Tracheobronchomalacia is a condition that occurs when the airways collapse during breathing or coughing. Symptoms most commonly include coughing, wheezing, shortness of breath, difficulty clearing phlegm, and repeated respiratory infections, such as pneumonia or bronchitis.
Most cases of tracheobronchomalacia develop from a type of lung disease called chronic obstructive pulmonary disease (COPD). Usually brought on by smoking cigarettes, COPD is marked by permanent damage to tissues in the lungs, making it hard to breathe. Emphysema and chronic bronchitis are two types of COPD.
Other causes of tracheobronchomalacia include:
- repeated infections
- injury after prolonged intubation (when a breathing tube is inserted into the trachea to help maintain breathing during a medical procedure)
- injury from a tracheostomy (surgery to create an opening into the windpipe)
- tumors or blood vessels pressing on the windpipe
- chronic inflammation
In addition, some individuals are born with a form of tracheobronchomalacia called tracheomegaly (also known as giant trachea or Mounier-Kuhn's syndrome).
For unknown reasons, many patients who cannot have breathing tubes removed have developed tracheobronchomalacia. These patients have trouble breathing or clearing phlegm when the ventilator is no longer being used. The insertion of a new breathing tube can relieve the symptoms, but is only a temporary solution to this complex problem.
Incorrect management of tracheobronchomalacia can lead to worsening of symptoms and spur the progression of an underlying disease. If a patient shows symptoms of tracheobronchomalacia, Memorial Sloan-Kettering physicians will work together to correctly diagnose the cause of these symptoms and to take all aspects of the disease process into consideration in managing the patient's condition.
Learn more below about the symptoms, diagnosis, and treatment of tracheobronchomalacia that we offer.
Symptoms
Tracheobronchomalacia may not be detected for a period of time because signs and symptoms may be mistaken for a variety of other disorders. This may delay treatment. At Memorial Sloan-Kettering, our physician assistants routinely spend time to obtain a detailed evaluation of the following symptoms on a patient's first visit to Memorial Sloan-Kettering.
Symptoms can include:
- shortness of breath
- coughing
- wheezing
- difficult or labored breathing (dyspnea)
- adult diagnosis of asthma or COPD that seems difficult to treat
- stridor, a high-pitched musical sound that can be heard as the breath is drawn in and is caused by a blockage in the throat or voice box (larynx)
- frequent inflammation of the lungs, such as pneumonitis, and other respiratory infections
- fatigue and general feeling of discomfort (malaise)
- cyanosis, a bluish color in the skin or in the mucous membranes of the mouth or nose
- second-hand cigarette smoke
Diagnosis
Video
In a virtual bronchosopy, special high-resolution CT scans are used to examine the airways noninvasively.
(16 seconds)
If a patient exhibits any of the symptoms listed above, the doctor may conduct an evaluation using a number of standard respiratory questionnaires and other assessment methods.
Following initial evaluation, our specialists perform one or more of the following tests to diagnose tracheobronchomalacia, including:
- x-ray of the chest and windpipe
- dynamic 3-D CT scan of the neck and chest
- laryngoscopy — an endoscopic examination of the larynx (voice box)
- bronchoscopy — an endoscopic examination of the trachea and bronchi
- biopsy
All of these tests are performed on an outpatient basis at Memorial Sloan-Kettering, the majority of which on the day of a patient's clinic visit.
In addition, our team conducts tests to evaluate respiratory function. These include:
- a test called spirometry that gauges how well air moves out of the lungs and helps determine the location of certain types of blockages
- a six-minute walk to test endurance and oxygen levels in the blood.
Physicians at Memorial Sloan-Kettering have developed a CT-scanning technique that enables dynamic three-dimensional visualization of the airway. This has been found to be effective in determining both the underlying cause and the extent of the tracheobronchomalacia.
Treatment
Because tracheobronchomalacia can sometimes develop as a result of an underlying medical condition, doctors will focus on the other condition before treating the tracheobronchomalacia.
One or more techniques can be used to treat tracheobronchomalacia at Memorial Sloan-Kettering. Surgical management depends on the exact location and the extent of the tracheobronchomalacia. Below are some of the most common treatment options for tracheobronchomalacia.
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Tracheobronchial Airway Stent
A tracheal stent is a silicone tube that is placed at the site of the collapse to help keep the airway open. Stents are used as both short- and long-term treatments for tracheobronchomalacia. Airway stenting is used as a diagnostic tool as well. Those patients who have improved symptoms from airway stenting are likely to benefit from surgical repair. -
Tracheobronchoplasty
This surgery can be used to treat the most severe forms of tracheobronchomalacia, especially when the doctor finds that airway stenting has improved symptoms. A surgically placed mesh is used to reinforce and stabilize the wall of the windpipe and minimize collapse. This is usually a very successful treatment for tracheobronchomalacia with excellent long-term results. -
Tracheal Resection and Reconstruction
In rare instances, this type of surgery can be used if the collapse is only in a small part of the windpipe. During a tracheal resection, the surgeon removes the injured section of the windpipe and rejoins the ends. This is usually a very successful treatment with excellent long-term benefits.
