children and adults. On average, lung function is normal, but towards the lower end of the normal range. About 1/3 of EA patients have completely normal lung function. About a third have narrower airways than the average, and about a third have somewhat smaller lungs than the average. Fortunately, exercise capacity is usually normal.

What Causes Asthma?

The exact cause of asthma isn’t known. Researchers think some genetic and environmental factors interact to cause asthma, most often early in life. These factors include:

An inherited tendency to develop allergies called atopy (AT-o-pe)

Parents who have asthma

Certain respiratory infections during childhood

Contact with some airborne allergens or exposure to some viral infections in infancy or in early childhood when the immune system is developing

If asthma or atopy runs in your family, exposure to irritants (for example, tobacco smoke) may make your airways more reactive to substances in the air.Some factors may be more likely to cause asthma in some people than in others. Researchers continue to explore what causes asthma.

The “Hygiene Hypothesis”

One theory researchers have for what causes asthma is the “hygiene hypothesis.” They believe that our Western lifestyle—with its emphasis on hygiene and sanitation—has resulted in changes in our living conditions and an overall decline in infections in early childhood.Many young children no longer have the same types of environmental exposures and infections as children did in the past. This affects the way that young children’s immune systems develop during very early childhood, and it may increase their risk for atopy and asthma. This is especially true for children who have close family members with one or both of these conditions.

Hard to Breathe: NHLBI Researchers Seek Treatments for Severe Asthma

The National Heart, Lung, and Blood Institute, part of the National Institutes of Health, is researching potential treatments for severe asthma. This video features an interview with Dr Stewart Lavine, an NHLBI researcher, who is conducting a clinical study to test new treatment options for patients who live with severe asthma. While 25 million Americans live with asthma, about 1.25 million of those individuals have severe asthma, a condition that can be difficult to control and treat.

Learn more about his research by visiting the NHLBI Laboratory of Asthma and Lung Inflammation website:

Who Is at Risk for Asthma?

Asthma affects people of all ages, but it most often starts during childhood. In the United States, more than 22 million people are known to have asthma. Nearly 6 million of these people are children.

Young children who often wheeze and have respiratory infections—as well as certain other risk factors—are at highest risk of developing asthma that continues beyond 6 years of age. The other risk factors include having allergies, eczema (an allergic skin condition), or parents who have asthma.

Among children, more boys have asthma than girls. But among adults, more women have the disease than men. It’s not clear whether or how sex and sex hormones play a role in causing asthma. Most, but not all, people who have asthma have allergies.

What Are the Signs and Symptoms of Asthma?

How Is Asthma Diagnosed?

 How Is Asthma Treated and Controlled?

How to use Asthma inhaler, watch this short video on how to do it right.

Asthma how-to: How to use an inhaler with a spacer and mask

How to treat a child having an asthma attack

British Red +


What is Spirometry?

Spirometry is a simple test used to help diagnose and monitor certain lung conditions by measuring how much air you can breathe out in one forced breath.

It’s carried out using a device called a spirometer, which is a small machine attached by a cable to a mouthpiece. Spirometry may be performed by a nurse or doctor at your GP surgery, or it may be carried out during a short visit to a hospital or clinic.


 Spirometry is the first and most commonly done lung function test. It measures how much and how quickly you can move air out of your lungs. For this test, you breathe into a mouthpiece attached to a recording device (spirometer). The information collected by the spirometer may be printed out on a chart called a spirogram.

 The more common lung function values measured with spirometry are:


Tracheobronchomalacia (TBM)

As you can see from the picture, patient’s with TBM are able to breathe in without much difficulty.  The collapse comes when a TBM sufferer tries to exhale.  The harder the TBM patient is exerting themselves the harder the airway will collapse. Coughing, laughing, crying hard and exercise will all cause the airway to collapse with greater force. It is often difficult to exercise with this condition which leads to other health conditions such as obesity. 

Tracheobronchomalacia (TBM) until recently was thought to be a rare condition that occurs when the walls of the airway (specifically the trachea and bronchi) are weak.  As more awareness and diagnostic understanding are being discovered,TBM we are realising that it is not so much rare, as it is under-diagnosed or misdiagnosed. It is often hidden inside of another more prevalent lung disease, or simply not known about.

There are two forms of TBM: a congenital form (called primary TBM) that typically develops during infancy or early childhood and an acquired form (called secondary TBM) that is usually seen in adults.  Some affected people may initially have no signs or symptoms. In rare cases, some patients may have a severe collapse and only manifest mild to moderate symptoms. However, the condition is typically progressive (becomes worse over time) and most people will eventually develop characteristic features such as shortness of breath, cough, sputum retention (inability to clear mucus from the respiratory tract), and wheezing or stridor with breathing.

For more help to understand this click link below



Common Variable Immune Deficiency

Common variable immune deficiency (CVID) is a disorder that impairs the immune system. People with CVID are highly susceptible to infection from foreign invaders such as bacteria, or more rarely, viruses and often develop recurrent infections, particularly in the lungs, sinuses, and ears. Pneumonia is common in people with CVID. Over time, recurrent infections can lead to chronic lung disease. Affected individuals may also experience infection or inflammation of the gastrointestinal tract, which can cause diarrhoea and weight loss.


 Stridor what is it?

Causes of Stridor and Wheeze (Breathing Sounds)

Stridor and wheezing are two terms for different breathing sounds that are often used synonymously although there is a difference. Wheezing refers to the high-pitched or whistling sound, which is most prominent when breathing out (expiration). A wheeze is usually heard clearly upon auscultation (use of a stethoscope) although at times it may be audible, especially to the patient, without any need for a stethoscope. A stridor is also high pitched but ‘rough’ sound sometimes described as crowing. It easily audible without the use of a stethoscope (auscultation) and while it is present when breathing in (inspiration) or out (expiration), it is usually more prominent on inspiration.

Anatomy of the Respiratory System

 Click on the underlined RED writing



The respiratory system is made up of the organs that allow ventilation, which is the entrance and exit of gas or air passages, and the lungs, which is responsible for gas exchange between the air and the blood. Starting from the nose, air travels through the nasal cavity, into the pharyng, larynx and trachea (air or windpipe). Here the air will diverge into the two bronchi, each of which divides multiple times to form bronchioles that empty air into the air sacs (alveoli) of the lungs. The tracheobronchial tree is a series of ‘tubes’ that lead to the lungs. These tubes are thin walled, lined with membranes that secrete mucus, and contain smooth muscle in the wall. Under certain conditions, the membranes may produce more mucus, the smooth muscle may contract or the wall of the tubes may become inflamed resulting in swelling. All these mechanisms will cause constriction (narrowing) of the tubes to varying degrees thereby affecting the flow of air. However any mass within the airways, whether a foreign body, abscess or tumour will also affect the passage of the air. The disrupted airflow is often the reason for abnormal breathing sounds like a wheeze or stridor, similar to the changes in the flow of air through a flute.

Baby with Croup Stridor Barking Cough visual & audio sound

Uploaded on Apr 14, 2011

My 2-year-old daughter at rest in bed with Croup – presenting with a barking cough, stridor and distressed breathing and depressions in the chest. These all together at rest are indications for you to seek medical attention for your child. 
My daughter was under prescription inhalers and we had a nurse monitoring her during the filming of this video. Never be afraid to call for help.

Croup already covered here on site click the link below

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