title: Current concepts in severe adult tracheobronchomalacia: evaluation and treatment.
abstract: There is increasing recognition of tracheobronchomalacia (TBM) in patients with respiratory complaints, though its true incidence in the adult population remains unknown. Most of these patients have an acquired form of severe diffuse TBM of unclear etiology. The mainstays of diagnosis are dynamic (inspiratory and expiratory) airway computed tomography (CT) scan and dynamic flexible bronchoscopy with forced expiratory maneuvers. While the prevailing definition of TBM is 50% reduction in cross-sectional area, a high proportion of healthy volunteers meet this threshold, thus this threshold fails to identify patients that might benefit from intervention. Therefore, we consider complete or near-complete collapse (>90% reduction in cross-sectional area) of the airway to be severe enough to warrant potential intervention. Surgical central airway stabilization by posterior mesh splinting (tracheobronchoplasty) effectively corrects malacic airways and has been shown to lead to significant improvement in symptoms, health-related quality of life, as well as functional and exercise capacity in carefully selected adults with severe diffuse TBM. A short-term stent trial clarifies a patient's candidacy for surgical intervention. Coordination of care between experienced interventional pulmonologists, radiologists, and thoracic surgeons is essential for optimal outcomes.
authors.affiliation: Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02215, USA.
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Buitrago
authors.affiliation: Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02215, USA.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Wilson
authors.affiliation: Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02215, USA.
authors.forename: Mihir
authors.initials: M
authors.lastname: Parikh
authors.affiliation: Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02215, USA.
authors.forename: Adnan
authors.initials: A
authors.lastname: Majid
authors.affiliation: Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02215, USA.
authors.forename: Sidhu P
authors.initials: SP
authors.lastname: Gangadharan
keywords: Expiratory central airway collapse (ECAC); severe diffuse tracheobronchomalacia (TBM); tracheobronchoplasty (TBP)