Tracheobronchopathy From Inhaled Corticosteroids

Husta, Bryan; Raoof, Suhail; Erzurum, Serpil C.; Mehta, Atul C.

doi:10.1016/j.chest.2017.08.013

Cited by 28 publications

(12 citation statements)

References 62 publications

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“…6,12 The etiology of ECAC is uncertain, but small airway obstruction, chronic inflammation, trauma or previous tracheostomy, relapsing polychondritis and other autoimmune diseases, COPD, asthma, obesity, and gastroesophageal reflux disease have been linked to the development of ECAC. 6,17 Notably, inhaled corticosteroids, commonly used in various airway diseases, have been postulated to have a causative role. 17 Hypothesized contributors to TBM include secondary injuries, such as infiltrative disorders, prolonged tracheal ischemia, or inhalation of toxins.…”

Section: Epidemiology and Etiologymentioning

confidence: 99%

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Central Airway Collapse, an Underappreciated Cause of Respiratory Morbidity

Abia‐Trujillo

Majid

Johnson

et al. 2020

Mayo Clinic Proceedings

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Dyspnea, cough, sputum production, and recurrent respiratory infections are frequently encountered clinical concerns leading patients to seek medical care. It is not unusual for a well-defined etiology to remain elusive or for the therapeutics of a presumed etiology to be incompletely effective. Either scenario should prompt consideration of central airway pathology as a contributor to clinical manifestations. Over the past decade, recognition of dynamic central airway collapse during respiration associated with multiple respiratory symptoms has become more commonly appreciated. Expiratory central airway collapse may represent the answer to this diagnostic void. Expiratory central airway collapse is an underdiagnosed disorder that can coexist with and mimic asthma, chronic obstructive pulmonary disease, and bronchiectasis. Awareness of expiratory central airway collapse and its spectrum of symptoms is paramount to its recognition. This review includes clear definitions, diagnostics, and therapeutics for this challenging condition. We performed a narrative review through the PubMed (MEDLINE) database using the following MeSH terms: airway collapse, tracheobronchomalacia, tracheomalacia, and bronchomalacia. We include reports from systematic reviews, narrative reviews, clinical trials, and observational studies from 2005 to 2020. Two reviewers evaluated potential references. No systematic reviews were found. A total of 28 references were included into our review. Included studies report experience in the diagnosis and/or treatment of dynamic central airway collapse; case reports and non-English or non-Spanish studies were excluded. We describe the current diagnostic dilemma, highlighting the role of dynamic bronchoscopy and tracheobronchial stent trial; outline the complex therapeutic options (eg, tracheobronchoplasty); and present future directions and challenges.

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Section: Epidemiology and Etiologymentioning

confidence: 99%

“…6,17 Notably, inhaled corticosteroids, commonly used in various airway diseases, have been postulated to have a causative role. 17 Hypothesized contributors to TBM include secondary injuries, such as infiltrative disorders, prolonged tracheal ischemia, or inhalation of toxins. 12…”

Section: Epidemiology and Etiologymentioning

confidence: 99%

Central Airway Collapse, an Underappreciated Cause of Respiratory Morbidity

Abia‐Trujillo

Majid

Johnson

et al. 2020

Mayo Clinic Proceedings

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“…TBM commonly manifests through an acquired etiology; that is, secondary to chronic obstructive pulmonary disease (COPD), relapsing polychondritis, tracheotomy, or chronic inhaled corticosteroid use. [1][2][3] Pathologically, severe TBM leads to atrophy of the posterior airway membrane and complete or nearcomplete collapse of the anterior tracheobronchial cartilage wall, ultimately attenuating dynamic airflow. 4 As a result, patients exhibit dyspnea, persistent cough, and are often predisposed to pneumonia and other respiratory infections.…”

Section: Perspectivementioning

confidence: 99%

First series of minimally invasive, robot-assisted tracheobronchoplasty with mesh for severe tracheobronchomalacia

Lazzaro

Patton

Lee

et al. 2019

The Journal of Thoracic and Cardiovascular Surgery

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Objective: Tracheobronchomalacia is a progressive, debilitating disease with limited treatment options. Open tracheobronchoplasty (TBP) is an accepted surgical option for management of severe tracheobronchomalacia. This study examined the outcomes of the first reported series of robot-assisted TBP (R-TBP). Methods:We retrospectively reviewed the records of patients with clinical suspicion for tracheobronchomalacia who had dynamic computed tomography scan and subsequent R-TBP from Results: Four hundred thirty-five patients underwent dynamic computed tomography scan for suspicion of tracheobronchomalacia. Of this group, 42 patients underwent R-TBP. In the surgery group, the median age was 66 years (interquartile range, 39-72 years) and there were 30 women (71%). Respiratory comorbidities included asthma (88%) and chronic obstructive pulmonary disease (52%). The median operative time was 249 minutes (interquartile range, 266-277 minutes). Median hospital length of stay was 3 days (interquartile range, 2-4.75 days), and there were 19 postoperative complications (11 minor and 8 major). There were no mortalities at 90 days. Comparison of preoperative and postoperative pulmonary function testing demonstrated improvement in forced expiratory volume at 1 second by 13.5% (P ¼ .01), forced vital capacity by 14.5% (P<.0001), and peak expiratory flow rate by 21.0% (P<.0001). Quality of life questionnaires also showed improvement with 82% reporting overall satisfaction with the procedure. Conclusions: R-TBP can be performed with low morbidity and mortality. Early follow-up reveals significant improvement in pulmonary function testing and high patient satisfaction when compared with preoperative baseline. Long-term follow-up is needed to demonstrate the durability of R-TBP and substantiate its role in the management of patients with symptomatic, severe tracheobronchomalacia. (J Thorac Cardiovasc Surg 2019;157:791-800) Preop Postop PEFR P < .0001 Percent Predicted 0 25 50 75 100 125 From the

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“…Считается, что примерно 25% больных БА не отвечают на действие ИГКС [7]. Опубликованы данные о возможных нежелательных эффектах, связанных с приемом ИГКС: инфекциях (пневмонии, кандидоз голосовых связок и полости рта, туберкулез, микобактериоз), системных эффектах ИГКС (остеопороз, катаракта и глаукома, надпочечниковая недостаточность), локальных эффектах ИГКС (дисфония) [6,[8][9][10].…”

Section: Introductionunclassified

Treatment approaches to asthma in adults and children: novel data

Churukina¹

2020

Russian Medical Review

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Бронхиальная астма (БА)-сложное гетерогенное хроническое воспалительное заболевание, имеющее высокую распространенность среди всех возрастных групп. Глобальная стратегия лечения и профилактики БА (GINA, 2019) определяет стратегию ведения и цели терапии данного заболевания, способы достижения общего контроля астмы, что означает контроль симптомов БА и снижение риска обострений. За последние десятилетия на порядок выросла доля пациентов с контролируемым течением заболевания, однако остается значительной доля пациентов, у которых не достигается контроль БА. На сегодняшний день для лечения пациентов с персистирующей БА рекомендуют базисную терапию препаратами ингаляционных глюкокортикостероидов (ИГКС), комбинаций ИГКС с β 2-агонистами длительного действия, которые имеют хороший профиль эффективности и безопасности. Антихолинергический препарат длительного действия тиотропия бромид рекомендован к применению у взрослых и детей старше 6 лет экспертами GINA, Российского респираторного общества и Педиатрического респираторного общества. Современные подходы к терапии БА не позволяют добиться успеха у всех пациентов, поэтому тиотропий становится новым инструментом для достижения контроля БА. В обзоре освещены фармакологические свойства тиотропия, представлены новые данные по его применению у больных БА, а также результаты собственного исследования автора.

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Tracheobronchopathy From Inhaled Corticosteroids

Cited by 28 publications

References 62 publications

Central Airway Collapse, an Underappreciated Cause of Respiratory Morbidity

Central Airway Collapse, an Underappreciated Cause of Respiratory Morbidity

First series of minimally invasive, robot-assisted tracheobronchoplasty with mesh for severe tracheobronchomalacia

Treatment approaches to asthma in adults and children: novel data

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