The Prevalence of Tracheobronchomalacia in Patients With Asthma or Chronic Obstructive Pulmonary Disease

Elastic Properties of the Central Airways in Obstructive Lung Diseases Measured Using Anatomical Optical Coherence Tomography

“…On the one hand, airway walls thickened by reticular basement membrane deposition of extracellular matrix, smooth muscle hyperplasia, and/or hypertrophy and extracellular edema would be stiffer, as has been demonstrated by several studies indicating reduced airway distensibility in asthma (1)(2)(3)(4). Conversely, the altered extracellular composition and architecture, cartilage degradation, and widespread elastolysis (5) seen in asthma, chronic obstructive pulmonary disease (COPD), and bronchiectasis could reduce airway wall elastance resulting in increased airway flaccidity and malacia (6)(7)(8). In addition to these intrinsic airway wall influences, airway caliber may be affected by changes in the radial traction exerted on the airway by the lung parenchyma (airway-parenchymal interdependence).…”

Commentary: Keepin' it real—the future is now

“…TBM is underdiagnosed and symptoms attributed to concomitant conditions may limit the search for and reporting of TBM: “It appears that either TBM or excessive dynamic airway collapse is present in approximately 4% to 23% of patients undergoing bronchoscopy for various indications.” 5 Additional studies “in the general population suggest that the overall incidence of TBM is 5% to 10%.” 6 In a retrospective review of patients admitted to a community hospital with a diagnosis of asthma or chronic obstructive pulmonary disease, who underwent computed tomography scan of the chest, Patel and colleagues 7 noted that 8.8% of these patients met the criteria for a radiologic diagnosis of TBM, which was reported by radiology in only 1.8%. When patients present with central airway collapse, TBM, and lower airway disease “it can be very problematic and challenging to sort out which disease is driving the patient's symptoms.” 8 Our institutional experience also notes that “TBM is a vastly underdiagnosed condition that has remained virtually untreated for decades and a robotic assisted approach to TBP can be performed with low morbidity and mortality.” 9 …”