Tracheobronchomalacia and Excessive Dynamic Airway Collapse

Murgu, Septimiu; Colt, Henri G.

doi:10.1016/j.ccm.2013.05.003

Cited by 139 publications

(153 citation statements)

References 111 publications

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“…TBM is characterized by softening of the tracheobronchial cartilaginous structures, while EDAC is described as atrophy of the muscular fibers in the posterior membranous wall [1,2,3]. Although the pathophysiology of airway mechanics in TBM and EDAC is different, the clinical characteristics and therapeutic approach are similar [4,5,6].…”

Section: Introductionmentioning

confidence: 99%

Short-Term Use of Uncovered Self-Expanding Metallic Airway Stents for Severe Expiratory Central Airway Collapse

Majid

Alape²,

Kheir³

et al. 2016

Respiration

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Background: Patients with severe symptomatic expiratory central airway collapse (ECAC) undergo a stent trial to determine whether they are candidate for tracheobronchoplasty. Most stent trials were done using silicone stents. However, there was a higher number of silicone stent-related complications. Objectives: The aim of this study was to evaluate the safety and efficacy of short-term uncovered self-expanding metallic airway stents (USEMAS) in patients with ECAC. Methods: This was a retrospective review. Baseline measurements were compared to those obtained after 7-14 days. Measurements included: Modified Medical Research Council (mMRC), Cough Quality of Life Questionnaire (CQLQ), spirometry testing, and 6-Minute Walk Test (6MWT). Stent- and procedure-related complications were reported. Results: 33 patients (median age, 52 years) underwent the USEMAS trial. Presenting symptoms were dyspnea in 100%, intractable cough in 90.3%, recurrent infection in 42.2%, and inability to clear secretions in 21.4%. Dyspnea, cough, and secretion clearance improved in 88, 70, and 57%, respectively. Overall, there was a significant improvement in mMRC (p < 0.001), CQLQ (p = 0.015), and 6MWT (p = 0.015). There was 1 airway infection, 1 stent migration, and 1 pneumothorax. The median duration of USEMAS was 7 days. All stents were removed without any complications. At the time of stent removal, no granulation tissue was observed in 30.9%, and mild granulation tissue was observed in 69.1%. Conclusion: The short-term USEMAS trial improves respiratory symptoms, quality of life, and exercise capacity with few complications in patients with severe symptomatic ECAC when performed by a multidisciplinary airway team in highly specialized centers with experience in the evaluation and treatment of this patient population.

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Section: Introductionmentioning

confidence: 99%

Short-Term Use of Uncovered Self-Expanding Metallic Airway Stents for Severe Expiratory Central Airway Collapse

Majid

Alape²,

Kheir³

et al. 2016

Respiration

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“…There may be significant overlap between the two processes and it can be difficult to tell if an individual's dyspnea is related to EDAC-tracheobronchomalacia or other underlying disease [5].…”

Section: Discussionmentioning

confidence: 99%

“…The definition distinguishes this disorder from tracheobronchomalacia, which is characterized by loss of structural integrity of the cartilaginous rings [4]. EDAC is commonly associated with underlying airway disorders such as chronic obstructive pulmonary disease (COPD), asthma, and bronchiectasis [5]. Indeed, prior studies have not identified this disorder in the absence of underlying lung disease [5,7,8].…”

mentioning

confidence: 99%

“…EDAC is commonly associated with underlying airway disorders such as chronic obstructive pulmonary disease (COPD), asthma, and bronchiectasis [5]. Indeed, prior studies have not identified this disorder in the absence of underlying lung disease [5,7,8]. Excessive dynamic airway collapse is thought to result from interactions between pleural pressures, elastic recoil, airway compliance, and peripheral airway resistance.…”

mentioning

confidence: 99%

“…Current guidelines suggest that functional status (exertion, daily activities, or rest), length of the tracheobronchial wall affected, and degree of obliteration of the airway lumen are important to define [5]. Patients with moderate to severe EDAC typically present with cough, wheezing, dyspnea, or recurrent respiratory infections related to exacerbations of their lung disease or after mild to moderate exertion.…”

mentioning

confidence: 99%

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Exercise-associated Excessive Dynamic Airway Collapse in Military Personnel

Weinstein

Hull²,

Ritchie³

et al. 2016

Annals ATS

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Among 240 military personnel evaluated after presenting with postdeployment exertional dyspnea, a combination of symptoms, auscultatory findings, imaging, and visualization of the airways by bronchoscopy identified six individuals with excessive dynamic central airway collapse as the sole apparent cause of dyspnea. Exercise-associated excessive dynamic airway collapse should be considered in the differential diagnosis of exertional dyspnea.

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