Tracheobronchomalacia

Tracheobronchomalacia (TBM) is a rare condition that occurs when the tissue that makes up the windpipe, or trachea, is soft and weak. A healthy windpipe, or trachea, is stiff. It remains open while you breathe or cough.

People with this disease have difficulty breathing because their windpipe collapses when they take a breath or cough. The disease is similar to to tracheomalacia.

There are two types of the condition:

  • Primary TBM, when people are born with weak windpipes. The disease is almost always found in babies and young children.
  • Secondary TBM, when the disease develops due to another lung condition, such as chronic obstructive pulmonary disease (COPD). This type is usually found in adults.

Symptoms

Patients have different symptoms depending on their age, the cause of their soft windpipe, and how severe their condition is. The most common symptom is difficulty breathing.

Other symptoms may include:

  • Wheezing when breathing out and a high-pitched noise when breathing in
  • Coughing
  • Difficulty clearing mucus and phlegm from the throat
  • Repeated upper respiratory infections
  • A bluish color to the skin surrounding the nose and mouth

Infants and children with primary TBM may also have a wheezing cough.


Causes and Risk Factors

Tracheobronchomalacia in children is believed to run in families.

Adults who smoke are the most likely to have the disease. People with TBM often also have chronic obstructive pulmonary disease (COPD).

Other causes:

  • Damage to the windpipe during a tracheostomy, where an incision is made into the windpipe and a tube is inserted to help with breathing
  • Tracheal fractures
  • Tumors pressing on the windpipe
  • Thyroid tumors
  • Dilated aortic or pulmonary arteries
  • Chronic irritation due to coughing, as from asthma
  • Secondhand smoke

Diagnosis

Diagnosing TBM usually begins with a physical exam. Your doctor will ask about your symptoms and past health problems. They will ask if you smoke, and for how long you smoked. The doctor will also look at your airway and esophagus, the tube that connects the mouth to the stomach.

Your doctor may order tests to check the diagnosis and the seriousness of your condition.

Chest X-rays, CT scans or a bronchoscopy may be used to see inside the chest and lungs.

A bronchoscopy looks inside the airways, including the bronchi, which carry air into the lungs. The doctor might also take a tissue sample to look at under a microscope.

Other tests might be used to find out how much damage has been done to the airways and lungs, as well as how well your lungs are working. These tests may include many types of lung function testing .

Treatments

Most people with TBM will need surgery to fix the collapsed windpipe. There are several options. The experts at the Advanced Lung Disease Program can help you determine what’s best for you.

Some people will receive a stent, a silicone tube put into the windpipe to open the airway. If the stenting works well, the surgeon may recommend a mesh stent be put into the windpipe permanently. These mesh tubes are placed in the windpipe through a procedure called a tracheobronchoplasty.

Some people with TBM have damage to only a small part of their windpipe. Surgeons might be able to remove the damaged part and join the ends together.

Atracheostomy may also be used to treat TBM as a short-term solution or on a more permanent basis. During this procedure, a hole is cut in the front of the neck and into the windpipe to help with better breathing.