SESSION TITLE: Lung Pathology 1 SESSION TYPE: Affiliate Case Report Poster PRESENTED ON: Tuesday, October 31, 2017 at 01:30 PM - 02:30 PM INTRODUCTION: Tracheobronchomalacia (TBM) can cause debilitating paroxysms of cough, wheezing, dyspnea, and recurrent respiratory infections. In severe cases, patients experience morbidity including limitations on public excursions, loss of ability to work, recurrent hospital and even intensive care unit admissions. We present a novel, low-cost, handheld device used to abort coughing paroxysms in a patient with severe TBM. CASE PRESENTATION: A 70-year-old man with COPD presented with chronic cough. He had been recurrently hospitalized at another institution, including an intubation for respiratory distress associated with his coughing. On exam, he had episodes of profound coughing paroxysms accompanied by respiratory distress with transient desaturation. The cough had a distinct vibratory quality. Bronchoscopy revealed 100% expiratory collapse of his trachea and mainstem bronchi. Airway diameter was too large for stent placement. Tracheobronchoplasty was discussed, but the patient wished for a trial of conservative management. His coughing paroxysms did not improve with steroids, bronchodilators, nor antitussives, including narcotics. CPAP helped but the time and coordination required to don the equipment limited its utility, given his acute distress with episodes. Furthermore, his insurance did not approve a CPAP device for this off-label indication. We fashioned a novel, low-cost, handheld device that the patient could self-apply to abort coughing paroxysms: A positive expiratory pressure (PEP) device typically for airway clearance, with mouthpiece removed, was attached to a flexible face mask (Fig. 1,2). PEP was titrated to effect; 15cm H2O aborted coughing. He improved with this device and was discharged. DISCUSSION: Conventional management of TBM includes airway stenting and tracheobronchoplasty in patients whose symptoms improve with stenting. For patients who are not candidates or fail those therapies, treatment options are limited. Use of CPAP has been reported,1 but impact on dyspnea and cough is variable and for some patients (like ours) the logistics of obtaining and donning the equipment is problematic. A handheld mask device to provide PEP with a tight facial seal can provide as-needed positive pressure. CONCLUSIONS: A novel, low-cost, handheld device to provide intermittent positive airway pressure may treat debilitating coughing paroxysms in TBM. Reference #1: Ferguson GT, Benoist J. Nasal continuous positive airway pressure in the treatment of tracheobronchomalacia. Am Rev Respir Dis. 1993;147(2)457. DISCLOSURE: The following authors have nothing to disclose: Lindsay Boole, Talal Dahhan, Edward Kessler, Kamran Mahmood, Scott Shofer, Momen Wahidi, George Cheng We are presenting an off-label use of a positive expiratory pressure device and a flexible face mask.