From the Guidelines
Tracheomalacia is characterized by weakness and floppiness of the tracheal walls, leading to airway collapse during breathing, with symptoms including cough, dyspnea, stridor, or wheezing, and management depends on severity, ranging from conservative approaches to surgical interventions. The symptoms of tracheomalacia can vary in severity and may include a barking or brassy cough, wheezing that doesn't respond to bronchodilators, recurrent respiratory infections, difficulty clearing secretions, and stridor (high-pitched breathing sound) that worsens with activity, crying, or feeding 1. In severe cases, patients may experience cyanosis (bluish discoloration), apnea, or respiratory distress. Management of tracheomalacia typically begins with conservative approaches, such as observation and treatment of infections, chest physiotherapy to clear secretions, and continuous positive airway pressure (CPAP) to provide temporary airway support 1. Medications like ipratropium bromide or inhaled corticosteroids may help manage symptoms but don't address the underlying condition. For moderate to severe cases, surgical interventions might be necessary, including aortopexy (suturing the aorta to the sternum to pull the trachea forward), tracheal stenting, or tracheostomy in life-threatening situations 1. The condition often improves with age as the tracheal cartilage strengthens, particularly in congenital cases. Parents of affected children should be educated about positioning techniques (often upright or prone positions help), recognizing respiratory distress signs, and infection prevention strategies. The underlying mechanism involves inadequate cartilage support in the tracheal walls, causing dynamic airway collapse, particularly during increased respiratory effort. Some studies suggest that noninvasive ventilation, such as positive expiratory pressure (PEP) therapy, can be beneficial in improving airway clearance and reducing symptoms in patients with tracheomalacia 1.
Key Points
- Tracheomalacia is a condition characterized by weakness and floppiness of the tracheal walls, leading to airway collapse during breathing.
- Symptoms can include cough, dyspnea, stridor, or wheezing, and can range from mild to severe.
- Management depends on severity and can include conservative approaches, such as observation and treatment of infections, chest physiotherapy, and CPAP.
- Surgical interventions, such as aortopexy, tracheal stenting, or tracheostomy, may be necessary in moderate to severe cases.
- Noninvasive ventilation, such as PEP therapy, can be beneficial in improving airway clearance and reducing symptoms. The most effective management approach for tracheomalacia is a multidisciplinary approach that takes into account the severity of the condition, the patient's overall health, and the potential benefits and risks of different treatment options, as suggested by the most recent study 1.
From the Research
Symptoms of Tracheomalacia
- Dyspnea, sputum production, hemoptysis, and cough in adults 2
- Expiratory stridor and cough in children 3, 2
- Wheezing 4
- Recurrent dyspnea 4
- Barking cough 3
- Respiratory distress episodes 3
- Acute life-threatening events (ALTE) 3
Management of Tracheomalacia
- Surgical intervention, such as aortopexy, which is the most commonly performed surgery in children 5
- Tracheoplasty, which seems to be the best choice for selected cases of adult malacia 5
- Bronchoscopy and stent insertion, which can lead to significant improvement, but with a high complication rate 5
- Surgical lateropexia and tracheal resection 5
- Dynamic airway CT, a promising tool for noninvasive diagnosis 5
- Functional bronchoscopy, which is still not standardized 5
- Airway stabilization techniques using stents placed via bronchoscopy 6