Nocturnal continuous positive airway pressure offers symptomatic benefit in excessive dynamic airway collapse despite normal sleep study

Olley, Louise; Steier, Joerg; Kaltsakas, Georgios

doi:10.21037/jtd-22-1804

Cited by 2 publications

(1 citation statement)

References 5 publications

(20 reference statements)

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“…Olley et al, reported a case of EDAC managed with pneumatic stenting with nocturnal CPAP which significantly improved quality and duration of sleep, daytime symptoms and quality of life. ( 13 ) Park et al reported a case of severe EDAC managed with HFNOT as a measure of applying intermittent positive end expiratory pressure to successfully overcome the collapse of the airway, improving CO 2 retention and expectoration ( 14 ). There is an ongoing clinical trial studying the effect of CPAP on 6–minute walk test outcomes in patients with ECAC that could provide further details into the physiologic effects of pneumatic stenting ( 15 ).…”

Section: Discussionmentioning

confidence: 99%

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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Section: Discussionmentioning

confidence: 99%

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

View full text Add to dashboard Cite

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Feasibility of continuous bronchoscopy during exercise in the assessment of large airway movement in healthy subjects

Williams,

Orton,

Garner

et al. 2024

Journal of Applied Physiology

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Excessive dynamic airway collapse (EDAC) is a recognized cause of exertional dyspnea arising due to invagination of the trachea and/ or main bronchi. EDAC is typically assessed by evaluating large airway movement with forced expiratory maneuvers. This differs from the respiratory response to exercise hyperpnea. We aimed to evaluate large airway movement during physical activity, with continuous bronchoscopy during exercise (CBE), in healthy subjects and compare findings with resting bronchoscopic maneuvers and imaging techniques. Twenty-eight individuals were recruited to complete two visits including treadmill-based CBE, to voluntary exhaustion and cine magnetic resonance imaging (MRI) with forced expiratory maneuvers at rest. 25 subjects (aged 29 (26 - 33) years, 52% female) completed the study (n=2 withdrew before bronchoscopy, and one was unable to tolerate insertion of bronchoscope). The majority (76%) achieved a peak heart rate of >90% predicted during CBE. The procedure was prematurely terminated in five subjects (n=3; elevated blood pressure and n=2; minor oxygen desaturation). The CBE assessment enabled adequate tracheal visualization in all cases. Excessive dynamic airway collapse (tracheal collapse ≥50%) was identified in 16 subjects (64%) on MRI, and in 6 (24%) individuals during resting bronchoscopy, but in no cases with CBE. No serious adverse events were reported, but minor adverse events were evident. The CBE procedure permits visualization of large airway movement during physical activity. In healthy subjects, there was no evidence of EDAC during strenuous exercise, despite evidence during forced maneuvers on imaging, thus challenging conventional approaches to diagnosis.

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Nocturnal continuous positive airway pressure offers symptomatic benefit in excessive dynamic airway collapse despite normal sleep study

Cited by 2 publications

References 5 publications

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

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

Feasibility of continuous bronchoscopy during exercise in the assessment of large airway movement in healthy subjects

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