Introduction: No studies correlated ultrasonographic evaluation with doppler technique of subglottic stenoses with endoscopic measures. Aims and Objectives: The diagnosis of subglottic stenoses can be challenging and delayed. The gold standard is flexible bronchoscopy, which assesses the mobility of the vocal cords, the location, length and size of the stenosis. Ultrasonography isn’t frequently part of the diagnostic process, least of all doppler technique. Methods: We enrolled 22 patients with subglottic stenoses and 22 control patients. They underwent a bronchoscopic evaluation of the size of the tracheal lumen and subsequent ultrasonographic examination of the neck with doppler technique, both in inspiration and expiration, before and after the treatment. Results: We observed a significant difference between ultrasonographic doppler evaluation before and after the endoscopic treatment (Fig. 1), both in inspiration and expiration (p<0,001). Also, the difference between the tracheal lumen of the two populations was statistically significant. We observed no differences between ultrasonographic and endoscopic measures, both in inspiration (p=0,640) and expiration (p=0,067). Conclusions: Diagnosing and evaluating subglottic stenoses via ultrasounds with doppler technique strongly correlates with endoscopic measures. The use of doppler may ease this process, especially in case of doubt. Figure 1

Rationale: Physical effort plays a critical role in conditioning the life quality of subjects affected with asthma.The Asthma-related airway obstruction that occurred during exercise goes under the name of Exercise-induced Asthma (EIA).To find predictors for the development of EIA, we evaluated the functional parameters at rest and during the exercise of 20 subjects with a diagnosis of mild asthma.Methods: 20 subjects, aged 27±5 with mild asthma in stable conditions, who reported respiratory symptoms on exertion in the past, have been enrolled in a two-day protocol.On the first day of our study, we took measurements of functional respiratory parameters, and we assessed their airways responsiveness with a methacholine challenge after an adequate pharmacological washout.On the second day, we conducted a maximal, symptom-limited incremental cardiopulmonary exercise test (CPExT).To diagnose EIA, we monitored the FEV 1 change at 1, 3, 5, 7, 10, and 15 minutes, after the CPExT, with repeated maneuvers of maximal full forced expiration.Results: 19 of the 20 enrolled subjects completed the two-day protocol.We then split the subjects into two groups, according to the presence (12 subjects) or absence (7 subjects) of EIA after the CPExT.Despite 12 subjects showed EIA, no functional parameters both at rest and during the effort were useful to predict it.However, we documented that, unlike the asthmatics without EIA, in those with EIA, the mean Inspiratory Capacity (IC) did not increase with the raising of ventilatory requirements during CPExT.Interestingly 6 of the EIA subjects (50%) displayed dynamic pulmonary hyperinflation (DH) throughout the exercise, as documented by the progressive increase of end-expiratory lung volume.This subgroup of asthmatics with EIA, who in turn showed earlier and greater post-exercise FEV 1 fall, had significantly lower FEF 25-75% (% pred.) at rest (p<0.05) and higher airways responsiveness, expressed as PD 20 FEV 1 (p<0.05).Conclusions: No routine functional respiratory parameters measured at rest or during effort can predict EIA in mild asthmatics, even after the maximal exercise test.Interestingly, in a subgroup of asthmatics with EIA, we documented the development of DH during exercise, and this was associated with reduced forced expiratory flow-rates at lower lung volumes and higher airway hyperresponsiveness, suggesting a prominent small airways impairment.This information will certainly be useful to explain why some asthmatics with EIA start developing typical symptoms like wheezing, chest tightness, dry cough, and dyspnea during effort and not only after stopping it.

Background: Obstructive sleep apnea hypopnea (OSAH) is associated with decreased exercise tolerance and autonomic abnormalities and represents a risk for cardiovascular diseases. The aim of the study was to evaluate the effects of CPAP on cardiovascular autonomic abnormalities and exercise performance in patients with OSAH without changes in lifestyle and body weight during treatment.Methods: Twelve overweight subjects with OSAH underwent anthropometric measures, autonomic cardiovascular and incremental symptom-limited cardio-respiratory exercise tests before and after two months of treatment with CPAP.Results: Lower frequency component of power spectrum of heart rate variability (59.5 +/- 24.2 msec(2) vs 43.2 +/- 25.9 msec(2); p < 0.05) and improvements of maximal workload (99.3 +/- 13.5 vs 108.3 +/- 16.8%pred.; p < 0.05) and peak oxygen consumption (95.3 +/- 7.6 vs 105.5 +/- 7.9%pred.; p < 0.05) were observed in these patients after CPAP, being their BMI unchanged.Conclusions: CPAP-induced decrease of sympathetic hyperactivity is associated with better tolerance to the effort in OSAH patients that did not change their BMI and lifestyle, suggesting that OSAH limits per se the exercise capacity. (C) 2016 Elsevier B.V. All rights reserved.