Central airway obstruction: is it time to move forward?

Fernando Guedes,Ana Colette Maurício,Mariana V Branquinho,Rui D Alvites,António Bugalho,Ana C Sousa

doi:10.1186/s12890-022-01862-x

Abstract

IntroductionCentral airway obstruction (CAO) represents a pathological condition that can lead to airflow limitation of the trachea, main stem bronchi, bronchus intermedius or lobar bronchus.Main bodyIt is a common clinical situation consensually considered under-diagnosed. Management of patients with CAO can be difficult and deciding on the best treatment approach represents a medical challenge. This work intends to review CAO classifications, causes, treatments and its therapeutic limitations, approaching benign and malign presentations. Three illustrative cases are further presented, supporting the clinical problem under review.ConclusionManagement of CAO still remains a challenge. The available options are not always effective nor free from complications. A new generation of costume-tailored airway stents, associated with stem cell-based therapy, could be an option in specific clinical situations.

Highlights

ConclusionManagement of Central airway obstruction (CAO) still remains a challenge. The available options are not always effective nor free from complications
Central airway obstruction (CAO) represents a pathological condition that can lead to airflow limitation of the trachea, main stem bronchi, bronchus intermedius or lobar bronchus.Main body: It is a common clinical situation consensually considered under-diagnosed
Tracheobronchopatia osteochondroplastica (TO) is a rare benign disease with unknown origin that affects the cartilage rings of the trachea and, in lesser extent, the main bronchi. It occurs over the age of 50 years, and it is characterized by cartilaginous or osseous nodules projecting into the airway lumen, causing serious deformity

Summary

Conclusion

CAO represents an important clinical impairment caused by benign or malignant diseases. Surgical management remains the preferred approach but there are situations in which, whether due to patient limitation or the nature of the pathology, intervention bronchoscopy, with its accessory techniques such as laser, cryotherapy, mechanical dilation, or debridement, play a preponderant role. When it comes to the choice of a stent, several considerations must be considered. A recent evolutional step was made when manufacturers offered modifications of their products according to patients needs, with rapid prototyping 3D printing techniques, allowing stents to be tailored to the individuals airway in days or even hours [99].

Introduction

Findings

Introduction of a silicon Dumon Stent