From the Guidelines
Tracheomalacia is primarily caused by weakness of the tracheal cartilage, which can be due to congenital or acquired factors, with acquired tracheomalacia being more common and often resulting from prolonged intubation, chronic inflammation, or external compression, as noted in studies such as 1. The causes of tracheomalacia can be divided into congenital and acquired categories. Congenital tracheomalacia occurs when the cartilage in the trachea doesn't develop properly during fetal growth, often associated with conditions like esophageal atresia, tracheoesophageal fistula, or vascular rings that compress the trachea. Acquired tracheomalacia develops after birth and can result from:
- Prolonged intubation, as seen in patients with chronic lung disease of infancy 1
- Tracheostomy
- Chronic inflammation from conditions like polychondritis or tracheobronchitis
- External compression from enlarged thyroid or vascular structures
- Trauma to the trachea
- As a complication of certain surgeries Chronic obstructive pulmonary disease (COPD) can also contribute to tracheomalacia due to repeated coughing and increased airway pressure, as mentioned in 1. In some cases, the condition may be idiopathic, meaning the cause remains unknown. Treatment approaches vary based on severity and may include observation for mild cases, continuous positive airway pressure (CPAP), or surgical interventions like aortopexy or tracheal stenting for severe cases that significantly impact breathing, with the most recent guidelines suggesting tracheobronchial stenting as a potential treatment option for symptomatic expiratory central airway collapse (ECAC) 1.
From the Research
Causes of Tracheomalacia
The causes of tracheomalacia can be varied and include:
- Extrinsic compression of the trachea due to vascular anomalies, such as pulmonary artery sling 2 or double-arch aorta 3
- Chronic obstructive lung disease, which can cause high-grade, chronic, long-segment airway obstruction 4
- Intrinsic factors, such as tumors or strictures, which can also lead to tracheomalacia 4
- Other potential risk factors, including obesity and gastro-esophageal reflux disease, which have been associated with an increased risk of severe tracheomalacia 5
Specific Causes
Some specific causes of tracheomalacia include:
- Pulmonary vascular sling, which can cause chronic extrinsic compression of the trachea 2
- Double-arch aorta, which can also cause extrinsic compression of the trachea 3
- Chronic obstructive lung disease, which can cause tracheomalacia due to chronic inflammation and damage to the airway walls 4
Risk Factors
Several risk factors have been identified as potential contributors to the development of tracheomalacia, including:
- Obesity, which has been associated with an increased risk of severe tracheomalacia 5
- Gastro-esophageal reflux disease, which has also been linked to an increased risk of severe tracheomalacia 5
- High pre-intubation PaCO2 levels, which have been found to be significantly higher in patients with severe tracheomalacia 5