Tracheobronchomalacia

Tracheobronchomalacia or TBM is a condition characterized by flaccidity of the tracheal support cartilage which leads to tracheal collapse.^[1] This condition can also affect the bronchi. There are two forms of this rare condition: primary TB and secondary TB. Primary TB is congenital and starts as early as two years old. It is mainly linked to genetic causes. Secondary TB is acquired and starts in adulthood. It is mainly developed after an accident or chronic inflammation.^[2]

On 28 May 2013, it was reported that a cure had been developed via a 3D printed windpipe.^[3] This cure has currently saved the lives of at least 3 infants.

Symptoms

Initially symptoms asymptomatic or some patients do not experience symptoms at all. In a progressive TBM case symptoms include:

• shortness of breath
• a cough
• mucus build up
• wheezing
• difficulty in breathing
• bluish coloration to skin around the nose and mouth^[4]

Symptoms may become worse if the patient is stressed, sick, laying down, or forcing a cough.

Tests and Diagnosis

Diagnosis is conducted according to the severity of the symptoms. Initially pulmonary function tests^[5] are administered. These tests include: the lungs capability of air intake and outtake, and gas flow of oxygen and carbon dioxide between the body and environment. Following these function tests a CT scan or bronchoscopy will be ordered. The results to the scan and bronchoscopy ^[6] will display the status of the rare condition. A mild case of Tracheobronchomalacia would be if the patient’s trachea condenses 50% of its normal space when exhaling. Moderate Tracheobronchomalacia would be 25% of the normal trachea space constricting and a severe case would be if the walls touch each other.

Treatment

To properly treat a patient with Tracheobronchomalacia, first the type must be determined (primary or secondary). After the type is named, the cause must be identified, whether it is from genetics, a trauma accident, or chronic tracheal illness. If a trauma case or chromic tracheal illnesses were the cause, first steps to treatment would be to fix or help these underlying issues. If the cause is genetic or the previous underlying issues couldn’t be fixed, other treatments would be assessed. More severe treatments include: silicone stenting to prevent tracheal constriction, surgery to strengthen or attempt to rebuild the walls, continuous positive airway pressure^[7] that has a machine blow small amounts of air into the trachea to keep it open (mainly at night), or a tracheostomy^[8] which is surgically put into your neck that leads to your trachea to help with breathing. Patients who do not experience symptoms do not need treatment and often it goes undiagnosed.^[2]

Clinical presentation

• Chronic cough^[9]

See also

• Tracheomalacia
• Bronchomalacia

References

External links

• The Floppy Airway-A Review of Tracheobronchomalacia in Adults
• Swiss embryology (from UL, UB, and UF) rrespiratory/patholrespi01
• Tracheobronchomalacia in Children on Medscape
• Tracheobronchomalacia on Genetic and Rare Diseases Information Center (GARD)