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Excessive central airway collapse

Muhammad A Zafar, Aaron M Mulhall, William Eschenbacher, Ajay Kaul, Sadia Benzaquen, Ralph J Panos
BACKGROUND: Positive expiratory pressure(PEP) breathing modalities are commonly prescribed in obstructive lung diseases, however practical methods of airway pressures(AP) quantification for therapeutic efficacy are lacking. Excessive dynamic airway collapse(EDAC) is characterized by expiratory central airway collapse leading to dyspnea and poor quality of life(QoL), with limited therapeutic options. PURPOSE: To measure AP and exertional dyspnea in EDAC patients during normal breathing and with use of pursed-lip breathing(PLB), nasal PEP device(nPEP), and oral-PEP valve(oPEP) during rest and exercise using an Esophageal Manometer...
October 2017: Respiratory Medicine
Paul Leong, Anne Tran, Jhanavi Rangaswamy, Laurence E Ruane, Michael W Fernando, Martin I MacDonald, Kenneth K Lau, Philip G Bardin
BACKGROUND: Tracheal obstruction resulting from expiratory tracheal deformation has been associated with respiratory symptoms and severe airway exacerbations. In chronic obstructive pulmonary disease (COPD), acute exacerbations (AECOPD) create large intrathoracic pressure swings which may increase tracheal deformation. Excessive central airway collapse (ECAC) may be diagnosed when the tracheal area on expiration is less than 50% of that on inspiration. The prevalence of ECAC in AECOPD and its temporal course have not been systematically studied...
August 25, 2017: Respiratory Research
Abhishek Biswas, Michael A Jantz, P S Sriram, Hiren J Mehta
The term tracheobronchomalacia refers to excessively compliant and collapsible central airways leading to symptoms. Although seen as a coexisting condition with various other pulmonary condition, it may cause symptoms by itself. The condition is often misdiagnosed as asthma, bronchitis or just chronic cough due to a lack of specific pathognomonic history and clinical findings. The investigation revolves around different modes of imaging, lung function testing and usually confirmed by flexible bronchoscopy. The treatment widely varies based on the cause, with most cases treated conservatively with non-invasive ventilation...
October 2017: Disease-a-month: DM
Mehmet A Ozgul, Erdogan Cetinkaya, Mustafa Cortuk, Sinem Iliaz, Elif Tanriverdi, Sule Gul, Guler Ozgul, Hilal Onaran, Kenan Abbasli, Huseyin E Dincer
BACKGROUND: Expiratory central airway collapse (ECAC) is abnormal central airway narrowing during expiration. ECAC involves 2 different pathophysiological entities as tracheobronchomalacia and excessive dynamic airway collapse (EDAC). Although the exact cause is unknown, chronic obstructive pulmonary disease (COPD) is frequently accompanied by ECAC. Although there are various publications on the relationship between COPD and ECAC, there are very few data for stent placement in patients with tracheobronchomalacia accompanied severe COPD...
April 2017: Journal of Bronchology & Interventional Pulmonology
Javier A Longoria, Miwa Fujiwara, Catalina Guerra, Jeffrey L Lee, Catherine S H Sassoon, Farhad Mazdisnian
BACKGROUND: Expiratory central airway collapse is an increasingly recognized abnormality of the central airways and may be present in as many as 22% of patients evaluated for chronic obstructive pulmonary disease and/or asthma. Many current treatment options require invasive procedures that have been shown to cause significant morbidity and mortality. To test the hypothesis that Teflon injection will induce sufficient fibroblast proliferation and collagen deposition, we evaluated the time course on the effect of Teflon injection in the posterior membranous trachea on the histopathology of the tracheobronchial tree...
October 2016: Journal of Bronchology & Interventional Pulmonology
Ismael Matus, William Richter, Sriniwasan B Mani
BACKGROUND: Tracheobronchomalacia (TBM) is a disorder of expiratory central airway collapse. TBM is separate from excessive dynamic airway collapse. Historically TBM has lacked a universally accepted definition. No consensus recommendations on evaluation and management exist. We suspect these unresolved issues contribute to deficits in pulmonologists' awareness and management of TBM. METHODS: We created a 20-question survey obtaining information about overall awareness, knowledge base, competencies, and practice patterns in managing TBM...
April 2016: Journal of Bronchology & Interventional Pulmonology
Jisoo Park, Yeon Joo Lee, Se Joong Kim, Jong Sun Park, Ho Il Yoon, Jae Ho Lee, Choon-Taek Lee, Young-Jae Cho
Excessive dynamic airway collapse (EDAC) is a disease entity of excessive reduction of the central airway diameter during exhalation, without cartilage collapse. An 80-year-old female presented with generalized edema and dyspnea at our hospital. The patient was in a state of acute decompensated heart failure due to pneumonia with respiratory failure. We accordingly managed the patient with renal replacement therapy, mechanical ventilation and antibiotics. Bronchoscopy confirmed the diagnosis of EDAC. We scheduled extubation after the improvement of pneumonia and heart condition...
October 2015: Tuberculosis and Respiratory Diseases
Naresh M Punjabi
No abstract text is available yet for this article.
January 2016: Chest
Michael R Lyaker, Victor R Davila, Thomas J Papadimos
Central airway collapse plays a significant, underrecognized role in respiratory failure after extubation of critically ill patients. Historically, airway collapse has been attributed to tracheomalacia (TM), softening of the cartilage in the trachea and other large airways. More recently, excessive dynamic airway collapse (EDAC) has been described as a distinct process unrelated to a loss of cartilaginous airway support. EDAC is caused by the posterior wall of the trachea bulging forward and causing airway obstruction during exhalation...
2015: Case Reports in Anesthesiology
Konrad E Bloch, Tsogyal D Latshang, Silvia Ulrich
Bloch, Konrad E., Tsogyal D. Latshang, and Silvia Ulrich. Patients with obstructive sleep apnea at altitude. High Alt Med Biol 16:110-116, 2015.--Obstructive sleep apnea (OSA) is highly prevalent in the general population, in particular in men and women of older age. In OSA patients sleeping near sea level, the apneas/hypopneas associated with intermittent hypoxemia are predominantly due to upper airway collapse. When OSA patients stay at altitudes above 1600 m, corresponding to that of many tourist destinations, hypobaric hypoxia promotes frequent central apneas in addition to obstructive events, resulting in combined intermittent and sustained hypoxia...
June 2015: High Altitude Medicine & Biology
Erik B Hysinger, Howard B Panitch
Intrathoracic tracheomalacia is characterized by increased compliance of the central airway within the thorax. This leads to excessive dynamic collapse during exhalation or periods of increased intrathoracic pressure such as crying. Extrathoracic tracheomalacia involves dynamic collapse of the airway between the glottis and sternal notch that occurs during inhalation rather than exhalation. The tone of the posterior membrane of the trachea increases throughout development and childhood, as does the rigidity of the tracheal cartilage...
January 2016: Paediatric Respiratory Reviews
C Represas-Represas, V Leiro-Fernández, R Mallo-Alonso, M I Botana-Rial, A Tilve-Gómez, A Fernández-Villar
INTRODUCTION: The prevalence of EDAC (Excessive Dynamic Airway Collapse) has not been studied specifically in patients with chronic obstructive pulmonary disease (COPD). OBJECTIVE: The aim of this study was to investigate the prevalence of EDAC in COPD and to determine whether there are clinical factors or functional variables that could influence the degree of expiratory collapse of central airways. METHODS: Prospective observational study of a group of patients with COPD...
April 2015: Annals of Thoracic Medicine
Mohammed Akil D Gani, Vanessa J C Rogers, Khalid H Sachak, Joseph F K Marzouk
Flat trachea syndrome, commonly known as 'tracheobronchomalacia', is a central airway disease characterised by excessive expiratory collapse of the tracheobronchial posterior membrane due to weakness in the airway walls. Patients present with symptoms such as chronic cough, dyspnoea and recurrent respiratory tract infections, which are often attributed to more common conditions such as asthma and chronic obstructive pulmonary disease (COPD). The term 'Flat Trachea Syndrome' was first proposed by Niranjan and Marzouk in 2010 following a retrospective study of 28 patients with the condition who underwent surgery for it...
February 26, 2015: BMJ Case Reports
Sophie Ismael, Delphine Wermert, Kim-Diep Dang-Tran, Marion Venot, Jean-Yves Fagon, Jean-Luc Diehl
Airway and cystic lung diseases can be observed in patients with Sjögren's syndrome. We report a case of such a patient suffering from respiratory failure due to recurrent episodes of right pneumothorax, requiring invasive mechanical ventilation. Despite thoracic drainage and adequate pneumothorax management, the patient could not be weaned from the ventilator. Fiberoptic bronchoscopy revealed severe central excessive dynamic airway collapse of the lower part of the trachea and proximal bronchi. The severity of airway collapse was maximal at the intermediate bronchus level, with a near-complete obstruction during expiration...
October 2014: Respiratory Care
Septimiu Murgu, Henri Colt
Tracheobronchomalacia and excessive dynamic airway collapse are morphologic types of expiratory central airway collapse with specific pathophysiology, cause, and structural changes in airway wall. Physicians caring for symptomatic patients with expiratory central airway collapse must localize the flow-limiting airway segments amenable to bronchoscopic or surgical interventions. Functional bronchoscopy and dynamic radiologic studies are performed for the initial evaluation and to design follow-up strategies...
September 2013: Clinics in Chest Medicine
W De Backer
Obstructive sleep apnea/hypopnea syndrome (OSAHS) is characterized by recurrent episodes of partial or complete upper airway collapse during sleep that is highlighted by a reduction in, or complete cessation of, airflow despite documented on going inspiratory efforts. Due to the lack of adequate alveolar ventilation that results from the upper airway narrowing, oxygen saturation may drop and partial pressure of CO2 may occasionally increase. The events are mostly terminated by arousals. Clinical consequences are excessive daytime sleepiness related to the sleep disruption...
June 2013: Panminerva Medica
Pierluigi Ciet, Piotr Wielopolski, Rashindra Manniesing, Sandra Lever, Marleen de Bruijne, Giovanni Morana, Pier Carlo Muzzio, Maarten H Lequin, Harm A W M Tiddens
Tracheobronchomalacia (TBM) is defined as an excessive collapse of the intrathoracic trachea. Bronchoscopy is the gold standard for diagnosing TBM; however it has major disadvantages, such as general anaesthesia. Cine computed tomography (CT) is a noninvasive alternative used to diagnose TBM, but its use in children is restricted by ionising radiation. Our aim was to evaluate the feasibility of spirometer-controlled cine magnetic resonance imaging (MRI) as an alternative to cine-CT in a retrospective study...
January 2014: European Respiratory Journal: Official Journal of the European Society for Clinical Respiratory Physiology
(no author information available yet)
OBJECTIVE: The objective of this health technology policy assessment was to evaluate the clinical utility and cost-effectiveness of sleep studies in Ontario. CLINICAL NEED: TARGET POPULATION AND CONDITION Sleep disorders are common and obstructive sleep apnea (OSA) is the predominant type. Obstructive sleep apnea is the repetitive complete obstruction (apnea) or partial obstruction (hypopnea) of the collapsible part of the upper airway during sleep. The syndrome is associated with excessive daytime sleepiness or chronic fatigue...
2006: Ontario Health Technology Assessment Series
Judith Zhi Yie Tan, Michael Ditchfield, Nicholas Freezer
Tracheobronchomalacia is characterised by excessive airway collapsibility due to weakness of airway walls and supporting cartilage. The standard definition requires reduction in cross-sectional area of at least 50% on expiration. However, there is a paucity of information regarding the normal range of central airway collapse among children of varying ages, ethnicities and genders, with and without coexisting pulmonary disease. Consequently, the threshold for pathological collapse is considered somewhat arbitrary...
August 2012: Pediatric Radiology
Shiroh Isono
Epidemiological evidence suggests there are significant links between obesity and obstructive sleep apnoea (OSA), with a particular emphasis on the importance of fat distribution in the development of OSA. In patients with OSA, the structure of the pharyngeal airway collapses. A collapsible tube within a rigid box collapses either due to decreased intraluminal pressure or increased external tissue pressure (i.e. reduction in transmural pressure), or due to reduction in the longitudinal tension of the tube. Accordingly, obesity should structurally increase the collapsibility of the pharyngeal airway due to excessive fat deposition at two distinct locations...
January 2012: Respirology: Official Journal of the Asian Pacific Society of Respirology
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