Central Airway Stabilization for Tracheobronchomalacia Improves Quality of Life in Patients With COPD

Ernst, Armin; Odell, David D.; Michaud, Gaëtane; Majid, Adnan; Herth, Felix; Gangadharan, Sidhu P.

doi:10.1378/chest.10-3051

Cited by 58 publications

(55 citation statements)

References 19 publications

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“…Dynamic flexible bronchoscopy (20) is currently the gold standard for diagnosing TBM since it permits real-time examination of the airways and accurately captures dynamic airway properties, with reproducible valid results in regard to information on morphology, degree, extent, and location of pathology (21). At BIDMC, patients undergo bronchoscopy under minimal sedation using intravenous midazolam and fentanyl to allow them to follow commands.…”

Section: Diagnostic Interventionsmentioning

confidence: 99%

“…At this point, patients are instructed to inhale deeply, hold it and then forcefully exhale (forced expiratory maneuver). Samples of imaging are obtained at six different locations in the tracheobronchial tree (proximal trachea, mid-trachea, distal trachea, right main stem bronchus, bronchus intermedius and left main stem bronchus) and evaluated for degree of luminal narrowing in the anteroposterior diameter (9,21). In addition, dynamic flexible bronchoscopy facilitates the detection of coexisting pathology such as vocal cord abnormalities or bronchitis and permits biopsy of the mucosa as well as sputum sampling for histological and microbiologic analysis.…”

Section: Diagnostic Interventionsmentioning

confidence: 99%

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Current concepts in severe adult tracheobronchomalacia: evaluation and treatment

et al. 2017

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Section: Diagnostic Interventionsmentioning

confidence: 99%

Section: Diagnostic Interventionsmentioning

confidence: 99%

Current concepts in severe adult tracheobronchomalacia: evaluation and treatment

et al. 2017

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“…Of those patients who responded positively to the stent trial, 80% will have improvements in quality of life after tracheobronchoplasty (12,13). Stent placement leads to improvements in respiratory symptoms, quality of life, and functional status in patients with ECAC (10).…”

Section: Patient Selection and Workupmentioning

confidence: 99%

“…Despite limited data on longterm outcomes and complications after stent placement, our preference is to avoid definitive treatment of ECAC by stenting in patients who are able to undergo definitive surgical treatment because many patients will develop a stent-related complication after approximately 2 weeks. Patients treated with airway stents for long term airway stabilization can develop significant granulation tissue at the proximal and distal ends of the stent leading to worsening airway stenosis and symptoms (10,13). Some patients will experience significant improvements during a stent trial but will be deemed poor surgical candidates for tracheobronchoplasty or will choose to defer surgical intervention.…”

Section: Patient Selection and Workupmentioning

confidence: 99%

Airway stenting in excessive central airway collapse

Parikh¹,

Wilson²,

Majid³

et al. 2017

J. Vis. Surg.

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In tracheobronchomalacia (TBM) and other disorders, weakened airway walls lead to expiratory central airway collapse (ECAC) and can cause symptoms of cough, dyspnea, retained secretions, and recurrent pulmonary infections. Diagnosis of severe ECAC is based on the presence of >90% expiratory airway collapse on dynamic computed tomography (CT) and/or bronchoscopy. We offer patients with severe ECAC a trial of airway stenting to determine whether splinting of the central airways leads to improvements in symptoms, quality of life, exercise capacity, or respiratory function. Patients who respond positively to airway stenting are considered for tracheobronchoplasty.

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“…During recent years, various stents have been used for this indication [61,65]. It is difficult, however, to draw conclusions about the efficacy of endoluminal stents pertaining only to TBM and excessive dynamic airway collapse based on available data [61].…”

Section: Tracheobronchomalaciamentioning

confidence: 99%

The use of self-expandable metallic stents in the airways in the adult population

Dutau¹,

Musani

Plojoux³

et al. 2014

Expert Review of Respiratory Medicine

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The airway stents restore patency in the face of luminal compromise from intrinsic and/or extrinsic pathologies. Luminal compromise beyond 50% often leads to debilitating symptoms such as dyspnea. Silicone stents remain the most commonly placed stents worldwide and have been the "gold standard" for the treatment of benign and malignant airway stenoses over the past 20 years. Nevertheless, silicone stents are not the ideal stents in all situations. Metallic stents can serve better in some selected conditions. Unlike silicone stents, there are large and increasing varieties of metallic stents available on the market. The lack of prospective or comparative studies between various types of metallic stents makes the choice difficult and expert-opinion based. International guidelines are sorely lacking in this area.KEYWORDS: airway stenting . benign airway stenosis . bronchoscopy . central airway obstruction . self-expandable metallic stentDumon was the first physician to place a dedicated and specially designed airway stent in 1987 in Marseille. This dedicated stent consisted of a silicone tube with small studs on the external surface to reduce migration [1]. Consequently, several companies started to develop other airway stents with silicone and metal. In the last 20 years, numerous reports have been published about the use of selfexpanding and balloon expandable metal stents for the treatment of tracheobronchial malignant and benign stenoses, tracheobronchomalacia (TBM), fistulas and dehiscences [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16].Self-expandable stents are made of a shapememory alloy, generally nitinol (nickel-titanium). When the stent is released, it expands spontaneously to reach its original shape and diameter. On the other hand, balloon expandable metallic stents (the first generation of airway metallic stents) were made of metal (steel) meshes that did not possess a memory shape. A balloon was then necessary to deploy them. Most of these stents had originally been developed for use in the vascular system but were found to be adequate for placement in the central airways after only minor modifications, if any at all. The latest developments include stents made of shape memory alloys and composite stents made from metals and polymers [17][18][19]. But, so far, the Dumon stent (Tracheobronxane Ò , Novatech, La Ciotat, France) remains the most commonly placed stent worldwide. Dumon stents have been the 'gold standard' for the treatment of benign and malignant airway stenoses over the past 20 years [20,21], with two specific designs: straight and Y-shaped (for disease involving the carina) [22]. By the way, it is interesting to notice that, in the Thoracic Endoscopy Unit of Marseille, where the Dumon stent was conceptualized and used, the percentage of silicone stent placement has dropped from 100% in 2000 to 65% in 2013. The remaining 35% of the stents used are now fully covered, selfexpandable, metallic stents (SEMS). This goes to prove that the Dumon stents are not the ideal stents in all situa...

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Central Airway Stabilization for Tracheobronchomalacia Improves Quality of Life in Patients With COPD

Cited by 58 publications

References 19 publications

Current concepts in severe adult tracheobronchomalacia: evaluation and treatment

Current concepts in severe adult tracheobronchomalacia: evaluation and treatment

Airway stenting in excessive central airway collapse

The use of self-expandable metallic stents in the airways in the adult population

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