Tracheobronchomalacia (TBM)

Tracheobronchomalacia (TBM) is a condition of the airways that causes them to become weak and floppy and collapse with breathing. Normally the central airways (the trachea and bronchi) remain open when you breathe.

Overview and Symptoms

Tracheobronchomalacia is a rare condition, and often misdiagnosed. In most cases, it is not clear what causes TBM. Sometimes it can be seen at the same time as another lung disorder, such as COPD, asthma, or cystic fibrosis. Our researchers are working to understand the underlying processes that lead to tracheobronchomalacia.

Symptoms of TBM include:

Shortness of breath
Labored breathing
A persistent cough that sounds like a bark or very rumbling
Difficulty clearing phlegm or mucus from your throat
Build-up of secretions in your lungs
Frequent respiratory infections

What does the TBM cough sound like?

Other lung conditions, such as asthma, COPD, or emphysema, can cause symptoms that are similar to TBM. To ensure an accurate diagnosis, we offer patients one-stop access to a multidisciplinary team of experts.

Our specialists will first ask about your symptoms and past health problems, and do a thorough physical exam. They may also ask you to undergo two specialized medical tests — a dynamic flexible bronchoscopy and a dynamic expiratory CT scan — to determine whether you have TBM – and if so, how severe it is.

Dynamic Expiratory CT Scan

Dynamic Flexible Bronchoscopy

Treatment

BIDMC is a world leader in diagnosing and treating tracheobronchomalacia (TBM). When you make an appointment with our TBM Program, you will benefit from the expertise of a multidisciplinary team of interventional pulmonologists, thoracic surgeons, ear/nose/throat specialists, speech pathologists, endocrinologists, general pulmonologists, behavioral health providers, anesthesiologists, and radiologists.

We evaluate and treat more patients with TBM than anywhere else in the United States. Through our TBM Program, we offer you an extraordinary level of expertise and care.

Treatment of Mild or Moderate TBM

We determine whether you have TBM, and how severe it is, by assessing your symptoms and how much your airway narrows when you breathe. If your TBM is diagnosed as mild or moderate, treatment is symptomatic and options include:

Airway oscillatory devices (flutter valve)

These are hand-held devices to help clear your airways. You inhale, and then exhale forcefully. This helps clear phlegm and mucus.

External percussion vests

These inflatable vests are connected to a compressor and help clear the lungs of mucus and phlegm. These are usually used 2 or 3 times a day.

Expectorant

This is a medication that makes it easier to cough up mucus and phlegm, clearing the airways.

Pulmonary rehabilitation

This involves education and training to improve your quality of life. You will learn more about TBM, and how to breathe more productively, conserve energy, and keep active.

Pursed lip breathing

This is a breathing technique in which you inhale through your nose, while keeping your lips closed, and then exhale through tightly pursed lips. It is a simple yet effective way to slow your breathing and alleviate shortness of breath.

CPAP (continuous positive airway pressure) or BiPap (Bilevel positive airway pressure)

A CPAP or BiPap device is used while you sleep. Both devices increase the air pressure in your throat, so that your airway doesn't collapse when you breathe.

Treatment of Severe TBM

If your TBM is severe, we conduct further tests to determine if you might benefit from a surgical procedure called tracheobronchoplasty. This procedure offers effective and permanent treatment for TBM.

To ensure that you will benefit from surgery, our multidisciplinary team will first determine whether you have other conditions that commonly occur in addition to TBM and need to be treated. For this reason, we will assess:

Your vocal cord health
Whether you have GERD (gastroesophageal reflux disease)
Whether you have other lung disorders (asthma, COPD, emphysema)
We also determine whether you are healthy enough to undergo surgery.

Stent trial

The final step in determining whether you will benefit from surgery is a 1-2 week "stent trial." The stent will keep your airways open, much as a cardiac stent keeps blood vessels open. This mimics what happens to your airways after surgery, so it will give you some idea of how much your symptoms will improve after surgery.

During the stent trial, using validated questionnaires (to assess shortness of breath, quality of life, and cough) we will monitor how you are doing and ask that you return to the TBM clinic for follow-up. In addition, you will undergo physiological evaluation using tests to assess lung function and 6-minute walking capacity. When the trial is over, we remove the stent. (We prefer not to implant stents permanently, as they can cause irritation or become infected. Surgery offers a better long-term solution for most patients.)

Tracheobronchoplasty

If your symptoms improve during the stent trial, and your overall health suggests you may benefit from surgery, we will schedule you for tracheobronchoplasty. This is an open surgical procedure, which means that you will have a long incision in your chest. During the procedure, the surgeon opens the chest wall to reach the airways. The surgeon sutures sections of mesh at multiple points on the outside of the floppy airway, to stabilize it (much like a splint will keep a broken bone steady). As you heal, scar tissue forms around the mesh, making it stable.

You will spend several days in the Intensive Care Unit, followed by a longer stay in the hospital. After you are discharged, we will monitor your recovery closely. Patients from out of state may need to find temporary housing in the area for the first month after discharge.

Monitoring after surgery

We want to ensure that you recover as well as possible. For that reason, we ask that you return three months after surgery for evaluation. From then on, we will ask you to return to the TBM clinic once a year, so that we can continue to monitor your recovery.

TBM Program at BIDMC

BIDMC is a world leader in diagnosing and treating tracheobronchomalacia (TBM). Our specialists evaluate and treat more patients with TBM than any other program in the United States.

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