From time to time, most of us develop brief, mild coughs from colds or other illnesses. However, when a patient comes to my pulmonology practice with a loud, barking cough that won’t go away, I consider a wide range of underlying health problems.
One of which is tracheobronchomalacia (TBM), an underdiagnosed condition that occurs when the walls of the airway — known as the trachea and the bronchi — are weak. This can cause a patient’s airway to narrow or collapse when breathing out.
TBM can be serious. In addition to causing an uncomfortable cough, it can make it harder for a patient to breathe and carry out daily activities. In some cases, it can even become life-threatening.
TBM can share symptoms with other conditions — it commonly occurs in patients who suffer from other pulmonary issues such as asthma. So, it’s easy to overlook or misdiagnose it.
That’s why I’d like more people to be aware that it exists. Understanding the condition and knowing the possible signs can empower patients to seek help sooner and get the treatment they need to better their breathing.
Here are the top 4 things I tell my patients about TBM — and what I’d like everyone to know about it.
1. Diagnosing TBM takes a specialist
TBM can be challenging to spot because the symptoms can overlap with those of other pulmonary conditions that cause coughing, such as asthma (which causes the airways to become swollen and inflamed) and chronic obstructive pulmonary disease, or COPD (which prevents the lungs from getting enough air). My patients with TBM often experience:
- A deep, barking cough that’s painful, persistent, and disruptive
- Trouble breathing, especially when exhaling, coughing, laughing, or exercising
- Noisy breathing
- Trouble clearing mucus
- Frequent lung infections
Because many TBM symptoms are nonspecific, I encourage patients with signs of possible TBM to see a pulmonologist who specializes in TBM.
Diagnosis requires a deep knowledge of pulmonary conditions and the use of specialized tests. In fact, the best way to tell whether a patient has TBM is through bronchoscopy, where a tiny camera is inserted into the windpipe. The camera can show whether a patient’s airway collapse is abnormal and can grade the severity of the collapse.
2. TBM can develop after experiencing trauma
TBM often develops after a patient’s airways have experienced trauma like from a tracheal fracture or tracheostomy; chronic inflammation from things like asthma or exposure to secondhand smoke; or long-term compression from things like a tracheal tumor. This is called secondary TBM.
3. TBM can worsen over time
Acquired TBM usually happens when cartilage that normally supports the airways starts to break down. Without treatment, the cartilage grows weaker, and a patient’s symptoms tend to get worse. That can make it harder to do everyday activities. It could eventually lead to severe breathing problems, which can sometimes occur suddenly.
4. There are multiple treatment options
My recommendations for managing a patient’s TBM are based on the severity of their symptoms. Some patients with mild TBM may be able to improve their breathing with respiratory therapy and weight loss. Others find success with medications (like antibiotics, inhalers, or mucus-dissolving drugs) or with medical equipment, like continuous positive airway pressure (CPAP). When conservative measures are not enough, a patient may need to undergo surgery to create better support for the airway.
No matter the treatment, producing a comprehensive and individualized plan requires a team of experts. I often collaborate with other physicians, including radiologists; thoracic surgeons; and ear, nose, and throat doctors. This team approach helps ensure that all of a patient’s needs are met.
I’ll also refer my patients with TBM to respiratory therapists, nutritionists, speech and swallowing specialists as needed. The more resources we take advantage of, the better a patient’s outcome tends to be.
Take the next step
Getting treatment for TBM is important, since the condition can worsen over time. Even if you don’t feel like your symptoms are bad right now, they may not stay that way.
If you have a persistent barking cough and shortness of breath that is not improving with treatment — or if you’ve been given a diagnosis like asthma or COPD and the recommended treatments are not helping — consider seeing a pulmonologist at an academic medical center that has extensive experience in diagnosing and treating TBM.
Here at the Temple Lung Center, our dedicated pulmonologists have specialized skills and knowledge to diagnose TBM and offer the most comprehensive treatment options. In fact, we have the only dedicated TBM program in the Philadelphia region.
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