| Objectives:To investigate the clinical features of adults tracheobronch-omalacia(TBM)and to improve the recognition of the diease.Methods:The clinical data of two cases of adult TBM patients diagnosed in the Second Affiliated Hospital of Guangxi Medical University was retrospectively analyzed,and the details of 291 cases of adult TBM retrieved from Pubmed and other databases were reviewed.Results:(1)Data in 2cases of adult TBM:they were both female,aged 66-76 years old,presented recurrent chronic cough,sputum and wheezeing significantly with a long history of biofuel exposure.the lung examination showed emphysema.The mMRC symptom score was 1-3.The Epworth Sleepiness Scale score of the case2 was 12 points.Neck and chest CT scan showed stenosed obviously of trachea and bronchus lumen.Electronic fibreoptic bronchoscopy showed the posterior wall of trachea and bronchus bulged to lumen during expiration,but no change during inspiratory,leading to the cross-sectional area of the corresponded lumen decreased by 75%-85%during expiration.case 1 underwent intratracheal metal coated stent implantation,and case 2 received Bi-level positive airway pressure(BiPAP)treatment.the symptoms of them improved significantly,and had not deterioration for followed-up one year.(3)The results of literature review:about 396 cases of adult TBM were reported since 1978 with a toal of 291 cases having detailed information retrieved from Pubmed and other databases.There were 90 males and 201 females with an average age of 52.4 ± 13.7 years.The most common clinical manifestations were dyspnea(136/291),cough(26/291),sputum(18/291),wheezeing(28/291),recurrent pulmonary infection(14/291),hoarseness(15/291).The pulmonary function tests suggested mild to moderateobstructive ventilatory dysfunction(21/24).The Walsh-Miller test showed positive in 70 cases,including the tracheal difference in diameter of 36 cases was more than 4mm,an average of 5.6mm.The imaging examination showed tracheal stenosis(136/149),right main bronchus stenosis(13/149)and left main bronchus stenosis(10/149).The bronchocopy revealed a widening of the membranous part of the trachea(6/55),tracheal cartilage ring disappeared(3/55),signifcant airway collapse of trachea and bronchus in forced expiratory(49/55),even completely occluded(6/55).197 patients underwent tracheal suspension,37 patients underwent tracheotomy or tracheal intubation,17 patients underwent intratracheal stent implantation,and the remaining 40 patients recevied conservately treatment or noninvasive airway positive pressure ventilation.The respiratory symptoms of most patients improved gradually,and 76 cases of them lead a normal life as long-term follow up.Conclusions:1.The incidence of adult TBM is unknown,mainly occur in the middle-aged and elderly people,mostly secondary forms,the most common cause of which are secondary to goiter;2.The main clinical manifestations of adult TBM are dyspnea,chronic cough,recurrent wheezed and pulmonary infection,but the symptoms of which are nonspecific,easily misdiagnosed as chronic obstructive pulmonary disease,bronchial asthma and other diseases;3.Imaging performance reveales the stenosis of tracheal and bronchus.obstructive ventilation dysfunction is the most common changes of pulmonay function test.As a gold standard of diagnosis,the bronchocopy showes signifcantly dynamic airway collapse of malacia airway during breathing,the mainly position of which are trachea and main bronchus;4.The treatment should be based on the cause,the position and extent of malacia airway and the severity of symptoms,including conservative treatment,the non-invasive ventilator assisted ventilation,intratracheal stent implantation and surgery with a good short-term prognosis. |
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