Tracheobronchomalacia
Tracheobronchomalacia (TBM) is an uncommon condition characterized by the softening of the airway (windpipe) with subsequent airway narrowing.
The cause of this condition is unknown but is frequently associated with common conditions such as chronic obstructive pulmonary disease (COPD) and asthma.
Symptoms
This narrowing produces symptoms such as cough, shortness of breath, wheezing, inability to clear secretions and recurrent respiratory infections.
Diagnosis
The evaluation begins with a complete anatomic and functional assessment of the airways using bronchoscopy, airway computer tomography (CT), pulmonary function test and a six minute walk test.
After this evaluation, if there is evidence of significant TBM, a stent trial will be done.
Treatment
Current treatments include continuous positive airway pressure (CPAP), airway stents and surgical tracheal reconstruction.
Treatment with CPAP involves placing a mask over the nose (nasal) or nose and mouth (oronasal) and administrating pressurized air to help open the airways. Although useful, it may only be used as a bridge to a more definitive treatment since it is not tolerated well by patients for long periods of time.
A stent (tracheobronchial prostheses) is a plastic hollow device placed in the airway to keep it open. Unfortunately, since long term use of airway stents is associated with complications, they are used only for a short period of time to try to identify those patients that would benefit from a permanent surgical therapy.
For this reason, clinical improvement will be assessed within 10-14 days. If symptoms have improved (less cough, less shortness of breath, improvement in ability to clear secretions, less oxygen use etc.) then the patient will be considered a candidate for surgical tracheobronchoplasty. If symptoms did not improve, the patient’s stents will be removed and current medical management is continued.
