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We agree with Murgu and Colt [1Murgu S.D. Colt H.G. Expiratory collapse of the central airways.Ann Thorac Surg. 2006; 82 (letter): 768Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar] that careful definitions are in order. Our patients all had tracheobronchomalacia (TBM) as they describe it rather than excessive dynamic airway collapse (EDAC) [2Wright C.D. Grillo H.C. Hammoud Z.T. et al.Tracheoplasty for expiratory collapse of central airways.Ann Thorac Surg. 2005; 80: 259-267Abstract Full Text Full Text PDF PubMed Scopus (59) Google Scholar]. We have not operated on patients with EDAC with the technique of posterior membranous splinting. All of our patients have had “soft” tracheal cartilages and an archer’s bow deformity of their trachea. However, an important component of obstruction in these patients was marked widening of the membranous tracheal wall and its anterior displacement on expiration, especially when forceful or with cough. We have seen a few patients with EDAC referred for evaluation of “tracheomalacia” but have not offered them an operation. All of these patients have quite normal looking tracheal cartilages with the normal “D” shape. It is possible they may be helped with fixation of the posterior membranous wall, but that remains to be seen. We have viewed patients with EDAC as having a hyperirritable airway and have just recommended medical management of their very common reactive airways disease. We agree with Murgu and Colt [1Murgu S.D. Colt H.G. Expiratory collapse of the central airways.Ann Thorac Surg. 2006; 82 (letter): 768Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar] that careful definitions are in order. Our patients all had tracheobronchomalacia (TBM) as they describe it rather than excessive dynamic airway collapse (EDAC) [2Wright C.D. Grillo H.C. Hammoud Z.T. et al.Tracheoplasty for expiratory collapse of central airways.Ann Thorac Surg. 2005; 80: 259-267Abstract Full Text Full Text PDF PubMed Scopus (59) Google Scholar]. We have not operated on patients with EDAC with the technique of posterior membranous splinting. All of our patients have had “soft” tracheal cartilages and an archer’s bow deformity of their trachea. However, an important component of obstruction in these patients was marked widening of the membranous tracheal wall and its anterior displacement on expiration, especially when forceful or with cough. We have seen a few patients with EDAC referred for evaluation of “tracheomalacia” but have not offered them an operation. All of these patients have quite normal looking tracheal cartilages with the normal “D” shape. It is possible they may be helped with fixation of the posterior membranous wall, but that remains to be seen. We have viewed patients with EDAC as having a hyperirritable airway and have just recommended medical management of their very common reactive airways disease. Expiratory Collapse of the Central AirwaysThe Annals of Thoracic SurgeryVol. 82Issue 2PreviewWe read with enthusiasm the article by Wright and colleagues [1] on tracheoplasty for expiratory collapse of the central airways. We applaud this established surgical team for pursuing original research of a disease for which the understanding has been compromised during the years because of uncertainties regarding definitions, pathogenesis, and cause. Our own experience prompts us to emphasize that expiratory collapse of the central airways describes the collapse of cartilaginous rings, but it may also describe an excessive bulging of the posterior membrane within the airway lumen. Full-Text PDF