Assessment of Friedman Classification by Measuring Actual Tonsil Size During Surgery

Background and Objectives: Adenotonsillar enlargement is a common cause of pediatric illnesses, including obstructive respiratory disease and recurrent airway infection. The current tonsil grading systems evaluate tonsil size, but the correlation with actual tonsillar size in a clinical setting has not been established.Materials and Method: Between May and July of 2018, we recruited 31 children who underwent adenotonsillectomy with no major craniofacial abnormalities. The actual size of the palatine tonsils, the long (L1) and short (S1) axes of the tonsil beyond the anterior pillar, and the real axes (L2 and S2) after tonsil extraction from the fossa were measured during surgery. Adenoid size was determined by measuring the adenoid-nasopharynx (AN) ratio through lateral view x-ray of the neck.Results: Though S1 was related to the Friedman scale (p<0.001), measured real axes were not (L2: p=0.058, S2: p=0.056). Also, adenoid size and AN ratio did not relate statistically to the Friedman scale (p=0.565). One of the measured real tonsil size parameters (S2) was related to AN ratio (p=0.048).Conclusion: For pediatric patients undergoing tonsillectomy and adenoidectomy, the Friedman grading scale based on physical examination may not reflect the actual size of the tonsils. Therefore, for children with obstructive sleep disorder or recurrent tonsillitis, intraoperative measurement of tonsil size can be helpful.

Physical activity among Canadian adults with obstructive respiratory diseases

The objective of this study was to investigate the amount and modes of physical activity in which adults with obstructive respiratory disease engage. Data from respondents with self-reported asthma (n = 4293), chronic obstructive pulmonary disease (COPD) (n = 3118), both diseases (n = 1569), and neither obstructive respiratory disease (n = 64 175); these data are from the Canadian Community Health Survey (2011–2012). Logistic regressions were used to assess associations between modes of physical activity and type of respiratory disease. Linear regressions were used to investigate the association between daily energy expenditure and respiratory disease. Adults with COPD and both diseases had the lowest participation in all modes of physical activity. Those with both diseases were less likely to report walking (odds ratio (OR) = 0.74, 95% confidence interval (CI) = 0.63–0.88), while those with COPD were less likely to report participation in endurance activities (OR = 0.79, 95% CI = 0.68–0.92), compared with those with neither obstructive respiratory disease. Those with asthma had similar daily energy expenditure levels and physical activity preferences compared with those with neither obstructive respiratory disease. In conclusion, adults with COPD and both asthma and COPD were less likely to engage in common activities such as walking, while physical activity levels among adults with asthma did not differ from the general population.

Mucins: the frontline defence of the lung

Mucus plays a vital role in protecting the lungs from environmental factors, but conversely, in muco-obstructive airway disease, mucus becomes pathologic. In its protective role, mucus entraps microbes and particles removing them from the lungs via the co-ordinated beating of motile cilia. This mechanism of lung defence is reliant upon a flowing mucus gel, and the major macromolecular components that determine the rheological properties of mucus are the polymeric mucins, MUC5AC and MUC5B. These large O-linked glycoproteins have direct roles in maintaining lung homeostasis. MUC5B is essential for interaction with the ciliary clearance system and MUC5AC is up-regulated in response to allergic inflammatory challenge. Mucus with abnormal biophysical properties is a feature of muco-obstructive respiratory disease and can result from many different mechanisms including alterations in mucin polymer assembly, mucin concentration and the macromolecular form in mucus, as well as changes in airway surface hydration, pH and ion composition. The abnormal mucus results in defective lung protection via compromised ciliary clearance, leading to infection and inflammation.