From the Guidelines
The treatment for expiratory dynamic airway collapse (EDAC) should prioritize tracheobronchial stenting, with surgical treatment with tracheoplasty or tracheobronchoplasty considered the definitive treatment after a stent trial. This approach is based on the most recent and highest quality study available, which emphasizes the importance of providing structural support to prevent the excessive inward movement of the posterior membrane during expiration 1.
Key Considerations
- The treatment of EDAC aims to alleviate symptoms such as chronic cough and dyspnea, and to improve the patient's quality of life.
- Tracheobronchial stenting is a viable option for managing EDAC, especially in patients who are not good candidates for surgical intervention.
- Surgical treatment, including tracheoplasty or tracheobronchoplasty, is considered the definitive treatment for EDAC, as it provides a more permanent solution to the problem of airway collapse.
Treatment Options
- Tracheobronchial stenting: This involves the placement of a stent in the trachea or bronchi to provide structural support and prevent collapse.
- Surgical treatment: This includes tracheoplasty or tracheobronchoplasty, which involves reinforcing the posterior membrane of the trachea and main bronchi to prevent collapse.
- Medical therapy: This may include bronchodilators and anticholinergics to reduce airway resistance, although the primary focus should be on providing structural support to the airways.
Individualized Treatment
- Treatment selection should be individualized based on symptom severity, extent of collapse, and patient comorbidities.
- The choice of treatment should be made in consultation with a multidisciplinary team of healthcare professionals, including pulmonologists, thoracic surgeons, and radiologists.
From the Research
Treatment for Expiratory Dynamic Airway Collapse (EDAC)
The treatment for EDAC involves a combination of medical and supportive therapies. Some of the key treatment options include:
- Treatment of coexisting conditions such as chronic obstructive pulmonary disease, asthma, gastroesophageal reflux disease, and vocal cord dysfunction 2
- Supportive treatment of dynamic central airway collapse, including antibiotics for respiratory infections, aggressive therapy, pulmonary physiotherapy, pulmonary rehabilitation, and continuous positive airway pressure 2
- Use of N-acetylcysteine and adjustable positive expiratory pressure valves, which have been shown to improve symptoms in some patients 3
- High flow nasal oxygen therapy, which can generate physiologic positive end expiratory pressure (PEEP) effects and improve EDAC 4
- Stent trial in selected patients with severe symptomatic EDAC to assess whether patients will have improvement in symptoms and thus identify patients who will benefit from surgical central airway stabilization 2, 5
- Thermoablative bronchoscopic treatments, such as Argon plasma coagulation (APC) and laser techniques, which are a promising alternative to traditional surgery, but require further research to assess their safety and effectiveness in humans 5
- Tracheobronchoplasty, which is suggested as a definitive treatment approach in severe cases where medical treatment fails 5
Key Considerations
When treating EDAC, it is essential to:
- Diagnose the condition accurately using dynamic flexible bronchoscopy and/or dynamic computed tomography scan, as well as clinical symptoms that are not fully explained by other lung diseases 2
- Be aware of the airway shape when performing nondynamic CT in refractory asthma patients, as recognizing the existence of EDAC may help when deciding on the treatment strategy 6
- Consider a multidisciplinary airway team in highly specialized centers with experience in the evaluation and treatment of this patient population for optimal outcomes 2