The hidden airway: central airway collapse mimicking obstructive lung disease

Abstract

Central airway collapse is an underrecognized cause of respiratory failure and is often misdiagnosed as Chronic Obstructive Pulmonary Disease or Bronchial asthma. Traditionally central airway collapse was attributed to tracheomalacia (TM), it is now increasingly differentiated from excessive dynamic airway collapse (EDAC). Excessive dynamic airway collapse (EDAC) is an underrecognized cause of chronic respiratory symptoms and is frequently presents with clinical manifestations such as cough, wheezing and exertional dyspnoea. EDAC is characterized by excessive inward bulging of the posterior membranous wall of the trachea during expiration, resulting in marked airway narrowing despite preserved tracheal cartilaginous support. Recent advances in diagnostic modalities, particularly dynamic computed tomography and fiberoptic bronchoscopy, have improved the recognition of this condition and demonstrated its occurrence in both symptomatic and asymptomatic individuals. We report the case of an 81-year-old woman who had a significant history of occupational exposure to stone dust and was an ex-smoker presented with a 10-year history of chronic cough and progressive exertional dyspnoea. Further evaluation established the diagnosis of EDAC. The patient demonstrated marked symptomatic improvement following initiation of bilevel positive airway pressure therapy along with bronchodilator treatment. This case highlights the importance of considering EDAC in patients with persistent respiratory symptoms despite standard treatment.