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Genetic and Rare Diseases Information Center (GARD)

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Tracheobronchomalacia


Other Names for this Disease
  • TBM
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Your Question

I have just been diagnosed with TBM and I want to find out as much as possible about this disease, specifically regarding diagnosis, treatment, and prognosis.

Our Answer

We have identified the following information that we hope you find helpful. If you still have questions, please contact us.

What is tracheobronchomalacia (TBM)?

Tracheomalacia (TM) is a rare condition where the trachea is weak due to soft cartilage in a certain area or throughout the trachea.  If the mainstem bronchi are involved as well, the term tracheobronchomalacia (TBM) is used. Breathing becomes difficult as a result of the soft tracheal cartilage. Other signs and symptoms include wheezing, frequent upper respiratory infections and a bluish color to the skin surrounding the mucous membranes of the nose and mouth. The cause of this condition is believed to be hereditary when it occurs in children. In adults, smoking or second hand smoke, thyroid tumors, chronic irritation and damage to the trachea are all possible causes. The recommended treatment for this condition is surgery to correct the weakened trachea. It should be noted that, historically, many authors have used TM and TBM interchangeably, especially in studies found in the pediatric literature. (Click here to view a diagram of the respiratory system which includes the trachea and the bronchi.)  [1] [2]
Last updated: 9/12/2013

How is tracheobronchomalacia diagnosed in adults?

Tracheobronchomalacia (TBM) can be diagnosed with CT scan or bronchoscopy. TBM is considered mild if the trachea narrows to 50% of its initial size while the individual is breathing out, moderate if it narrows to 25%, and severe if the walls of the trachea touch.[3]
Last updated: 7/15/2013

What are the signs and symptoms of tracheobronchomalacia in adults?

Characteristic signs and symptoms of tracheobronchomalacia (TBM) include shortness of breath, cough, sputum retention, and wheezing or stridor with breathing. Symptoms may become worse during periods of stress, when reclining, or when forcing a cough. If mild, TBM may cause no symptoms.[3]
Last updated: 7/15/2013

How might tracheobronchomalacia be treated in affected adults?

Management of symptomatic tracheobronchomalacia (TBM) first involves identifying underlying conditions contributing to symptoms, such as a chronic infection, chronic inflammation, compression, or injury. Initial treatment will target these underlying medical concerns.[3]

If symptoms persist, people with TBM undergo a pulmonary function test or other functional assessment to help guide therapy choice and allow monitoring of the indiviudal's response to treatment. 

Treatment options may include:[3]

Silicone stenting 
Long-term stenting 
Surgical correction (tracheobronchoplasty) 
Positive pressure therapy 
T-tube placement

We strongly recommend that you discuss your treatment options with a healthcare provider.
Last updated: 7/15/2013

What is the long-term prognosis of adults with tracheobronchomalacia?

Tracheobronchomalacia (TBM) can remain stable over time, but tends to worsen in a majority of affected individuals.[1] If an affected adult does not pursue treatment, TBM may cause significant breathing problems, but it is rarely life-threatening.  In general, advances in treatment of TBM have improved the long-term outlook for affected individuals.[4]
Last updated: 7/15/2013

References
  • Carden KA, Boiselle PM, Waltz DA, and Ernst A. . Tracheomalacia and Tracheobronchomalacia in Children and Adults: An In-Depth Review. Chest. 2005; 127(3):984-1005. http://www.ncbi.nlm.nih.gov/pubmed/15764786. Accessed 9/12/2013.
  • Chapter 19 - Large Airway disease.. Grainger & Allison's Diagnostic Radiology: A Textbook of Medical Imaging, 4th ed. . 2001;
  • Ernst A, Carden K, Gangadharan SP. Tracheomalacia and tracheobronchomalacia in adults. In: Basow, DS. UpToDate. Waltham, MA: UpToDate; 2013;
  • Ridge CA, O'donnell CR, Lee EY, Majid A, Boiselle PM. Tracheobronchomalacia: current concepts and controversies. Journal of Thoracic Imaging. 2011; 26:278-289. http://www.ncbi.nlm.nih.gov/pubmed/22009081. Accessed 11/20/2012.