From the Guidelines
The management approach for patients with expiratory dynamic airway collapse (EDAC) should prioritize symptomatic treatment with tracheobronchial stenting, with surgical treatment with tracheoplasty or tracheobronchoplasty considered as the definitive treatment after a stent trial. This approach is based on the most recent evidence from the Journal of the American College of Radiology, which highlights the importance of treating symptomatic ECAC with tracheobronchial stenting and considering surgical treatment for definitive management 1.
Key Considerations
- Symptomatic ECAC can be treated with tracheobronchial stenting, which can provide relief from symptoms such as chronic cough and dyspnea 1.
- Surgical treatment with tracheoplasty or tracheobronchoplasty is considered the definitive treatment for ECAC, and should be considered after a stent trial 1.
- The goal of management is to improve symptoms, prevent exacerbations, and maintain quality of life by stabilizing the airways during expiration when the dynamic collapse occurs.
Treatment Options
- Tracheobronchial stenting: This can be used to treat symptomatic ECAC, and can provide relief from symptoms such as chronic cough and dyspnea 1.
- Surgical treatment: Tracheoplasty or tracheobronchoplasty can be considered as the definitive treatment for ECAC, and should be considered after a stent trial 1.
- Other treatments: Other treatments such as preventive airway clearance therapies, anti-inflammatory agents, prophylactic or therapeutic antibiotics, and pulmonary rehabilitation may also be considered, depending on the underlying cause and severity of symptoms.
Monitoring and Follow-up
- Regular follow-up with pulmonary function testing is important to monitor disease progression and treatment response.
- The goal of management is to improve symptoms, prevent exacerbations, and maintain quality of life by stabilizing the airways during expiration when the dynamic collapse occurs.
From the Research
Management Approach for EDAC
The management approach for patients with expiratory dynamic airway collapse (EDAC) involves several steps, including:
- Addressing underlying conditions such as asthma, COPD, and gastro-esophageal reflux 2
- Using airway stents or tracheobronchoplasty (TBP) as a corrective treatment for severe central airway collapse (>90%) and severe symptoms 3
- Considering thermoablative bronchoscopic treatments, such as Argon plasma coagulation (APC) and laser techniques, as a promising alternative to traditional surgery 2
- Using a severity scoring system to assess the severity of EDAC and determine the need for subsequent intervention 4
Treatment Options
Treatment options for EDAC include:
- Airway stenting, which can be used as a predictor for successful outcomes after central airway stabilization surgery via TBP 5
- Tracheobronchoplasty (TBP), which is suggested as a definitive treatment approach for severe cases 2
- Thermoablative bronchoscopic treatments, such as APC and laser techniques, which are a promising alternative to traditional surgery 2
- N-acetylcysteine and adjustable positive expiratory pressure valves, which can be used to treat EDAC and improve symptoms 6
- Continuous Positive Airway Pressure (CPAP), which can be used as a non-invasive alternative to evaluate surgical candidacy in cough-predominant EDAC presentations 5
Diagnostic Evaluation
Diagnostic evaluation for EDAC includes:
- Bronchoscopy, which can be used to detect excess collapse of tracheobronchial posterior membrane 6
- Expiratory chest CT, which can be used to visualize excess central airway collapse 6
- Spirometry, which can be used to assess obstruction, although it may not always reveal obturation in patients with EDAC 6
- Dynamic bronchoscopy, which can be used to evaluate expiratory central airway collapse and assess the severity of EDAC 4