Semin Respir Crit Care Med 2022; 43(04): 530-535
DOI: 10.1055/s-0042-1747937
Review Article

Nonmalignant Central Airway Obstruction: Options for Challenging Cases

David Abia-Trujillo
1   Divisions of Pulmonary, Allergy, Sleep Medicine & Respiratory Services, Mayo Clinic, Jacksonville, Florida
,
Sebastian Fernandez-Bussy
1   Divisions of Pulmonary, Allergy, Sleep Medicine & Respiratory Services, Mayo Clinic, Jacksonville, Florida
› Author Affiliations

Abstract

Benign central airway obstruction is commonly referred as nonmalignant central airway obstruction (NMCAO). This is in part related to its lack of benign nature and significant life-quality impairment in patients. It is a pathologic entity with various etiologies and therefore a wide range of therapeutic options are available. Evidence regarding the optimal management that could provide a sustained restoration of airway patency is lacking. The lack of a common pathophysiologic pathway translating into a nonspecific symptom presenting as NMCAO has complicated treatment standardization and subsequently limited solid research to favor of one approach over another one. Our intent is to describe the limited evidence of the most utilized nonsurgical treatment for NMCAO as well as some upcoming promising therapeutic options such as mitomycin C injection, microdebrider, biodegradable stents, radiotherapy, Hybrid Knife, and endoluminal spray cryotherapy. Our goal with this manuscript is to motivate other authors to venture into prospective, multicenter, open-label trials aimed to describe long-term outcomes in patients with NMCAO.



Publication History

Article published online:
21 June 2022

© 2022. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 
  • References

  • 1 Oberg CL, Holden VK, Channick CL. Benign central airway obstruction. Semin Respir Crit Care Med 2018; 39 (06) 731-746
  • 2 Chauhan K, Surmachevska N, Hanna A. Relapsing Polychondritis. Treasure Island, FL: StatPearls; 2021
  • 3 Huang Z, Wei P, Gan L. et al. Protective effects of different anti-inflammatory drugs on tracheal stenosis following injury and potential mechanisms. Mol Med Rep 2021; 23 (05) 314
  • 4 Murgu SD, Egressy K, Laxmanan B, Doblare G, Ortiz-Comino R, Hogarth DK. Central airway obstruction: benign strictures, tracheobronchomalacia, and malignancy-related obstruction. Chest 2016; 150 (02) 426-441
  • 5 Chen H, Zhang J, Qiu X. et al. Choice of bronchoscopic intervention working channel for benign central airway stenosis. Intern Emerg Med 2021; 16 (07) 1865-1871
  • 6 Agrawal A, Baird BJ, Madariaga MLL, Blair EA, Murgu S. Multi-disciplinary management of patients with benign airway strictures: a review. Respir Med 2021; 187: 106582
  • 7 Razi SS, Lebovics RS, Schwartz G. et al. Timely airway stenting improves survival in patients with malignant central airway obstruction. Ann Thorac Surg 2010; 90 (04) 1088-1093
  • 8 Abia-Trujillo D, Majid A, Johnson MM. et al. Central airway collapse, an underappreciated cause of respiratory morbidity. Mayo Clin Proc 2020; 95 (12) 2747-2754
  • 9 Emam W, Mostafa Y, Madkour A. et al. Bronchoscopic management as an alternative treatment in non-operable benign tracheal stenosis. Int J Clin Pract 2021; 75 (05) e14058
  • 10 Yin Y, Ma WH, Li W, Ma HF, Kang J, Herth FJF, Hou G. Hybrid Knife, a Novel Drug Delivery Tool for Treatment of Tracheal Stenosis: A Case Report. Ear Nose Throat J 2022; 101 (03) NP92-NP95 DOI: 10.1177/0145561320946649. Mar; Epub 2020 Aug 13
  • 11 Fan Y, Li X, Fang X. et al. Antifibrotic role of nintedanib in tracheal stenosis after a tracheal wound. Laryngoscope 2021; 131 (09) E2496-E2505
  • 12 Lee HJ, Labaki W, Yu DH. et al. Airway stent complications: the role of follow-up bronchoscopy as a surveillance method. J Thorac Dis 2017; 9 (11) 4651-4659
  • 13 Folch E, Keyes C. Airway stents. Ann Cardiothorac Surg 2018; 7 (02) 273-283
  • 14 Genden EM, Miles BA, Harkin TJ. et al. Single-stage long-segment tracheal transplantation. Am J Transplant 2021; 21 (10) 3421-3427
  • 15 Bondesson D, Schneider MJ, Silbernagel E, Behr J, Reichenberger F, Dinkel J. Automated evaluation of probe-based confocal laser endomicroscopy in the lung. PLoS One 2020; 15 (05) e0232847
  • 16 Rodrigues AJ, Takimura CK, Lemos Neto PA, Figueiredo VR. Optical coherence tomography in conjunction with bronchoscopy. J Bras Pneumol 2012; 38 (02) 174-180
  • 17 Tiran B, Parluk T, Kleinhendler E, Man A, Fomin I, Schwarz Y. Fiberoptic bronchoscopic submucosal injection of mitomycin C for recurrent bening tracheal stenosis: a case series. Isr Med Assoc J 2020; 22 (12) 757-760
  • 18 Feinstein AJ, Goel A, Raghavan G. et al. Endoscopic management of subglottic stenosis. JAMA Otolaryngol Head Neck Surg 2017; 143 (05) 500-505
  • 19 Yung KC, Chang J, Courey MS. A randomized controlled trial of adjuvant mitomycin-c in endoscopic surgery for laryngotracheal stenosis. Laryngoscope 2020; 130 (03) 706-711
  • 20 Smith ME, Elstad M. Mitomycin C and the endoscopic treatment of laryngotracheal stenosis: are two applications better than one?. Laryngoscope 2009; 119 (02) 272-283
  • 21 Davidson KR, Elmasri M, Wahidi MM, Shofer SL, Cheng GZ, Mahmood K. Management of lung transplant bronchial stenosis with mitomycin C. J Bronchology Interv Pulmonol 2019; 26 (02) 124-128
  • 22 Celebi OO, Song SA, Santeerapharp A, Choksawad K, Franco Jr RA. Assessment of side effects after serial intralesional steroid injections for idiopathic subglottic stenosis. Eur Arch Otorhinolaryngol 2021; 278 (02) 445-450
  • 23 Alrabiah A, Alsayed A, Aljasser A. et al. Effect of inhaled fluticasone propionate on laryngotracheal stenosis after balloon dilation: a randomized controlled trial. Eur Arch Otorhinolaryngol 2021; 278 (05) 1505-1513
  • 24 Bertelsen C, Shoffel-Havakuk H, O'Dell K, Johns III MM, Reder LS. Serial in-office intralesional steroid injections in airway stenosis. JAMA Otolaryngol Head Neck Surg 2018; 144 (03) 203-210
  • 25 Hoffman MR, Francis DO, Mai JP, Dailey SH. Office-based steroid injections for idiopathic subglottic stenosis: patient-reported outcomes, effect on stenosis, and side effects. Ann Otol Rhinol Laryngol 2020; 129 (04) 361-368
  • 26 Raman T, Chatterjee K, Alzghoul BN. et al. A bronchoscopic approach to benign subglottic stenosis. SAGE Open Med Case Rep 2017; 5: X17713151
  • 27 Allen AM, Abdelrahman N, Silvern D, Fenig E, Fruchter O, Kramer MR. Endobronchial brachytherapy provides excellent long-term control of recurrent granulation tissue after tracheal stenosis. Brachytherapy 2012; 11 (04) 322-326
  • 28 Jung HS, Chae G, Kim JH. et al. The mechanical characteristics and performance evaluation of a newly developed silicone airway stent (GINA stent). Sci Rep 2021; 11 (01) 7958
  • 29 Lischke R, Pozniak J, Vondrys D, Elliott MJ. Novel biodegradable stents in the treatment of bronchial stenosis after lung transplantation. Eur J Cardiothorac Surg 2011; 40 (03) 619-624
  • 30 Stramiello JA, Mohammadzadeh A, Ryan J, Brigger MT. The role of bioresorbable intraluminal airway stents in pediatric tracheobronchial obstruction: a systematic review. Int J Pediatr Otorhinolaryngol 2020; 139: 110405
  • 31 Stehlik L, Hytych V, Letackova J, Kubena P, Vasakova M. Biodegradable polydioxanone stents in the treatment of adult patients with tracheal narrowing. BMC Pulm Med 2015; 15: 164
  • 32 Fernandez-Bussy S, Labarca G, Majid A. Biodegradable stent for vanishing bronchus syndrome after lung transplantation. J Heart Lung Transplant 2016; 35 (11) 1378-1379
  • 33 Di Dedda G, Mirabile C. Use of a biodegradable, oversized stent in a child with tracheomalacia secondary to vascular external compression. Cardiol Young 2017; 27 (01) 196-198
  • 34 Lunn W, Garland R, Ashiku S, Thurer RL, Feller-Kopman D, Ernst A. Microdebrider bronchoscopy: a new tool for the interventional bronchoscopist. Ann Thorac Surg 2005; 80 (04) 1485-1488
  • 35 Casal RF, Iribarren J, Eapen G. et al. Safety and effectiveness of microdebrider bronchoscopy for the management of central airway obstruction. Respirology 2013; 18 (06) 1011-1015
  • 36 Vincent AG, Barker Jr JL, Ducic Y. Pilot study of external beam radiotherapy for recurrent unremitting tracheal stenosis. Ann Otol Rhinol Laryngol 2021; 130 (10) 1112-1115
  • 37 Gu C, Chen J, Zheng X, Sun J. Bronchoscopic submucosal dissection with Hybrid Knife: a new technique treating tracheal leiomyoma. Eur J Cardiothorac Surg 2021; 60 (02) 428-430
  • 38 Bhora FY, Ayub A, Forleiter CM. et al. Treatment of benign tracheal stenosis using endoluminal spray cryotherapy. JAMA Otolaryngol Head Neck Surg 2016; 142 (11) 1082-1087
  • 39 Benn BS, Krishna G. A novel multimodal approach to treating proximal tracheal obstructions with spray cryotherapy. J Thorac Dis 2019; 11 (02) 613-617
  • 40 Finley DJ, Dycoco J, Sarkar S. et al. Airway spray cryotherapy: initial outcomes from a multiinstitutional registry. Ann Thorac Surg 2012; 94 (01) 199-203 , discussion 203–204