Clinical course of tracheobronchopathia osteochondroplastica

Abstract

Background: Tracheobronchopathia osteochondroplastica (TPO) is characterized by the presence of diffuse cartilaginous or bony submucosal nodules that lead to airway lumen narrowing. So far, there was no study in South Korea analysing a large number of TPO patients. We aimed to elucidate its treatment strategy and clinical course by analysing the characteristics of TPO patients. Methods: In this retrospective study, we reviewed the clinical data of 40 patients diagnosed with TPO by bronchoscopy between October 1997 and April 2019 at a single referral hospital. Results: Of the 40 patients, 26 (65.0%) were male and the median age was 63.0 years. The most common symptom was cough (n=12, 30%). Pulmonary function test (PFT) revealed an obstructive pattern in 10 (25.7%) patients. Chest computed tomography (CT) scan showed 23 (62.6%) patients with diffuse narrowing and calcified nodules. In bronchoscopy, the entire trachea was found to be involved in 30 (75.0%) patients and airway narrowing was identified in 6 (15.0%) patients. Endobronchial biopsies were obtained from 15 patients and the most common findings included typical cartilaginous and bony tissues (n=14, 93.3%). Since most patients were asymptomatic or had mild symptoms, they did not undergo any specific treatment. Of the 19 symptomatic patients, 2 (5.0%) patients received laser therapy for treating tracheal stenosis. Conclusions: TPO is a slowly progressing disease and is well managed with conservative therapies.Although TPO shows a distinctive pattern by bronchoscopy, it follows a benign clinical course.

Tracheobronchopathia osteochondroplastica: clinical, bronchoscopic, and comorbid features in a case series

“…In our study and others [ 1 , 4 , 11 ], TO occurred in men and women in the same proportion. Compared to other series [ 1 , 4 – 6 , 11 ], our patients were more frequently smokers (56% vs 18–42%). Occupational exposure to inhaled irritants or pollutants was described in 60% of the cases.…”

“…The diagnosis of TO relies on bronchoscopy, which is frequently performed for another medical indication or non-specific symptoms. In our 19% of the subjects did not describe any respiratory symptom (5-52% in other series [1,4,6],). Our results and others [20][21][22][23] identified TO-related symptoms like chronic cough, dyspnea on exertion, hemoptysis, and dysphonia.…”

“…Our series of 36 cases of TO is one of the largest reported series [ 1 , 4 – 6 , 11 ]. Our results identified a typical clinical and bronchoscopic presentation of TO and suggested that no treatment might be required in most cases.…”

“…A standard form was used to retrospectively record from patients’ files the details of patients and TO characteristics, including demographics, smoking status, occupational exposure, medical history, respiratory symptoms, pulmonary function tests (PFT) results, and radiological and histological findings. Bronchoscopic data included TO location, tracheal stenosis, and classification depending on nodules concentration in the mucosa: scattered, diffuse or confluent [ 6 ]. When available, microbiologic results of bronchial aspiration conventional culture were recorded.…”

“…Since its first description more than a century ago [3], about 500 cases of TO have been published as observations or small series [1,[4][5][6]. No guidelines are currently available for its diagnosis and therapeutic management.…”