Nocturnal continuous positive airway pressure offers symptomatic benefit in excessive dynamic airway collapse despite normal sleep study.

Abstract

Excessive dynamic airway collapse (EDAC) and tracheobronchomalacia (TBM) cause debilitating symptoms yet are often misdiagnosed as asthma or chronic obstructive pulmonary disease (COPD). EDAC/TBM should be considered in all cases of obstructive ventilatory defect refractory to medical management. Diagnosis is made with flexible bronchoscopy and/or inspiratory and expiratory phase computed tomography (CT) scans. Treatment should be individualised and "pneumatic stenting" with the use of continuous positive airway pressure (CPAP) may lead to symptomatic relief, and in some cases regardless of the degree of collapse or absence of sleep disordered breathing in overnight oximetry. The case of a 63-year-old female referred to a tertiary respiratory department for a trial of CPAP due to EDAC is presented. Over the course of a few months, she had presented frequently to hospital with cough and shortness of breath which had been attributed to asthma. As she had not responded to treatment, an inpatient flexible bronchoscopy was performed which identified EDAC of the right main bronchus and she was referred to a tertiary ventilation department. Despite a normal sleep study whilst self-ventilating, nocturnal CPAP therapy significantly improved quality and duration of sleep, daytime symptoms and therefore quality of life. She was discharged with nocturnal CPAP and remains adherent to treatment.