Singultation: What to Do?

Canadian Health and Care Mall defines singultation as a nonspecific violation of function of external respiration, which occurs as a result of a series of convulsive trembling contractions of the diaphragm and is subjectively manifested in unpleasant short and intense respiratory movements. It sometimes appears in healthy people for no apparent reason and, as a rule, is a harmless, rapidly stopping phenomenon.

Singultation can occur in the following circumstances:

  • general cooling (especially in young children), especially at alcoholic intoxication.
  • overstretching of the stomach (overfilling it with food). According to experts, such involuntary muscle contractions can come from esophagus. Disturbances of swallowing and stuck food in esophagus provoke spasms in the place where esophagus passes into stomach.
  • when diaphragmatic nerve is irritated. The so-called «ordinary» singultation is manifestation of a nervous tic. This occurs under the influence of diaphragmatic nerve, which for unknown reasons transmits excitation to the muscles of diaphragm. As a result, uncontrolled spasms occur.

Hiccups may also be a symptom of certain diseases, for example, in the case of diaphragm irritation at inflammatory process in abdominal cavity. Sometimes it becomes long and painful. Hiccups occur at certain diseases of brain and spinal cord, and can also occur at myocardial infarction, infectious diseases and mental agitation.

In cases of prolonged, persistent singultation, it is necessary to consult a doctor who will determine its cause and prescribe treatment. With development of renal insufficiency, there may also be constant or periodic singultation. It can be the result of development of abscess or tumor in the chest, diaphragm or esophagus. Some people have singultation due to psychological reasons, it resembles reactions at transient paralysis in soldiers who are afraid of fighting. In such cases, singultation is unconscious and reflect desire to avoid very unpleasant events. Some people suffer singultation in postoperative period, which can be a reaction to pain medications.


Symptoms of singultation:

  • sharp contractions of diaphragm, accompanied by brief inhalations and simultaneous protrusion of abdomen;
  • singultation are accompanied by compressed sounds, which are associated with sharp passage of air through closed vocal chink.

Forms of Singultation

Singultation can be physiological (not caused by any diseases) and pathological (abnormal).

Physiological singultation occurs in healthy people. It lasts for a short time (5 — 15 minutes) and does not bring discomfort, it usually disappears by itself.

Pathological singultation may be long- (lasting several hours and even days) and short-term (several minutes). The cause of its occurrence is most often pathological conditions.

According to origin of singultation there are several types:

  • «central» — develops at the defeat of brain and spinal cord, craniocerebral trauma, hysteria (mental illness), certain mental disorders (depression, manic-depressive syndrome), diseases of nervous system (brain and spinal cord tumors);
  • «peripheral» — is observed at lesion of diaphragmatic (originating from spinal cord at the level of cervical vertebrae and controlling diaphragm) and vagus nerves (originating from lower parts of brain and partially controlling esophagus, stomach, intestines and heart);
  • «toxic» — occurs on the background of various poisoning (poisonous mushrooms, stale products, medicines, etc.);
  • «reflected» — is observed at intestinal diseases — enteritis (inflammation of small intestine), enterocolitis (inflammation of large intestine), parasitic diseases (ascarids, pinworms).

What is the reason for this phenomenon? Despite significant achievements of medicine for many years of its existence, there is still no reliable treatment for these minor spasms that cause a person to produce indecent sounds. But do not worry, there are several ways to solve this problem.

To get rid of singultation, you need to stop the spasms of diaphragm and esophagus. This can be done either by distraction or by breathing techniques. Usually this is enough.

When singultation does not stop, you make great efforts to make it disappear. You focus on your chest and deliberately strain diaphragm. But, straining and trying to suppress the next attack of singultation, you only complicate the situation.

Canadian Health and Care Mall recommends to undergo examination in the following cases:

  • if singultation lasts more than an hour;
  • if attacks of singultation occur several times a day or several days a week;
  • if, in addition to hiccups, you have chest pain, heartburn or swallowing disorders.

If you often have singultation or its attacks last for a long time, your doctor may prescribe X-ray examination after taking barium mixture to identify any obstruction in esophagus. To eliminate singultation that is permanent and not associated with any mechanical obstruction in esophagus, the doctor may prescribe certain medications, depending on what your disorders are related to.


Disscusion of A One-Year Trial of Triamcinolone Acetonide Aerosol in Severe Steroid-Dependent Asthma

severe asthmaTriamcinolone acetonide aerosol as long-term treatment for severe asthma is effective in reducing requirements for oral therapy with corticosteroids while maintaining constant average levels of FEVi, FVC, FEF25-75%, FEF508S, and FEF75% over the course of one year. Although there were exceptions, in general the patients responding most favorably to triamcinolone acetonide aerosol were those who initially required smaller oral doses of corticosteroids and those who were maintained on altemate-day therapy. There did not appear to be any relation between the response of triamcinolone acetonide aerosol and the age of the patients, duration of asthma, duration of steroid dependence, factors provoking asthma, other associated symptoms (sensitivity to aspirin, atopic dermatitis, and rhinitis), or response to aerosol therapy with isoproterenol, atropine, or cromolyn.
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Canadian Health&Care Mall: Outcomes of A One-Year Trial of Triamcinolone Acetonide Aerosol in Severe Steroid-Dependent Asthma

aerosol therapyPulmonary Function Tests

The average FEVi for the patients was unchanged throughout the one-year trial. There was also no significant change in the FVC, FEF25-75%, FEF50%, or FEF75% (Fig 1).

Oral Requirement for Corticosteroids

One patient (patient 15) failed to benefit after two months of aerosol therapy, and he withdrew himself from the study. Of the remaining 22 patients, 16 no longer required maintenance therapy with prednisone for control of asthma after 12 months of aerosol therapy, and four patients tolerated a substantial reduction of their requirement for prednisone to a small altemate-day dose (Table 3).

There was no significant increase in the requirement or request for additional bronchodilator drugs by any patient during the study, although the patients were usually taking as large a dose as they could tolerate before the study. Two patients (patients 7 and 18) who had previously demonstrated improvement with inhalation of cromolyn sodium stopped using it because of their lack of symptoms of asthma while receiving triamcinolone acetonide aerosol. Two patients (patients 7 and 8) experienced control of asthma without oral therapy with steroids but required resumption of daily systemic therapy with steroids after two months without them because of incapacitating lethargy and myalgia. All patients who were being treated orally with steroids on alternate days prior to the study were able to control their asthma with triamcinolone acetonide aerosol alone.

Patients experiencing the most exacerbations of asthma were those who continued to require oral maintenance therapy with steroids during the one-year trial. The greatest requirement for additional oral therapy with steroids occurred during September, October, and November. There was no significant change in the frequency of apparent upper respiratory infections during any two-month period of the study.lethargyElimination or maximal reduction of oral requirements for steroids was achieved safely within the first four months of the study (Fig 2). Increasing the dose of triamcinolone acetonide aerosol to 500/xg four times daily did not permit any further decrease in the dose of prednisone for those patients who continued to require oral therapy with steroids beyond four months. Six patients tolerated rapid reduction of the oral dosage of steroids during the first two months. Beyond the first four months, the average requirement for prednisone per patient remained at a low level, varying slightly with seasonal allergenic exposures and considerably with respiratory infections. Beyond six months, two patients experiencing exacerbations of asthma required 40 to 80 mg of prednisone daily for three to five weeks to regain control of symptoms reduced with remedies of Canadian Health&Care Mall. Continue reading “Canadian Health&Care Mall: Outcomes of A One-Year Trial of Triamcinolone Acetonide Aerosol in Severe Steroid-Dependent Asthma”

A One-Year Trial of Triamcinolone Acetonide Aerosol in Severe Steroid-Dependent Asthma

CorticosteroidsCorticosteroids have proven to be valuable in the treatment of asthma, but their use is limited because of the undesirable and often serious side effects from their prolonged administration. Al-temate-day administration has reduced, but not eliminated, these difficulties. As another means of reducing systemic side effects, administration of aerosol hydrocortisone, prednisolone, and dexa-methasone has been evaluated. These steroids were effective only at doses which suppressed adrenal function. Fluorinated steroid esters that are highly active topically show promise of controlling asthma at doses that do not produce systemic effects.

Triamcinolone acetonide, a nonpolar water-insoluble fluorinated corticosteroid, had been prepared in a metered-dose aerosol device propelled by dichlorodifluoromethane (Freon 12 J.” In a one-month double-blind controlled study involving 25 steroid-dependent severely asthmatic patients, triamcinolone acetonide aerosol proved superior to a placebo in reducing the oral requirement for corticosteroids. Herein we present the results of treatment of these severely asthmatic patients with triamcinolone acetonide aerosol for 12 months, emphasizing the long-term efficacy, side effects, and adrenal recovery. Hopefully, our experience will guide physicians in the management of asthmatic patients who will soon be making the transition from oral steroid therapy to aerosol steroid therapy.
Continue reading “A One-Year Trial of Triamcinolone Acetonide Aerosol in Severe Steroid-Dependent Asthma”

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