Tracheobronchomalacia/excessive dynamic airway collapse in patients with chronic obstructive pulmonary disease with persistent expiratory wheeze: A pilot study

Abstract

Background:Tracheobronchomalacia (TBM) refers to a condition in which structural integrity of cartilaginous wall of trachea is lost. Excessive dynamic airway collapse (EDAC) is characterized by excessive invagination of posterior wall of trachea. In both these conditions, airway lumen gets compromised, especially during expiration, which can lead to symptoms such as breathlessness, cough, and wheezing. Both these conditions can be present in obstructive lung diseases; TBM due to chronic airway inflammation and EDAC due to dynamic compressive forces during expiration. The present study was planned with the hypothesis that TBM/EDAC could also produce expiratory wheeze in patients with obstructive airway disorders. Hence, prevalence and factors affecting presence of this entity in patients with obstructive airway diseases were the aims and objectives of this study.Materials and Methods:Twenty-five patients with obstructive airway disorders (chronic obstructive pulmonary disease [COPD] or bronchial asthma), who were stable on medical management, but having persistent expiratory wheezing, were included in the study. They were evaluated for TBM/EDAC by bronchoscopy and computed tomographic scan of chest. The presence of TBM/EDAC was correlated with variables including age, sex, body mass index (BMI), smoking index, level of dyspnea, and severity of disease.Results:Mean age of the patients was 62.7 ± 7.81 years. Out of 25 patients, 14 were males. TBM/EDAC was found in 40% of study subjects. Age, sex, BMI, severity of disease, frequency of exacerbations and radiological findings etc., were not found to have any association with presence of TBM/EDAC.Conclusion:TBM/EDAC is common in patients with obstructive airway disorders and should be evaluated in these patients, especially with persistent expiratory wheezing as diagnosis of this entity could provide another treatment option in these patients with persistent symptoms despite medical management.

Detection and diagnosis of large airway collapse: a systematic review

“…Eight studies instructed the participants to breath in, hold (for a count of 2 [ 28 ]) and blow out [ 21 , 24 , 26 , 29 – 32 ]. Two studies requested patients to breathe deeply twice, then to exhale as completely as possible before performing a breath-hold, at which point the imaging commenced [ 33 , 34 ], or to take a deep breath in, blow out all the way and hold breath (four studies; 25%) [ 35 – 38 ]. M c D ermott et al .…”

“…Thirteen studies reported the prevalence of LAC in patients with chronic airway diseases or smokers, including COPD [ 6 , 7 , 24 , 33 , 34 , 42 , 43 , 44 ], asthma [ 7 , 34 ], cystic fibrosis [ 39 ], emphysema [ 45 , 46 ], bronchiectasis [ 36 ] or pulmonary sarcoidosis [ 35 ]. We performed a meta-analysis for LAC prevalence in eight studies of patients either with COPD or asthma, as the number of studies on other respiratory conditions such as cystic fibrosis, emphysema or bronchiectasis was too small.…”

“…We performed a meta-analysis for LAC prevalence in eight studies of patients either with COPD or asthma, as the number of studies on other respiratory conditions such as cystic fibrosis, emphysema or bronchiectasis was too small. The studies included in the meta-analysis are summarised in supplementary e-table 4 , and most of them utilised a >50% reduction [ 6 , 7 , 33 , 34 , 42 , 43 , 44 ]. LAC was found in 27% (95% CI: 11–46%; I 2 =97%) of the included patients ( figure 4 ).…”

Tracheobronchomalacia following allogeneic haematopoietic stem cell transplantation

“…TBM is characterized by a loss of cartilaginous integrity of the trachea or bronchi 6 . TBM is caused by the pathological collapse of airway lumen at the anterolateral wall, resulting in symptoms such as intractable cough, wheezing, dyspnea, and recurrent bronchitis or pneumonia 7,8 . In contrast, BOS is the most prevalent late noninfectious pulmonary complication in patients who underwent allogeneic HSCT 3,4 .…”

Author's reply to concern on excessive dynamic airway collapse and wheeze

“…We highly appreciate the keen interest you have shown in our study. [ 1 ] Your point about the definition (by ATS) and theory of origin of wheeze technically appear correct. [ 2 ] However, let me explain how the idea of this study came to our mind.…”