Tracheobronchomalacia and Large Airway Collapse

Summary

“Collapse of the large airways” is a term often associated with tracheobronchomalacia (“trak-ee-o-bron-ko-mal-ay-sh-ee-a”) (TBM) and excessive dynamic airway collapse (EDAC). Collapse occurs when the windpipe (trachea) and/or large airways (bronchi) narrow excessively, in some cases almost closing completely. This can cause shortness of breath, repeated coughing, and difficulty clearing mucus, increasing the risk of chest infections. Managing these symptoms should include an airway clearance, breathing, and exercise capacity (ABC) approach alongside controlling any underlying conditions. This is done to prevent flare-ups (exacerbations) when symptoms become worse.

What Does Collapse of the Large Airways Mean?

Collapse of the large airways is a term associated with TBM and/or EDAC. These are different conditions but can overlap. Symptoms are often similar. They occur because the trachea and/or main bronchi narrow excessively when you cough or breathe out hard (Figure 1). Symptoms can worsen with flare-ups, making it more difficult to clear mucus (sputum) from the lungs.

Figure 1.

(A) Trachea (windpipe) and main bronchi (large airways that connect the trachea to the lungs). (B) How collapse of the large airways occurs.

What Are the Common Symptoms?

• •Shortness of breath
• •A distinctive barking or “seal-like” cough
• •Being unable to cough up mucus
• •Frequent chest infections

Which Respiratory Diseases Can Cause Collapse of the Large Airways?

Collapse of the large airways with these symptoms is commonly seen in people with TBM. It may also occur with underlying conditions such as chronic obstructive pulmonary disease, asthma, bronchitis, bronchiectasis (“bron-kee-eck-tuh-sis”), and reflux, leading to EDAC. Symptoms may be misdiagnosed as asthma. If underlying conditions worsen, leading to flare-ups, symptoms often get worse.

How Is Collapse of the Large Airways Diagnosed?

Collapse of the large airways is diagnosed by a clinician specializing in pulmonary or respiratory disease. Clinicians may use a specialist scan (e.g., computed tomography or magnetic resonance imaging) or “flexible bronchoscopy” (“bron-kos′ko-pi”) to investigate.

How Is Collapse of the Large Airways Treated?

This is a chronic (i.e., long-term) condition. Many people can manage their common symptoms with a range of measures. Your respiratory therapist can help you with a management plan. This will likely include an ABC approach as follows, although surgery may be an option for some people with severe airway collapse.

A: Airways and Airway Clearance

Clearing your nose and keeping your chest free of sticky mucus are key. This becomes more important during flare-ups. Mucus stuck in your lungs can get infected and cause further chest infections. Special breathing exercises or blowing into a device to keep your airways open or shake them gently when you huff or cough can help you clear mucus. Good hydration—drinking about 4 pints (2 L) of water each day—is also important.

B: Breathing

Breathing through your nose will help calm throat irritation and control your cough. Using your lower chest/ribs to breathe rather than your upper chest is more efficient and will help your energy levels. If you become breathless with exertion, blowing out through pursed lips can help control unpleasant sensations in your chest. Adopting “positions of ease” can relieve breathlessness. Pacing activities will enable you to recover more quickly and manage fatigue.

C: Capacity for Exercise

Although exercise might make you short of breath, it is generally very good for you, especially if you have lung disease. It makes your muscles and heart stronger. Continuous positive airway pressure (CPAP), for those who use it, can be helpful for recovery if you are breathless with activities of daily living like showering. CPAP has the effect of inflating or “splinting” the airways open.

See data supplement for further information for patients.

Flare-ups

Making sure that any underlying condition (e.g., asthma) is well managed can help prevent flare-ups, as can following the ABC approach to managing day-to-day symptoms. However, a sudden worsening of your condition can be scary, and it is important to consult your healthcare provider for advice about antibiotics, for example. During a flare-up, to reduce breathlessness, try to stay calm. Use pursed-lipped breathing (or CPAP if needed). Increase your daily airway clearance to keep your airways clear of mucus and reduce your cough.

Rx Action Plan

• •Follow your daily treatment plan: take medications advised by your healthcare provider, manage your underlying condition, and follow the ABC approach.
• •Recognize when you have a change in symptoms and signs of a flare-up. Contact your healthcare provider promptly for advice.
• •Keep active: challenge yourself and measure your step count using your phone.
• •Get your flu and coronavirus disease (COVID-19) jabs as recommended by your healthcare provider.
• •Healthcare provider’s contact number: ______________________

See data supplement for additional information for clinicians.

American Thoracic Society Patient Education Resources

• •Chronic obstructive pulmonary disease: https://www.thoracic.org/patients/patient-resources/resources/copd-intro.pdf.
• •Bronchiectasis: https://www.thoracic.org/patients/patient-resources/resources/bronchiectasis-treatment.pdf.
• •Asthma: https://www.thoracic.org/patients/patient-resources/resources/asthma-treatment.pdf.