From the Guidelines
Tracheobronchomalacia is primarily caused by weakness in the cartilage that supports the walls of the trachea and bronchi, which can be congenital or acquired due to various factors such as prolonged intubation, chronic inflammation, or external compression. The condition can lead to excessive collapse of these airways during breathing, resulting in symptoms like chronic cough, wheezing, recurrent respiratory infections, and breathing difficulties. According to the most recent and highest quality study 1, the etiologies of nonmalignant central airway obstruction, which includes tracheobronchomalacia, can be categorized into several groups, including postintubation/tracheostomy-related tracheal stenosis, inflammatory conditions, infections, and mechanical compression by surrounding structures.
Causes of Tracheobronchomalacia
- Congenital weakness of the cartilage
- Acquired causes:
- Prolonged intubation
- Chronic inflammation from conditions like COPD or recurrent infections
- Chronic cough
- Aging-related degeneration of cartilage
- External compression from abnormal blood vessels, tumors, or enlarged heart chambers
- Connective tissue disorders like Ehlers-Danlos syndrome
- Other contributing factors:
- History of airway intubation and mechanical ventilation
- Local effects of artificial airways
- Barotrauma
- Infections like TB, fungal, or recurrent respiratory papillomatosis
The management of tracheobronchomalacia depends on the severity of the condition and may include continuous positive airway pressure (CPAP), bronchodilators, or in severe cases, surgical interventions such as stent placement or tracheoplasty, as suggested by studies 1. However, the most recent guideline 1 emphasizes the importance of a systematic approach to the management of central airway obstruction, including tracheobronchomalacia, due to the complexity and variability of the condition.
From the Research
Causes of Tracheobronchomalacia
The causes of tracheobronchomalacia (TBM) can be categorized into two main types: congenital and acquired.
- Congenital causes: TBM can be a congenital condition, meaning it is present at birth, and is often associated with other congenital anomalies and syndromes 2, 3.
- Acquired causes: TBM can also be acquired due to various factors such as previous exposure to cigarettes, which is more common in middle age and the elderly 4.
Associated Conditions
TBM is often associated with other conditions, including:
- Recurrent and prolonged respiratory tract infections 2, 3
- Chronic lung disease 2
- Gastroesophageal reflux disease 2, 4
- Chronic obstructive pulmonary disease (COPD) 4
- Asthma 4, 5
Pathophysiology
The pathophysiology of TBM involves an excessively compliant and collapsible central airway, leading to symptoms such as cough, dyspnea, and recurrent infections 5, 6.
- The condition is characterized by weakness of the airway wall and dynamic decrease in the tracheal lumen and large bronchi, particularly during expiration 4.