Modified Tracheobronchoplasty for Chronic Cough Due to Excessive Dynamic Airway Collapse: A Case Series

Excessive dynamic airway collapse (EDAC) is a condition characterized by expiratory collapse of trachea and main bronchi due to a weak membranous wall without cartilagineous malacia. This condition may be associated with chronic cough and airway obstruction. We evaluated the effect of a novel tracheobronchoplasty procedure for treating airway membranous wall collapse, cough, and lung function in four patients with EDAC associated with chronic cough. Functional fibrobronchoscopy (FBS), dynamic computed tomography (CT) scan, and lung function assessment and cough severity score, the latter assessed by means of a visual analogue scale and the Leicester cough questionnaire, were performed at baseline and 6 months after surgery. Cough threshold was also measured and cough intensity was indexed in terms of cough peak expiratory flow and integrated abdominal electromyographic activity. At baseline, patients displayed an inward bulging of the posterior membrane during expiration and voluntary coughing. Following surgery, functional FBS and dynamic CT scan consistently demonstrated a restored shape of the trachea with no obvious airway collapse during expiration and voluntary coughing. The anatomical changes achieved after surgery were consistently accompanied by an improvement in lung function and marked reduction in spontaneous cough. Stabilization of the posterior airway by means of the MTBRS seems to be a safe procedure with positive outcomes in patients with incessant and chronic cough associated with EDAC