From the Guidelines
Expiratory dynamic airway collapse (EDAC) typically presents with symptoms including chronic cough and dyspnea, which are the most frequent symptoms, as noted in the study by 1. These symptoms can be similar to those experienced by patients with tracheomalacia or tracheobronchomalacia, but EDAC is characterized by isolated excessive anterior bowing of the posterior membranous tracheal wall with tracheal narrowing. The symptoms of EDAC can include:
- Chronic cough
- Dyspnea
- Wheezing
- Stridor
- Difficulty clearing secretions
- Recurrent respiratory infections It's worth noting that EDAC can be associated with a decreased quality of life, as mentioned in the study by 1. The diagnosis of EDAC often requires dynamic airway assessment via bronchoscopy or dynamic CT imaging during forced exhalation, as the condition can be occult at inspiration, but an inspiratory elongated transverse diameter of the trachea can be highly correlated with tracheomalacia, as confirmed by expiratory CT, according to the study by 1. In contrast to the older study by 1, which reported cough and expiratory wheeze as common symptoms in patients with airway malacia, the more recent study by 1 provides a more comprehensive understanding of the symptoms associated with EDAC. Therefore, based on the most recent and highest quality evidence, the symptoms of EDAC include chronic cough and dyspnea, and diagnosis requires dynamic airway assessment, as noted in the study by 1.
From the Research
Symptoms of Expiratory Dynamic Airway Collapse (EDAC)
The symptoms of EDAC can be non-specific and may include:
- Dyspnea (shortness of breath) 2, 3, 4
- Cough, which can be chronic 2, 3, 5
- Mucostasis (accumulation of mucus in the airways) 3
- Recurrent respiratory infections 3, 4
- Poor quality of life 3
- Breathlessness or wheezing 2, 3
Diagnosis and Severity
Diagnosis of EDAC is typically based on dynamic flexible bronchoscopy and/or dynamic computed tomography scan, as well as clinical symptoms that are not fully explained by other lung diseases 3. The severity of EDAC can be assessed using a scoring system, with higher scores indicating more severe airway collapse 6. A cutoff score of 9 has been proposed to predict severe EDAC, with a sensitivity of 94% and a specificity of 74% 6.
Treatment
Treatment of EDAC may involve addressing underlying conditions such as chronic obstructive pulmonary disease, asthma, or gastroesophageal reflux disease, as well as supportive treatments like antibiotics, pulmonary physiotherapy, and continuous positive airway pressure 3. In some cases, airway stenting or tracheobronchoplasty may be considered 3, 4.