Overview
Tracheomalacia is a congenital or acquired condition characterized by abnormal softening of the tracheal cartilage, leading to tracheal collapse, particularly during expiration. It can occur independently or in association with other congenital or acquired disorders, presenting with symptoms such as stridor, wheezing, recurrent infections, and respiratory distress 1.Diagnosis
Clinical Presentation: Early-onset stridor, fixed wheeze, recurrent respiratory infections, brassy cough, and near-death attacks 1.
Diagnostic Tests:
- Flexible bronchoscopy in a free-breathing state is typically diagnostic 1.
- Dynamic imaging techniques: low-contrast volume bronchography, CT, MRI 1.
Grading: No universally accepted severity classification exists 1.Management
First-line Treatments:
- Medical management includes bronchodilators, anti-muscarinic agents, mucolytics, and antibiotics 1.
- Treatment of comorbidities and associated conditions 1.
Adjunctive Treatments:
- Chest physiotherapy is commonly prescribed 1.
- In specific cases, continuous positive airway pressure (CPAP) may be used, e.g., 20-25 cm H2O for maintaining tracheal patency 2.Special Populations
Pediatrics: Respiratory distress and need for interventions like tracheostomy are common; CPAP can be effective without hemodynamic complications 2.Key Recommendations
Diagnose tracheomalacia primarily through flexible bronchoscopy and dynamic imaging techniques (Evidence: Moderate 1).
Initiate medical management with bronchodilators, anti-muscarinic agents, and address underlying comorbidities (Evidence: Weak 1).
Consider continuous positive airway pressure as an adjunctive therapy in severe cases, particularly in pediatric patients (Evidence: Expert opinion 2).References
1 Wallis C, Alexopoulou E, Antón-Pacheco JL, Bhatt JM, Bush A, Chang AB et al.. ERS statement on tracheomalacia and bronchomalacia in children. The European respiratory journal 2019. link
2 Grundfast KM, Mumtaz A, Kanter R, Pollack M. Tracheomalacia in an infant with multiplex congenita (Larsen's) syndrome. The Annals of otology, rhinology, and laryngology 1981. link