Tracheobronchomalacia treatment: how far have we come?

López-Padilla, Daniel; García-Luján, Ricardo; Poch, Eduardo de Miguel

doi:10.21037/jtd.2016.12.91

Cited by 7 publications

(13 citation statements)

References 22 publications

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“…TBM and EDAC have been described in the literature as two separate pathophysiological causes of central airway expiratory dynamic obstruction or otherwise collectively described as excessive central airway collapse (ECAC) (3)(4)(5). EDAC is characterised by inward bulging of muscular fibres in the posterior airway membrane during exhalation, as in this case, whilst TBM is characterised by weakness of the anterior tracheobronchial cartilage wall that may present with or without excessive dynamic invagination of the posterior membranous wall (3).…”

Section: Discussionmentioning

confidence: 99%

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

Olley¹,

Steier²,

Kaltsakas³

2023

J Thorac Dis

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Excessive dynamic airway collapse (EDAC) and tracheobronchomalacia (TBM) cause debilitating symptoms yet are often misdiagnosed as asthma or chronic obstructive pulmonary disease (COPD). EDAC/ TBM should be considered in all cases of obstructive ventilatory defect refractory to medical management.Diagnosis is made with flexible bronchoscopy and/or inspiratory and expiratory phase computed tomography (CT) scans. Treatment should be individualised and "pneumatic stenting" with the use of continuous positive airway pressure (CPAP) may lead to symptomatic relief, and in some cases regardless of the degree of collapse or absence of sleep disordered breathing in overnight oximetry. The case of a 63-year-old female referred to a tertiary respiratory department for a trial of CPAP due to EDAC is presented. Over the course of a few months, she had presented frequently to hospital with cough and shortness of breath which had been attributed to asthma. As she had not responded to treatment, an inpatient flexible bronchoscopy was performed which identified EDAC of the right main bronchus and she was referred to a tertiary ventilation department. Despite a normal sleep study whilst self-ventilating, nocturnal CPAP therapy significantly improved quality and duration of sleep, daytime symptoms and therefore quality of life. She was discharged with nocturnal CPAP and remains adherent to treatment.

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Section: Discussionmentioning

confidence: 99%

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

Olley¹,

Steier²,

Kaltsakas³

2023

J Thorac Dis

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“…We will discuss both approaches in this series, but regardless, a thorough evaluation of who will benefit from TBP is paramount to ensure optimal outcomes. A short-term stent trial for 7 to 14 days is the only method practiced by most centers to establish which patients will benefit from TBP (1,2,18).…”

Section: Discussionmentioning

confidence: 99%

Endoscopic management of patients with excessive central airway collapse: a narrative review

Kheir¹,

Uribe²,

Thakore³

et al. 2022

J Vis Surg

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To provide a narrative review of the novel endoscopic approaches available in the literature for the treatment of excessive central airway collapse (ECAC). ECAC is characterized by excessive expiratory collapse of the central airway which can lead to dyspnea, cough, difficulty clearing secretions and recurrent respiratory infections. Surgical stabilization of the airway via tracheobronchoplasty (TBP) has been considered the standard of care for patients who have severe symptomatic ECAC despite optimal medical management. However, a significant proportion of patients are not adequate candidates for surgery. We performed a systematic search of MEDLINE/PubMed and ClinicalTrials.gov databases, then narrative reviews of identified reports, focusing on those published in the last 10 years. Of 129 references to ECAC from a MEDLINE/PubMed search, 54 were from the last 10 years and 30 were the focus of this review.Further cross reference was made to ClinicalTrials.gov for 1 study, however the results have not yet been published and the study is currently underway. Endoscopic thermo-ablative techniques such as argon plasma coagulation (APC) has been evaluated in ex-vivo as well as in-vivo models, showing promising results; However human studies are underway. Laser TBP and custom designed stents are currently under development, although the evidence is limited to case reports and case series. Novel endoscopic treatments are promising for the treatment of ECAC. However, more studies are needed to prove efficacy.

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“…The addition of CPAP as an airway clearance adjunct is based on the theory that CPAP may work as a “pneumatic splint”, helping to prevent dynamic airways collapse as flow and effort increase [ 10 , 51 ]. Physiological increases in flow at FRC arise secondarily to an increase in lung volume with CPAP [ 52 ]. This may help in generating higher elastic recoil and increased expiratory flow [ 53 ].…”

Section: The Abc Model Of Physiotherapy Assessmentmentioning

confidence: 99%