Central airway obstruction

Central airway obstruction (CAO) commonly presents with non-specific symptoms including dyspnoea, cough, and wheeze. Patients may be misdiagnosed with other airway diseases. A high degree of suspicion is necessary to ascertain the diagnosis.

In severe obstruction presenting with impending respiratory failure, immediate attention must be given to securing the airway. Rigid bronchoscopy is the procedure of choice, providing capacity for both diagnostic and therapeutic airway intervention.

Definitive confirmation of CAO requires diagnostic bronchoscopy diagnostic bronchoscopy (flexible or rigid). Imaging of the chest with plain x-rays and computed tomography, as well as pulmonary function tests, are useful ancillary investigations.

A multidisciplinary approach to management, involving a pulmonologist, otolaryngologist, thoracic surgeon, thoracic radiologist, and interventional bronchoscopist, is key to improved patient outcomes.

The distinction between malignant and non-malignant CAO is important. If malignancy is suspected or confirmed, the opinion of an oncologist and radiation oncologist should be sought following any immediate stabilisation of the airway.

Surgery (end-to-end anastomosis, tracheal sleeve resection) may be considered in patients who present with benign diseases or resectable malignancies. Bronchoscopic therapy may be an alternative for selected patients with benign disease or for those with non-resectable tumours.

Central airway obstruction (CAO) refers to a variety of obstructive processes that impede airflow within the central airways and is generally defined as >50% obstruction of the trachea, and/or mainstem bronchi.[1]Murgu SD, Egressy K, Laxmanan B, et al. Central Airway Obstruction: Benign Strictures, Tracheobronchomalacia, and Malignancy-related Obstruction. Chest. 2016 Aug;150(2):426-41. https://journal.chestnet.org/article/S0012-3692(16)00615-2/fulltext http://www.ncbi.nlm.nih.gov/pubmed/26874192?tool=bestpractice.com ​ CAO may be secondary to malignant or benign disease, and represents a significant source of morbidity and mortality with a considerable impact on quality of life. As CAO frequently presents with life-threatening respiratory failure, some experts recommend that the word non-malignant be used instead of benign.[2]Ernst A, Feller-Kopman D, Becker HD, et al. Central airway obstruction. Am J Respir Crit Care Med. 2004;169:1278-97. http://www.ncbi.nlm.nih.gov/pubmed/15187010?tool=bestpractice.com ​​