Download PDF
Semin Respir Crit Care Med 2018; 39(06): 667-673
DOI: 10.1055/s-0038-1676571
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Tracheobronchomalacia and Excessive Dynamic Airway Collapse: Medical and Surgical Treatment

Fayez Kheir
1   Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
2   Division of Pulmonary Diseases, Critical Care and Environmental Medicine, Tulane University Health Sciences Center, New Orleans, Louisiana
,
Adnan Majid
1   Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
› Author Affiliations
Further Information

Publication History

Publication Date:
14 January 2019 (online)

    Permissions and Reprints

Abstract

Excessive central airway collapse (ECAC) is characterized by excessive narrowing of the airway lumen during exhalation leading to dyspnea, cough, mucostasis, recurrent respiratory infections, and poor quality of life. Tracheobronchomalacia and excessive dynamic airway collapse are heterogeneous entities of ECAC and are characterized by a diverse nonspecific symptom profile. Although the pathophysiology of airway mechanics as well as morphology in both entities is different, current evidence so far shows no practical benefit in making such distinction since both have similar symptoms and the diagnostic and therapeutic work-ups are the same. The diagnosis of ECAC should be based on dynamic flexible bronchoscopy and/or dynamic computed tomography scan as well as clinical symptoms that are not fully explained by other lung diseases. Initial treatment of symptomatic ECAC includes treatment of coexisting conditions (such as chronic obstructive pulmonary disease, asthma, gastroesophageal reflux disease, and vocal cord dysfunction) and supportive treatment of dynamic central airway collapse (antibiotics for respiratory infections, aggressive therapy, pulmonary physiotherapy, pulmonary rehabilitation, and continuous positive airway pressure). A short-term stent trial in selected patients with severe symptomatic ECAC is needed to assess whether patients will have improvement in symptoms and thus identify patients who will benefit from surgical central airway stabilization. A multidisciplinary airway team in highly specialized centers with experience in the evaluation and treatment of this patient population is essential for optimal outcomes.

Keywords

excessive central airway collapse - tracheobronchomalacia - excessive dynamic airway collapse
 

  • References

  • 1 Buitrago DH, Wilson JL, Parikh M, Majid A, Gangadharan SP. Current concepts in severe adult tracheobronchomalacia: evaluation and treatment. J Thorac Dis 2017; 9 (01) E57-E66
    CrossrefPubMedGoogle Scholar
  • 2 Murgu S, Colt H. Tracheobronchomalacia and excessive dynamic airway collapse. Clin Chest Med 2013; 34 (03) 527-555
    CrossrefPubMedGoogle Scholar
  • 3 Ridge CA, O'donnell CR, Lee EY, Majid A, Boiselle PM. Tracheobronchomalacia: current concepts and controversies. J Thorac Imaging 2011; 26 (04) 278-289
    CrossrefPubMedGoogle Scholar
  • 4 Carden KA, Boiselle PM, Waltz DA, Ernst A. Tracheomalacia and tracheobronchomalacia in children and adults: an in-depth review. Chest 2005; 127 (03) 984-1005
    CrossrefPubMedGoogle Scholar
  • 5 Jokinen K, Palva T, Nuutinen J. Chronic bronchitis. A bronchologic evaluation. ORL J Otorhinolaryngol Relat Spec 1976; 38 (03) 178-186
    CrossrefPubMedGoogle Scholar
  • 6 Palombini BC, Villanova CA, Araújo E. , et al. A pathogenic triad in chronic cough: asthma, postnasal drip syndrome, and gastroesophageal reflux disease. Chest 1999; 116 (02) 279-284
    CrossrefPubMedGoogle Scholar
  • 7 Ikeda S, Hanawa T, Konishi T. , et al. [Diagnosis, incidence, clinicopathology and surgical treatment of acquired tracheobronchomalacia]. Nihon Kyobu Shikkan Gakkai Zasshi 1992; 30 (06) 1028-1035
    PubMedGoogle Scholar
  • 8 Ochs RA, Petkovska I, Kim HJ, Abtin F, Brown M, Goldin J. Prevalence of tracheal collapse in an emphysema cohort as measured with end-expiration CT. Acad Radiol 2009; 16 (01) 46-53
    CrossrefPubMedGoogle Scholar
  • 9 Boiselle PM, O'Donnell CR, Bankier AA. , et al. Tracheal collapsibility in healthy volunteers during forced expiration: assessment with multidetector CT. Radiology 2009; 252 (01) 255-262
    CrossrefPubMedGoogle Scholar
  • 10 Litmanovich D, O'Donnell CR, Bankier AA. , et al. Bronchial collapsibility at forced expiration in healthy volunteers: assessment with multidetector CT. Radiology 2010; 257 (02) 560-567
    CrossrefPubMedGoogle Scholar
  • 11 O'Donnell CR, Litmanovich D, Loring SH, Boiselle PM. Age and sex dependence of forced expiratory central airway collapse in healthy volunteers. Chest 2012; 142 (01) 168-174
    CrossrefPubMedGoogle Scholar
  • 12 Woodring JH, Howard II RS, Rehm SR. Congenital tracheobronchomegaly (Mounier-Kuhn syndrome): a report of 10 cases and review of the literature. J Thorac Imaging 1991; 6 (02) 1-10
    PubMedGoogle Scholar
  • 13 Murgu SD, Colt HG. Tracheobronchomalacia and excessive dynamic airway collapse. Respirology 2006; 11 (04) 388-406
    CrossrefPubMedGoogle Scholar
  • 14 Majid A, Gaurav K, Sanchez JM. , et al. Evaluation of tracheobronchomalacia by dynamic flexible bronchoscopy. A pilot study. Ann Am Thorac Soc 2014; 11 (06) 951-955
    CrossrefPubMedGoogle Scholar
  • 15 Ciet P, Boiselle PM, Michaud G, O'Donnell C, Litmanovich DE. Optimal imaging protocol for measuring dynamic expiratory collapse of the central airways. Clin Radiol 2016; 71 (01) e49-e55
    CrossrefPubMedGoogle Scholar
  • 16 Zhang J, Hasegawa I, Feller-Kopman D, Boiselle PM. 2003 AUR Memorial Award. Dynamic expiratory volumetric CT imaging of the central airways: comparison of standard-dose and low-dose techniques. Acad Radiol 2003; 10 (07) 719-724
    CrossrefPubMedGoogle Scholar
  • 17 Lee KS, Sun MRM, Ernst A, Feller-Kopman D, Majid A, Boiselle PM. Comparison of dynamic expiratory CT with bronchoscopy for diagnosing airway malacia: a pilot evaluation. Chest 2007; 131 (03) 758-764
    CrossrefPubMedGoogle Scholar
  • 18 Gangadharan SP, Bakhos CT, Majid A. , et al. Technical aspects and outcomes of tracheobronchoplasty for severe tracheobronchomalacia. Ann Thorac Surg 2011; 91 (05) 1574-1580 , discussion 1580–1581
    CrossrefPubMedGoogle Scholar
  • 19 Majid A, Kheir F, Alape D. , et al. The prevalence of gastroesophageal reflux in patients with excessive central airway collapse. Chest 2018
    PubMedGoogle Scholar
  • 20 Tamura Y, Sakatani K, Yamakoshi N. , et al. [A case of severe COPD associated with tracheo-bronchial stenosis, treated with non-invasive positive pressure ventilation]. Nihon Kokyuki Gakkai Zasshi 2008; 46 (11) 915-920
    PubMedGoogle Scholar
  • 21 Ferguson GT, Benoist J. Nasal continuous positive airway pressure in the treatment of tracheobronchomalacia. Am Rev Respir Dis 1993; 147 (02) 457-461
    CrossrefPubMedGoogle Scholar
  • 22 Adliff M, Ngato D, Keshavjee S, Brenaman S, Granton JT. Treatment of diffuse tracheomalacia secondary to relapsing polychondritis with continuous positive airway pressure. Chest 1997; 112 (06) 1701-1704
    CrossrefPubMedGoogle Scholar
  • 23 Patout M, Mylott L, Kent R, Arbane G, Murphy PB, Hart N. Trial of portable continuous positive airway pressure for the management of tracheobronchomalacia. Am J Respir Crit Care Med 2016; 193 (10) e57
    CrossrefPubMedGoogle Scholar
  • 24 Kheir F, Alape D, Gangadharan S. , et al. Predictors of positive stent trial in patients with excessive central airway collapse. Chest 2018; 154 (04) 44A-45A
    CrossrefPubMedGoogle Scholar
  • 25 Ernst A, Majid A, Feller-Kopman D. , et al. Airway stabilization with silicone stents for treating adult tracheobronchomalacia: a prospective observational study. Chest 2007; 132 (02) 609-616
    CrossrefPubMedGoogle Scholar
  • 26 Majid A, Guerrero J, Gangadharan S. , et al. Tracheobronchoplasty for severe tracheobronchomalacia: a prospective outcome analysis. Chest 2008; 134 (04) 801-807
    CrossrefPubMedGoogle Scholar
  • 27 Ernst A, Odell DD, Michaud G, Majid A, Herth FF, Gangadharan SP. Central airway stabilization for tracheobronchomalacia improves quality of life in patients with chronic obstructive pulmonary disease. Chest 2011; 140: 1162-1168
    CrossrefPubMedGoogle Scholar
  • 28 Majid A, Alape D, Kheir F. , et al. Short-term use of uncovered self-expanding metallic airway stents for severe expiratory central airway collapse. Respiration 2016; 92 (06) 389-396
    CrossrefPubMedGoogle Scholar
  • 29 Wright CD, Mathisen DJ. Tracheobronchoplasty for tracheomalacia. Ann Cardiothorac Surg 2018; 7 (02) 261-265
    CrossrefPubMedGoogle Scholar
  • 30 Buitrago DH, Majid A, Alape DE. , et al. Single-center experience of tracheobronchoplasty for tracheobronchomalacia: perioperative outcomes. Ann Thorac Surg 2018; 106 (03) 909-915
    CrossrefPubMedGoogle Scholar
  • 31 Bezuidenhout AF, Boiselle PM, Heidinger BH. , et al. Longitudinal follow-up of patients with tracheobronchomalacia after undergoing tracheobronchoplasty: computed tomography findings and clinical correlation. J Thorac Imaging 2018
    PubMedGoogle Scholar
  • 32 Castellanos P, Mk M, Atallah I. Laser tracheobronchoplasty: a novel technique for the treatment of symptomatic tracheobronchomalacia. Eur Arch Otorhinolaryngol 2017; 274 (03) 1601-1607
    CrossrefPubMedGoogle Scholar
  • 33 Dutau H, Maldonado F, Breen DP, Colchen A. Endoscopic successful management of tracheobronchomalacia with laser: apropos of a Mounier-Kuhn syndrome. Eur J Cardiothorac Surg 2011; 39 (06) e186-e188
    CrossrefPubMedGoogle Scholar
  • 34 Schweiger T, Gildea TR, Prosch H, Lang G, Klepetko W, Hoetzenecker K. Patient-specific, 3-dimensionally engineered silicone Y-stents in tracheobronchomalacia: clinical experience with a novel type of airway stent. J Thorac Cardiovasc Surg 2018; 156 (05) 2019-2021
    CrossrefPubMedGoogle Scholar
  • 35 Morrison RJ, Hollister SJ, Niedner MF. , et al. Mitigation of tracheobronchomalacia with 3D-printed personalized medical devices in pediatric patients. Sci Transl Med 2015; 7 (285) 285ra64
    CrossrefPubMedGoogle Scholar
  • 36 Lazar JF, Posner DH, Palka W, Spier LN, Lazzaro RS. Robotically assisted bilateral bronchoplasty for tracheobronchomalacia. Innovations (Phila) 2015; 10 (06) 428-430
    CrossrefPubMedGoogle Scholar
  • 37 Satake R, Komura M, Komura H. , et al. Patch tracheoplasty in body tissue engineering using collagenous connective tissue membranes (biosheets). J Pediatr Surg 2016; 51 (02) 244-248
    CrossrefPubMedGoogle Scholar