Expiratory Central Airway Collapse in Adults: Corrective Treatment (Part 2)

Milian, Ricardo Diaz; Foley, Edward; Bauer, Maria; Martinez-Velez, Andrea; Castresana, Manuel R.

doi:10.1053/j.jvca.2018.09.009

Cited by 6 publications

(7 citation statements)

References 42 publications

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“…5 Expiratory central airway collapse may also complicate ventilation during surgery of procedures performed under conscious sedation or become manifest after extubation or tracheostomy decannulation. 11,12 Pulmonary function tests may reveal obstructive (44%) or restrictive (17.8%) changes, but are normal in 20% of patients with ECAC. 6,13 Helpful clues during these tests include reduced maximum forced expiratory flow, a biphasic expiratory curve, flow oscillations, and notching, but these are not universally present.…”

Section: Diagnosismentioning

confidence: 99%

“…6,7 Up to 75% of patients selected for a stent trial exhibit an improvement in symptoms and are considered for further surgical intervention. 11 Recently, pneumatic stenting via nasal continuous positive pressure has been proposed as an alternative to diagnostic stent placement, 11,12 although some experts believe that this approach may overestimate the benefits of surgical stabilization. 3 TREATMENT Therapy for ECAC is determined by disease severity (degree of collapse and severity of symptoms) and comorbid conditions.…”

Section: Diagnosismentioning

confidence: 99%

“…6 Bronchoscopic laser TBP with the application of endoluminal laser to the posterior tracheal wall to induce fibrosis and wall rigidity holds promise as a less invasive therapy; however, more clinical trials are needed to establish its real value. 11,27 Tracheobronchoplasty is associated with a 1% mortality rate in appropriately selected adults with severe symptomatic ECAC when performed by an experienced airway surgeon and team. Perioperative adverse events occur in nearly half of patients, including respiratory failure or pneumonia.…”

Section: Diagnosismentioning

confidence: 99%

“…6 Excessive dynamic airway collapse should be used only to describe an abnormality in the posterior membranous portion of the airway that bulges into the lumen during expiration. 1,4,11,12 Abnormal motion of the anterolateral or cartilaginous portion of the tracheobronchial wall is termed as TBM. 1,8 Tracheobronchomalacia can be subdivided into cartilaginous or circumferential (or concentric).…”

mentioning

confidence: 99%

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Central Airway Collapse, an Underappreciated Cause of Respiratory Morbidity

Abia‐Trujillo

Majid

Johnson

et al. 2020

Mayo Clinic Proceedings

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Dyspnea, cough, sputum production, and recurrent respiratory infections are frequently encountered clinical concerns leading patients to seek medical care. It is not unusual for a well-defined etiology to remain elusive or for the therapeutics of a presumed etiology to be incompletely effective. Either scenario should prompt consideration of central airway pathology as a contributor to clinical manifestations. Over the past decade, recognition of dynamic central airway collapse during respiration associated with multiple respiratory symptoms has become more commonly appreciated. Expiratory central airway collapse may represent the answer to this diagnostic void. Expiratory central airway collapse is an underdiagnosed disorder that can coexist with and mimic asthma, chronic obstructive pulmonary disease, and bronchiectasis. Awareness of expiratory central airway collapse and its spectrum of symptoms is paramount to its recognition. This review includes clear definitions, diagnostics, and therapeutics for this challenging condition. We performed a narrative review through the PubMed (MEDLINE) database using the following MeSH terms: airway collapse, tracheobronchomalacia, tracheomalacia, and bronchomalacia. We include reports from systematic reviews, narrative reviews, clinical trials, and observational studies from 2005 to 2020. Two reviewers evaluated potential references. No systematic reviews were found. A total of 28 references were included into our review. Included studies report experience in the diagnosis and/or treatment of dynamic central airway collapse; case reports and non-English or non-Spanish studies were excluded. We describe the current diagnostic dilemma, highlighting the role of dynamic bronchoscopy and tracheobronchial stent trial; outline the complex therapeutic options (eg, tracheobronchoplasty); and present future directions and challenges.

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Section: Diagnosismentioning

confidence: 99%

Section: Diagnosismentioning

confidence: 99%

Section: Diagnosismentioning

confidence: 99%

mentioning

confidence: 99%

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Central Airway Collapse, an Underappreciated Cause of Respiratory Morbidity

Abia‐Trujillo

Majid

Johnson

et al. 2020

Mayo Clinic Proceedings

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“…1 Long-term management includes treatment of underlying conditions, noninvasive positive pressure ventilation, airway stenting, and surgical stabilization. 3 Although uncommon, expiratory central airway collapse should be considered on the differential for ventilatory difficulty and refractory hypoxia after the induction of anesthesia.…”

mentioning

confidence: 99%

Excessive Dynamic Airway Collapse with Induction of Anesthesia

et al. 2022

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Long‐term pneumatic stenting with positive expiratory pressure therapy for severe expiratory central airway collapse

Funes‐Ferrada,

Barrios‐Ruiz,

Yu Lee‐Mateus

et al. 2024

Respirology Case Reports

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Expiratory central airway collapse (ECAC) comprising excessive central airway collapse (EDAC) and tracheobronchomalacia. Treatment is challenging for severe cases that are not candidates for surgical management. We report a case of severe ECAC successfully managed with continuous positive airway pressure (CPAP) therapy. A 75‐year‐old female patient status post right pneumonectomy, presented with chronic cough. Dynamic bronchoscopy evaluation showed severe EDAC which improved with intraprocedural noninvasive positive pressure (NIPPV) therapy. Due to patients' comorbidities, she was not a candidate to surgical tracheobronchoplasty. Therefore, we attempted pneumatic stenting with long‐term CPAP therapy resulting in improvement of symptoms and functional capacity. The long‐term efficacy of pneumatic stenting has not been clearly established yet. Literature review of management of ECAC with NIPPV consist primarily of case reports and there is only one clinical trial being conducted to assess the efficacy of CPAP therapy in ECAC. While NIPPV arises as a sufficient alternative for management of severe ECAC, larger scale studies are needed to prove the real efficacy of NIPPV in this setting.

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Expiratory Central Airway Collapse in Adults: Corrective Treatment (Part 2)

Cited by 6 publications

References 42 publications

Central Airway Collapse, an Underappreciated Cause of Respiratory Morbidity

Central Airway Collapse, an Underappreciated Cause of Respiratory Morbidity

Excessive Dynamic Airway Collapse with Induction of Anesthesia

Long‐term pneumatic stenting with positive expiratory pressure therapy for severe expiratory central airway collapse

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