Management of tracheobronchomalacia

TBM: tracheobronchomalacia; PFTs: pulmonary function tests; FVL: flow volume loop; CT: computed tomography; PT: physical therapy; QOL: quality of life; PAP: positive airway pressure; TM: tracheomalacia.

* Common disorders associated with TBM include asthma, chronic obstructive lung disease, and gastroesophageal reflux disorder. Optimizing therapy for such disorders in many cases will lead to improvement in symptoms.

¶ In some patients with severe TBM isolated to the trachea, mainstem bronchus, and bronchus intermedius in whom dyspnea is not the primary symptom, consideration may be given to evaluating for surgery without a stent trial since a stent is unlikely to improve symptoms other than dyspnea.

Δ We generally apply intermittent noninvasive PAP before considering long-term silicone stenting; long term stenting is frequently poorly tolerated. A Montgomery T-tube may be an option in patients who are not surgical candidates, have an existing stoma, and do not require PAP for ventilatory failure. Tracheostomy is reserved for patients with TM who have respiratory failure requiring positive pressure ventilation.