Tracheomalacia is a condition of the trachea that is characterized by relaxation of the trachea and bronchi on exhalation, hampering the breathing process. The point on the causes, the diagnosis and the treatments.
Definition: what is tracheomalacia?
Tracheomalacia is a shrinkage of more than 50% the diameter of the trachea during expiration, preventing the passage of air. The trachea is the tube that connects the larynx to the bronchi and ensures the passage of air from the nose and mouth to the bronchi. “It is not a permanent tracheal narrowing but a dynamic tracheal stricture which occurs at the time of expiration. The walls of the trachea soften, causing a collapse (partial collapse) of the latter“, specifies Dr. Jean-Philippe Santoni, prevention pulmonologist at the Fondation du Souffle.
What are the causes of tracheomalacia in children?
Tracheomalacia in children is essentially of origin congenital, i.e. present from birth. Congenital causes manifest during childhood and are often associated with hereditary diseases or malformations of the heart and vessels or a malformation of the esophagus (atresia).
What causes tracheomalacia in adults?
There are congenital causes, genetic causes and acquired causes. Among those, intubation during a stay in intensive care which can be responsible for a stenosis (narrowing), as well as the tracheostomy which consists of piercing the trachea to pass a tube to ventilate the patient. Other causes are likely to cause tracheomalacia: trauma, shock at the cervical level, a lung transplant, compressions of the trachea by tumours, cysts or even malformations of the large thoracic vessels, especially the aorta. “Of the chronic inflammation which lead to a remodeling of the trachea and bronchi, mainly in subjects with emphysema (non-functional air bubbles compressing the bronchi and possibly the trachea) may also be involved“, develops the pulmonologist.
What are the symptoms of tracheomalacia?
Symptoms occur during the expiratory phase of breathing, i.e. during exhalation. They include a noisy breathing with some hissing, cough, shortness of breath, production of mucus difficult to expectorate (spit up), leading to recurrent tracheobronchial infections. “In some patients, the sputum becomes purulent or even bloody (hemoptysis). In babies, there is often a bluish discoloration of the skin (cyanosis) because he suffers from hypoxia and repeated pneumonia“, adds the specialist.
What sound does the breath make in tracheomalacia?
In tracheomalacia, breathing is loud and accompanied by hissing.
First, the diagnosis is based on history and clinical examination. But a bronchoscopy is needed to confirm the diagnosis. This examination consists of passing a soft and flexible tube (endoscope) transnasally in order to allow direct visualization of the stenosis and severity of tracheomalacia. “There are three degrees of severity: mild (narrowing of more than 50% of the diameter on expiration), moderate (narrowing of more than 75%) and severe when the walls of the trachea come into contact on expiration. breath measurements which help to objectify the importance of the obstruction at expiration can be carried out in addition“, details Dr. Jean-Philippe Santoni. A chest scan to measure the intensity of tracheomalacia and clarify its causes is often prescribed.
The treatment depends on the clinical situation, the cause and the location on the trachea. In mild tracheomalacia, with few symptoms, treatment is essentially based on physiotherapy, antibiotics in case of superinfection and bronchodilators in case of Chronic Obstructive Pulmonary Disease and emphysema. Sometimes endoscopic therapies consisting of placing the equivalent of a stent in the trachea under general anesthesia, and a thoracic surgery in case of malformation, compressive tumor or cyst can be proposed.
Thank you to Dr Jean-Philippe Santoni, lead prevention pulmonologist at the Breath Foundation.