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The European Respiratory Journal Sep 2019Tracheomalacia and tracheobronchomalacia may be primary abnormalities of the large airways or associated with a wide variety of congenital and acquired conditions. The...
Tracheomalacia and tracheobronchomalacia may be primary abnormalities of the large airways or associated with a wide variety of congenital and acquired conditions. The evidence on diagnosis, classification and management is scant. There is no universally accepted classification of severity. Clinical presentation includes early-onset stridor or fixed wheeze, recurrent infections, brassy cough and even near-death attacks, depending on the site and severity of the lesion. Diagnosis is usually made by flexible bronchoscopy in a free-breathing child but may also be shown by other dynamic imaging techniques such as low-contrast volume bronchography, computed tomography or magnetic resonance imaging. Lung function testing can provide supportive evidence but is not diagnostic. Management may be medical or surgical, depending on the nature and severity of the lesions, but the evidence base for any therapy is limited. While medical options that include bronchodilators, anti-muscarinic agents, mucolytics and antibiotics (as well as treatment of comorbidities and associated conditions) are used, there is currently little evidence for benefit. Chest physiotherapy is commonly prescribed, but the evidence base is poor. When symptoms are severe, surgical options include aortopexy or posterior tracheopexy, tracheal resection of short affected segments, internal stents and external airway splinting. If respiratory support is needed, continuous positive airway pressure is the most commonly used modality either a face mask or tracheostomy. Parents of children with tracheobronchomalacia report diagnostic delays and anxieties about how to manage their child's condition, and want more information. There is a need for more research to establish an evidence base for malacia. This European Respiratory Society statement provides a review of the current literature to inform future study.
Topics: Bronchomalacia; Bronchoscopy; Child; Europe; Humans; Magnetic Resonance Imaging; Multidetector Computed Tomography; Physical Therapy Modalities; Pulmonary Medicine; Respiratory Function Tests; Respiratory Sounds; Societies, Medical; Tracheomalacia
PubMed: 31320455
DOI: 10.1183/13993003.00382-2019 -
Current Problems in Pediatric and... Apr 2018Airway malacia can occur in the larynx (larygomalacia), trachea (tracheomalacia), or bronchi (bronchomalacia). As a group these are the most common congenital... (Review)
Review
Airway malacia can occur in the larynx (larygomalacia), trachea (tracheomalacia), or bronchi (bronchomalacia). As a group these are the most common congenital abnormalities of the pediatric airway and are characterized by increased airway compliance, resulting in excessive dynamic collapse during the respiratory cycle. While a diagnosis can be suspected based on clinical history and physical examination, definitive evaluation is based of nasopharyngolaryngoscopy and/or bronchoscopy. Observation and conservative management are typically all that are required. However, surgical intervention can be necessary in the most severe cases, and can result in significant improvement in symptoms.
Topics: Bronchomalacia; Bronchoscopy; Conservative Treatment; Humans; Laryngomalacia; Pediatrics; Severity of Illness Index; Tracheomalacia; Watchful Waiting
PubMed: 29622320
DOI: 10.1016/j.cppeds.2018.03.002 -
The Veterinary Clinics of North... Mar 2020Tracheal and airway collapse (bronchomalacia) are common causes of chronic cough in middle-aged to older dogs in which weakening of cartilage within the respiratory... (Review)
Review
Tracheal and airway collapse (bronchomalacia) are common causes of chronic cough in middle-aged to older dogs in which weakening of cartilage within the respiratory system leads to narrowing of airways, irritation, inflammation, partial to complete airway obstruction, and other secondary effects. Tracheomalacia occurs in small-breed dogs, whereas bronchomalacia can occur in any size dog. Successful treatment involves correct identification of the problem, recognition of concurrent disease processes, and appropriate medical therapy. Surgical intervention and intraluminal stenting are readily available so it is important to understand indications for such procedures.
Topics: Animals; Cough; Dog Diseases; Dogs; Tracheobronchomalacia
PubMed: 31864678
DOI: 10.1016/j.cvsm.2019.11.003 -
Veterinary Journal (London, England :... Jul 2021Bronchomalacia (BM) is an inconsistently defined term in dogs, impairing understanding of clinical presentation, therapeutic response and prognosis. Herein the authors... (Review)
Review
Bronchomalacia (BM) is an inconsistently defined term in dogs, impairing understanding of clinical presentation, therapeutic response and prognosis. Herein the authors propose to clarify the definition of canine bronchomalacia (CBM) as regional to diffuse dynamic airway collapse of segmental and/or subsegmental bronchi with associated clinical signs due to airflow limitation. In contrast to tracheal collapse, mainstem bronchial collapse, and in some cases lobar collapse, CBM requires advanced imaging. Common co-morbid conditions (e.g., chronic bronchitis, mitral valve degenerative disease, etc.) should be identified during a comprehensive diagnostic evaluation. Current empiric treatments advocated in absence of clinical trials documenting efficacy in the dog warrant evaluation, as some (e.g., bronchodilators) may have detrimental effects in certain types of airway collapse in humans. There is no direct treatment for CBM, as defined above, but non-specific therapies and targeted treatment of co-morbid disease may improve clinical signs and quality of life. In this manuscript, the authors provide a review of the different types of airway collapse focusing on CBM, reviewing their definition and etiology, proposing a classification scheme, and discussing clinical signs, diagnostic testing, and treatment. Future studies should focus on both improving understanding of the etiology and natural disease progression of CBM and treatment trials.
Topics: Animals; Bronchomalacia; Comorbidity; Dog Diseases; Dogs
PubMed: 34148610
DOI: 10.1016/j.tvjl.2021.105682 -
Anesthesiology Jun 2016
Topics: Bronchi; Bronchomalacia; Bronchoscopy; Humans; Infant; Male; Severity of Illness Index
PubMed: 26682632
DOI: 10.1097/ALN.0000000000000989 -
Annals of Cardiac Anaesthesia 2022Tracheo-bronchomalacia (TBM) is the weakness in the structural integrity of the cartilaginous ring and arch. It may occur in isolation with prematurity or secondarily in... (Observational Study)
Observational Study
BACKGROUND
Tracheo-bronchomalacia (TBM) is the weakness in the structural integrity of the cartilaginous ring and arch. It may occur in isolation with prematurity or secondarily in association with various congenital anomalies. Bronchomalacia is more commonly associated with congenital heart diseases. The conventional treatment options include positive pressure ventilation with or without tracheostomy, surgical correction of external compression and airway stenting.
AIM
To use "synchronized" nasal Dual positive airway pressure (DuoPAP), a non-invasive mode of ventilation as an alternative treatment option for bronchomalacia to avoid complications associated with conventional treatment modalities.
STUDY DESIGN
Prospective observational study conducted in Army Hospital Research and Referral from Jul 2019 to Dec 2020.
MATERIAL AND METHODS
We diagnosed seven cases of TBM post-cardiac surgery at our institute, incidence of 4.2%. Four infants were diagnosed with left sided bronchomalacia, 2 were diagnosed with right sided bronchomalacia and one with tracheomalacia. Those infants were managed by "synchronized" nasal DuoPAP, a first in ventilation technology by Fabian Therapy Evolution ventilator (Acutronic, Switzerland).
RESULTS
All seven infants showed significant improvement with synchronized nasal DuoPAP both clinically as well as radiologically. None of the infant required tracheostomy and discharged to home successfully.
CONCLUSION
The synchronized nasal DuoPAP is a low cost and effective treatment option for infants with TBM. It could be attributed to synchronization of the breaths leading to better tolerance and compliance in paediatric age group.
Topics: Bronchomalacia; Cardiac Surgical Procedures; Child; Humans; Infant; Intermittent Positive-Pressure Ventilation; Technology; Tracheomalacia
PubMed: 36254924
DOI: 10.4103/aca.aca_112_21 -
The Annals of Thoracic Surgery Jan 2022In recent years, external stenting has been used as a reliable method to relieve airway compression of the trachea and main bronchi in young children with acceptable...
In recent years, external stenting has been used as a reliable method to relieve airway compression of the trachea and main bronchi in young children with acceptable age-proportional airway growth. However, to our knowledge, little literature supporting this approach for the distal airway has been published. A 1-year-old girl with absent pulmonary valve syndrome who had recurrent respiratory infections was diagnosed with bronchomalacia. She underwent external stenting; the infections disappeared postoperatively. This case describes a successful external stenting for malacia of the bronchus intermedius, which exhibited short- and mid-term safety and effectiveness.
Topics: Bronchi; Bronchomalacia; Female; Humans; Infant; Stents; Thoracic Surgical Procedures
PubMed: 33891918
DOI: 10.1016/j.athoracsur.2021.04.022 -
The Annals of Thoracic Surgery Mar 2022Management of recurrent symptomatic tracheobronchomalacia and tracheobronchial compression after prior aortopexy and tracheobronchopexy is a surgical challenge. In...
Management of recurrent symptomatic tracheobronchomalacia and tracheobronchial compression after prior aortopexy and tracheobronchopexy is a surgical challenge. In patients with right aortic arch, the course of the aortic arch over the right mainstem bronchus can result in superior and posterior compression of the airway. This report presents 2 cases of recurrent bronchomalacia and bronchial compression treated with descending aortic translocation. The addition of bronchial splinting to aortic translocation effectively relieved airway symptoms.
Topics: Aorta, Thoracic; Bronchial Diseases; Bronchomalacia; Humans; Splints; Tracheobronchomalacia
PubMed: 34081976
DOI: 10.1016/j.athoracsur.2021.04.105 -
Paediatric Anaesthesia Jan 2003Tracheomalacia and bronchomalacia are becoming increasingly well recognized. Although pathologically benign conditions, they are responsible for considerable morbidity,... (Review)
Review
Tracheomalacia and bronchomalacia are becoming increasingly well recognized. Although pathologically benign conditions, they are responsible for considerable morbidity, occasional mortality and significant difficulties in the operating theatre and intensive care unit. We performed an extensive literature search to identify causal associations, methods of clinical and investigative assessment, treatment modalities and anaesthetic experience with these conditions.
Topics: Anesthesia, General; Anesthesia, Local; Bronchial Diseases; Bronchoscopy; Child; Child, Preschool; Humans; Infant; Spirometry; Tomography, X-Ray Computed; Tracheal Diseases
PubMed: 12535032
DOI: 10.1046/j.1460-9592.2003.00802.x -
American Journal of Diseases of... Jan 1968
Topics: Bronchi; Bronchography; Child, Preschool; Humans; Male
PubMed: 5635065
DOI: 10.1001/archpedi.1968.02100010090017