title: Tracheobronchial smooth muscle atrophy and separation.
abstract: We report a case series involving 4 patients with chronic obstructive pulmonary disease who were on an appropriate medical regimen including a high dose of inhaled corticosteroids (ICS). During bronchoscopy, patients were found to have an excessive dynamic collapse of the posterior wall and its separation from the ends of the adjacent cartilaginous rings. This was causing a near-total occlusion of the tracheal and bronchial lumen during exhalation, thereby presenting with an obstructive pattern on the pulmonary functions. We suspect that this was caused by the atrophy of the smooth muscles of the tracheobronchial wall. We reviewed the literature to explore the mechanisms causing atrophy of the bronchial smooth muscle, focusing on the potential role of long-term ICS use.
authors.affiliation: Respiratory Institute, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Atul C
authors.initials: AC
authors.lastname: Mehta
authors.forename: Khawaja Salman
authors.initials: KS
authors.lastname: Zaki
authors.forename: Amit
authors.initials: A
authors.lastname: Banga
authors.forename: Jarmanjeet
authors.initials: J
authors.lastname: Singh
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Gildea
authors.forename: Valeria
authors.initials: V
authors.lastname: Arrossi
mesh_terms: D000368:Aged; D000402:Airway Obstruction / Q000209:etiology* / Q000503:physiopathology; D001707:Biopsy, Needle; D001980:Bronchi / Q000473:pathology* / Q000503:physiopathology; D001999:Bronchoscopy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D009130:Muscle, Smooth / Q000473:pathology; D009133:Muscular Atrophy / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology*; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000473:pathology*; D012129:Respiratory Function Tests; D018570:Risk Assessment; D012494:Sampling Studies; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed / Q000379:methods; D014132:Trachea / Q000473:pathology* / Q000503:physiopathology