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Journal of Thoracic Disease Nov 2020Tracheobronchomalacia (TBM) is an obstructive airway disease characterized by laxity and redundancy of the posterior membrane of the main airways leading to dynamic... (Review)
Review
Tracheobronchomalacia (TBM) is an obstructive airway disease characterized by laxity and redundancy of the posterior membrane of the main airways leading to dynamic airway collapse during exhalation. The gold standard for diagnosis is dynamic computed tomography (DCT) scan and dynamic flexible bronchoscopy (DFB). Patients with complete or near-complete collapse (>90% reduction in cross-sectional area) of the airway are possible candidates for surgical management. Central airway stabilization by tracheobronchoplasty (TBP) effectively corrects malacic airways and has demonstrated significant improvement in objective functional measures, which is often but not uniformly accompanied by equal improvement in health-related quality of life (HRQOL) metrics. This article reviews HRQOL instruments used to report outcomes after TBM surgery.
PubMed: 33282396
DOI: 10.21037/jtd.2020.03.08 -
Journal of Veterinary Internal Medicine 2010Tracheobronchomalacia is diagnosed in people by documentation of a reduction in airway diameter during bronchoscopy. While tracheal collapse in the dog has been well...
BACKGROUND
Tracheobronchomalacia is diagnosed in people by documentation of a reduction in airway diameter during bronchoscopy. While tracheal collapse in the dog has been well described in the literature, little information is available on bronchomalacia in the dog.
HYPOTHESES
Bronchomalacia is common in dogs with tracheal collapse, is associated with inflammatory airway disease, and is poorly documented radiographically.
ANIMALS
One hundred and fifteen dogs admitted for evaluation for respiratory disease and examined by bronchoscopy.
METHODS
Case-controlled, observational study. Dogs examined and having a bronchoscopic procedure performed by a single operator were separated into groups with and without visually identified airway collapse. Clinical parameters and bronchoalveolar lavage findings were compared between groups. Radiographs were reviewed in masked fashion to assess the sensitivity and specificity for detection of bronchomalacia.
RESULTS
Tracheobronchomalacia was documented in 50% of dogs examined, with tracheal collapse in 21% and bronchomalacia in 47%. In dogs with bronchomalacia, collapse of the right middle (59%) and left cranial (52%) lung lobes was identified most commonly. Dogs with bronchomalacia were significantly more likely to display normal airway cytology and to have mitral regurgitation and cardiomegaly than dogs without airway collapse (P < .05). Radiographs were insensitive for detection of airway collapse.
CONCLUSIONS AND CLINICAL IMPORTANCE
Bronchomalacia was identified more commonly than tracheal collapse in this population of dogs, and documentation required bronchoscopy. This study could not confirm a role for airway inflammation in bronchomalacia, and further studies are required to determine the role of cardiomegaly in the disorder.
Topics: Animals; Dog Diseases; Dogs; Retrospective Studies; Tracheobronchomalacia
PubMed: 20051001
DOI: 10.1111/j.1939-1676.2009.0451.x -
The European Respiratory Journal Dec 2019
Topics: Bronchomalacia; Bronchoscopy; Child; Humans; Trachea; Tracheomalacia
PubMed: 31857383
DOI: 10.1183/13993003.02098-2019 -
The European Respiratory Journal Dec 2019
Topics: Bronchomalacia; Bronchoscopy; Child; Humans; Trachea; Tracheomalacia
PubMed: 31857384
DOI: 10.1183/13993003.02271-2019 -
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 -
Anesthesiology Jun 2016
Topics: Bronchi; Bronchomalacia; Bronchoscopy; Humans; Infant; Male; Severity of Illness Index
PubMed: 26682632
DOI: 10.1097/ALN.0000000000000989 -
North American Journal of Medical... Sep 2014Williams-Campbell syndrome is a rare congenital syndrome characterized by the absence of cartilage in subsegmental bronchi leading to formation of bronchiectasis distal... (Review)
Review
Williams-Campbell syndrome is a rare congenital syndrome characterized by the absence of cartilage in subsegmental bronchi leading to formation of bronchiectasis distal to the affected bronchi. The differential diagnosis of bronchiectasis is broad and the rarity of the disease poses a diagnostic and management challenge for clinicians. This present review aims to help the understanding of the clinical manifestations, pathophysiological features, diagnostic modalities, management and differential diagnosis of Williams-Campbell syndrome. A MedLine/PubMed search was performed identifying all relevant articles. No restrictions were used for publication dates. The author used the keywords "Williams-Campbell syndrome," "non-cystic fibrosis bronchiectasis" and "congenital bronchiectasis" finding 503, 195 and 489 articles, respectively.
PubMed: 25317385
DOI: 10.4103/1947-2714.141620 -
Turkish Archives of Pediatrics May 2022Asthma is the most common chronic lung disease in childhood. Difficult-to-treat asthma is defined as the continuation of symptoms or attacks of patients despite step 4...
OBJECTIVE
Asthma is the most common chronic lung disease in childhood. Difficult-to-treat asthma is defined as the continuation of symptoms or attacks of patients despite step 4 or 5 of Global Initiative for Asthma therapy. In the differential diagnosis of these patients, flexible fiberoptic bronchoscopy is recommended to exclude other lung diseases. In this study, we aimed to examine the clinical and radiologic features and flexible fiberoptic bronchoscopy findings of patients referred to our pediatric pulmonology department due to difficult-to-treat asthma and determine the effects of flexible fiberoptic bronchoscopy on the differential diagnosis and treatment.
MATERIALS AND METHODS
The demographic characteristics and flexible fiberoptic bronchoscopy results of 62 patients who were diagnosed as having difficult-to-treat asthma in our pediatric pulmonology department between January 2015 and June 2020 were evaluated retrospectively. The symptoms, history, medications, physical examination findings, pulmonary function tests, and radiologic findings of patients who underwent flexible fiberoptic bronchoscopy were evaluated.
RESULTS
The median age of the patients was 69 (interquartile range: 42-108 months). The most common reasons for the referral of these patients were chronic cough, recurrent pulmonary infections, and persistent wheezing. All patients had chest radiography and 37 (59.7%) had chest computed tomography at their first admission; 14 (37.8%) patients had abnormal findings on chest computed tomography. There was no significant difference in terms of age, physical examination findings, pulmonary function test results, and radiologic examinations between patients with and without pathologic bronchoscopy findings. None of the patients had complications during and after flexible fiberoptic bronchoscopy. The most common diagnoses of patients based on flexible fiberoptic bronchoscopy were persistent bacterial bronchitis in 19 (30.6%) patients, tracheomalacia and/or bronchomalacia in 12 (19.4%), and anatomic anomalies in 3 (4.8%) patients (separation of lingula into 3, separation of right upper lobe bronchus into 4, and tracheal dyskinesia). Mycobacterium tuberculosis growth was observed in the tuberculosis culture of 1 patient. According to the flexible fiberoptic bronchoscopy and bronchoalveolar lavage results, antituberculosis treatment was initiated in 1 patient and polypoid mass excision was performed in 1 patient. A proton pump inhibitor was started in 9 (15.5%) patients, physiotherapy in 5 (8.0%), antibiotics in 14 (22.5%), and ipratropium bromide in 7 (11.2%) patients. All patients were followed up with the diagnosis of asthma except for 2 patients.
CONCLUSION
To date, there is no prospective study evaluating the importance of flexible fiberoptic bronchoscopy in difficult-to-treat asthma in childhood. In our small cohort, persistent bacterial bronchitis, airway tracheomalacia and/or bronchomalacia, gastroesophageal reflux, and other anatomic anomalies were successfully diagnosed using flexible fiberoptic bronchoscopy and treated without any complications, suggesting that flexible fiberoptic bronchoscopy is an important diagnostic tool with a low complication rate in children with difficult-to-treat asthma.
PubMed: 35781234
DOI: 10.5152/TurkArchPediatr.2022.21315 -
JTCVS Techniques Feb 2023Congenital tracheomalacia can be the cause of respiratory failure in young children. Although the indication for surgical treatment has already been discussed...
OBJECTIVES
Congenital tracheomalacia can be the cause of respiratory failure in young children. Although the indication for surgical treatment has already been discussed vigorously, no clear guidelines about the modality are available.
METHODS
Through a sternotomy approach, a combination of posterior pexy and anterior tracheopexy using a tailored ringed polytetrafluoroethylene prosthesis is performed. Patient demographic characteristics, as well as operative details and postoperative outcomes, are included in the analysis.
RESULTS
Between 2018 and 2022, 9 children underwent the operation under review. All patients showed severe clinical symptoms of tracheomalacia, which was confirmed on bronchoscopy. The median age was 9 months. There was no operative mortality. Eight patients could be weaned from the ventilator. One patient died because of interstitial lung disease with bronchomalacia and concomitant severe cardiac disease. The longest follow-up now is 4 years, and shows overall excellent clinical results, without any reintervention.
CONCLUSIONS
Surgical treatment of tracheomalacia through a combination of posterior and anterior pexy is feasible, with acceptable short- and midterm results.
PubMed: 36820339
DOI: 10.1016/j.xjtc.2022.11.011 -
Journal of Veterinary Internal Medicine Mar 2022Reports of clinicopathologic features of bronchomalacia (BM) differ because of inconsistent definitions and frequent prevalence of comorbid cardiopulmonary disease....
BACKGROUND
Reports of clinicopathologic features of bronchomalacia (BM) differ because of inconsistent definitions and frequent prevalence of comorbid cardiopulmonary disease. Pulmonary hypertension (PH) secondary to BM is poorly described.
OBJECTIVES
Dogs with BM will be older but of any somatotype, and increased expiratory effort, ≥1 comorbid disease, and PH will be more common than in dogs without BM.
ANIMALS
Client-owned dogs (n = 210) evaluated for respiratory signs.
METHODS
Medical records of dogs with paired inspiratory: expiratory-breath-hold computed tomography, tracheobronchoscopy, or both between January 2016 and December 2019 were retrospectively reviewed. Comparisons between dogs with and without BM using Mann-Whitney rank sum or χ tests (P < .05 significant were made). Because of high numbers of variables, criteria with high prevalence (>25%) were identified (n = 10) for univariate analysis (P < .005 significant). Significant variables were submitted for multivariate analysis.
RESULTS
Bronchomalacia was identified in 41% of dogs of all sizes/somatotypes; 38% were >10 kg. All dogs with BM had ≥1 comorbid cardiopulmonary disorder. Dogs with BM were significantly older (P < .001), smaller (P < .001), and were more likely diagnosed with tracheal or mainstem bronchial collapse (P < .001) or bronchiectasis (P < .001). Multivariate analysis confirmed associations with age, tracheal or mainstem bronchial collapse, and bronchiectasis. In dogs with BM, PH was more prevalent.
CONCLUSIONS AND CLINICAL IMPORTANCE
Although significantly more common in older, smaller dogs, BM occurs in dogs of all sizes and in all instances with comorbidities. Echocardiography should be considered in dogs with BM to identify PH.
Topics: Animals; Bronchomalacia; Dog Diseases; Dogs; Hypertension, Pulmonary; Prevalence; Retrospective Studies
PubMed: 35129853
DOI: 10.1111/jvim.16381