About recurrent respiratory papillomatosis

What is recurrent respiratory papillomatosis?

Recurrent Respiratory Papillomatosis (RRP) is the respiratory condition characterised by the presence of recurrent wart-like growths called papillomas around the vocal cords in the respiratory tract.

  • It is caused by the Human Papillomavirus (HPV) that causes skin warts and genital warts HPV consists of 150 different subtypes most of them passing through genital contact as a result of sexual intercourse.
  • Recurrent respiratory poapillomatosis is of two types: Adult-onset RRP and Juvenile-onset RRP. 
  • Juvenile-onset RRP: This type of recurrent respiratory oapillomatosis develops in infants and children under 12 years of age. This type is more aggressive and highly recurring.
  • Adult-onset RRP: This type of recurrent respiratory oapillomatosis develops in adolescents and adults and is comparatively less aggressive than the juvenile category.
  • Papillomas can develop anywhere along the respiratory tract such as the nose, mouth, pharynx, larynx, trachea, various airway passages called bronchi, and lungs. 
  • They often occur in the larynx called laryngeal papillomatosis.
  • They occur less often within the oral cavity and the trachea.
  • They occur rarely around the lungs.
  • The occurring papillomas may be noncancerous or cancerous. The noncancerous papillomas are called benign tumours and the cancerous papillomas are called malignant tumours. 
  • Both benign and malignant papillomas can lead to severe life-threatening airway obstruction and respiratory complications if left untreated.



What are the symptoms for recurrent respiratory papillomatosis?

Stridor symptom was found in the recurrent respiratory papillomatosis condition

Recurrent Respiratory Papillomatosis (RRP) is a rare disorder affecting the respiratory tract. The following signs and symptoms are detected in patients with RRP:

Primary or common symptoms of recurrent respiratory papillomatosis

Secondary or rare symptoms of recurrent respiratory papillomatosis

Severe symptoms if recurrent respiratory papillomatosis are left untreated

  • Acute respiratory distress
  • Bronchiectasis or chronic lung disease
  • Progressive pulmonary failure
  • 1% cases of squamous cell carcinoma

List of symptoms

  • Chronic hoarseness 
  • Chronic cough
  • Episodes of choking
  • Stridor - inspiratory, expiratory, and biphasic
  • Failure to thrive
  • Dysphagia 
  • Dyspnea 
  • Chronic cough
  • Aphonia 
  • Dysphonia
  • Shortness of breath
  • Difficulty swallowing
  • Snoring

List of conditions

  • Chronic lung disease
  • Progressive pulmonary failure
  • Globus pharyngeus
  • Recurrent pneumonia

List of drugs

  • Cidofovir
  • Bevacizumab
  • Doxycycline



What are the causes for recurrent respiratory papillomatosis?

Recurrent respiratory papillomatosis is a very rare disease caused by the Human Papilloma Virus or HPV that accelerates the growth of tumors in the respiratory tract. 

  • These noncancerous tumors most commonly grow in the larynx and around the vocal cords; but afterwards, their growth may spread downward by affecting the trachea, bronchi, and the lungs. 
  • There are 150 types of HPV but Recurrent respiratory papillomatosis is caused by the two types of Human Papilloma Virus i.e. HPV 6 and HPV 11. Sometimes, apart from respiratory tract papillomas, genital warts also can form in those people who are exposed to HPV 6 and HPV 11.
  • Mostly the infants and the juvenile group of children who may have contracted the virus during childbirth, are getting affected by the Recurrent respiratory papillomatosis. 
  • If the HPV vaccination for boys and girls remains undone at the proper age i.e. 11-12 years, there can be a high risk of spreading the HPV-associated diseases like Recurrent respiratory papillomatosis.
  • Contagious HPV can be transmitted by the direct contact of the affected people unknowingly as they are not aware of their carriership. Leading an unhealthy and undisciplined lifestyle can increase its spread.



What are the treatments for recurrent respiratory papillomatosis?

There are different treatments involved for recurrent respiratory papillomatosis.

  • If somebody is already affected by recurrent respiratory papillomatosis, there is no cure but to operate on the tumors. The primary method to remove the tumors in the larynx and the air path between the nose and lungs is surgery. Traditional surgery may leave a scar in larynx tissue, so the surgeons are recommending laser surgery for this.
  • There are no assurances regarding the return of the tumors in those operated areas. Therefore multiple surgeries are needed for a patient.
  • In some cases, surgeons perform Tracheotomy as the severe growth of the tumors blocks the entire breathing path. An opening is made in front of the neck of the patient and a breathing tube is inserted through the slit into the trachea or the windpipe to make the patient inhale with little ease. Though the surgeons are needed to remove those tumors as soon as possible.
  • Vaccination for Human Papillomavirus HPV is extremely needed to decrease its spread. All children aged 11-12 years are highly recommended for the HPV vaccination program. It will protect the young generations from getting affected by HPV 6 and HPV 11 viruses which are mainly responsible for the disease recurrent respiratory papillomatosis.



What are the risk factors for recurrent respiratory papillomatosis?

Recurrent respiratory papillomatosis is a dangerous disease defined by recurrent wart-like growths clinched on the surface of the tissues of the vocal cords. The disease is caused by numeric types of the human papillomavirus. It tends to recur as the virus persists in the tissue after the growth cells are removed. 

Risk factors:

  • Being a first-born child. 
  • Having a vaginal delivery with prolonged labor. 
  • Mother being under 20 years of age.
  • Dysphagia is a condition where there is difficulty swallowing. It can be caused by a number of things, including stroke, Parkinson's disease, and cerebral palsy.
  • Dysphagia can also be caused by an injury to the head or neck. If you have dysphagia, you may have trouble swallowing liquids, solids, or both. 
  • Shortness of breath or difficulty breathing (dyspnea)
  • The sensation of a foreign body in the throat, and choking episodes are all risk factors for recurrent respiratory papillomatosis.
  • One of the most important risk factors for having aggressive recurrent respiratory papillomatosisdisease is HPV11 infection.
  • Weak Immune System-people with a weak immune system can be at the risk of getting this disease. 
  • People who have had their tonsils or adenoids removed are also at increased risk of getting recurrent respiratory papillomatosis.



Is there a cure/medications for recurrent respiratory papillomatosis?

Recurrent respiratory papillomatosis can occur anywhere in the respiratory tract, although the larynx and vocal cords are the most commonly affected (laryngeal papillomatosis). The condition affects the mouth (oral cavity), trachea, and bronchi less frequently. Only a small percentage of these tumors move to the lungs. 

Medications:

  • Cidofovir is one of the most commonly used antiviral drugs for the treatment of recurrent respiratory papillomatosis. This is an adjuvant therapy that is injected into the lesions directly (intralesional).
  • Some people with recurrent respiratory papillomatosis, particularly those with large papillomas, have been treated using photodynamic therapy, a method in which a medication known as a photosensitizer is combined with a special type of light.
  • A specific wavelength of light is utilized to activate the medication, which binds to oxygen and produces a chemical that kills the cells.
  • Additional medications are being researched as possible adjuvant therapy for people who have RRP. Bevacizumab, a monoclonal antibody, is one of these medications.
  • Bevacizumab can be injected into papilloma growths and used in combination with a pulse dye laser to stop papillomas from forming new blood vessels.
  • This method of treatment appears to be particularly effective in patients with recurrent papillomas of the larynx and trachea.



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