HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Murgu, S. D. Articles by Colt, H. G. Search for Related Content PubMed PubMed Citation Articles by Murgu, S. D. Articles by Colt, H. G. Related Collections Trachea and bronchi Related Article

Ann Thorac Surg 2006;82:768
© 2006 The Society of Thoracic Surgeons

---

Correspondence

Expiratory Collapse of the Central Airways

University of California at Irvine Medical Center, 101 The City Drive S, Orange, CA 92868

(Email: hcolt{at}uci.edu).

To the Editor:

We read with enthusiasm the article by Wright and colleagues [1] on tracheoplasty for expiratory collapse of the central airways. We applaud this established surgical team for pursuing original research of a disease for which the understanding has been compromised during the years because of uncertainties regarding definitions, pathogenesis, and cause. Our own experience prompts us to emphasize that expiratory collapse of the central airways describes the collapse of cartilaginous rings, but it may also describe an excessive bulging of the posterior membrane within the airway lumen. In this regard the terms tracheobronchial collapse, expiratory tracheobronchial collapse, expiratory tracheobronchial stenosis, tracheobronchial dyskinesia, tracheobronchomalacia (TBM), and dynamic airway collapse have each been used to depict this disorder [2–4].

We believe that novel imaging tools such as dynamic computed tomography and magnetic resonance imaging, as well as appropriately performed dynamic bronchoscopy, and potentially, morphometric bronchoscopy will allow greater distinction between the following two disorders: (1) TBM, in which collapse of the cartilaginous rings is noted, and (2) excessive dynamic airway collapse (EDAC), in which excessive inward bulging of the posterior membrane occurs during exhalation. The two conditions may or may not coexist.

A clear distinction between these two disorders (TBM and EDAC) is warranted because: (1) a certain degree of dynamic airway collapse is normal, causing up to 40% reduction in airway caliber during exhalation or cough [5]; (2) causes may be different; (3) pathogenesis may be different, and (4) treatment alternatives should be individualized. Increased awareness of these disorders, which may not be as rare as previously believed [3], will help avoid delays in diagnosis, particularly in patients otherwise presumed to have refractory asthma or bronchitis.

	References

Top References

 

1. Wright CD, Grillo HC, Hammoud ZT, et al. Tracheoplasty for expiratory collapse of central airways Ann Thorac Surg 2005;80:259-267.[Abstract/Free Full Text]
2. Reinert M, Steurich F. Correlation between lung function and tracheobronchial collapse Respiration 1976;33(1):47-53.[Medline]
3. Jokinen K, Palva T, Sutinen S, Nuutinen J. Acquired tracheobronchomalacia Ann Clin Res 1977;9:52-57.[Medline]
4. Park JG, Edell ES. Dynamic airway collapsedistinct from tracheomalacia. J Bronchol 2005;12:143-146.
5. Fraser RG. Measurements of the caliber of human bronchi in three phases of respiration by cine-bronchography J Can Assoc Radiol 1961;12:102-112.[Medline]

This article has been cited by other articles:

				C. D. Wright and H. C. Grillo Reply Ann. Thorac. Surg., August 1, 2006; 82(2): 768 - 769. [Full Text] [PDF]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Murgu, S. D. Articles by Colt, H. G. Search for Related Content PubMed PubMed Citation Articles by Murgu, S. D. Articles by Colt, H. G. Related Collections Trachea and bronchi Related Article