ERS statement on tracheomalacia and bronchomalacia in children

Colin Wallis, Efthymia Alexopoulou, Juan L. Antón-Pacheco, Jayesh M. Bhatt, Andrew Bush, Anne B. Chang, Anne Marie Charatsi, Courtney Coleman, Julie Depiazzi, Konstantinos Douros, Ernst Eber, Mark Everard, Ahmed Kantar, Ian B. Masters, Fabio Midulla, Raffaella Nenna, Derek Roebuck, Deborah Snijders, Kostas Priftis

    Research output: Contribution to journalArticleResearchpeer-review

    Abstract

    Tracheomalacia and tracheobronchomalacia may be primary abnormalities of the large airways or associated with a wide variety of congenital and acquired conditions. The evidence on diagnosis, classification and management is scant. There is no universally accepted classification of severity. Clinical presentation includes early-onset stridor or fixed wheeze, recurrent infections, brassy cough and even near-death attacks, depending on the site and severity of the lesion. Diagnosis is usually made by flexible bronchoscopy in a free-breathing child but may also be shown by other dynamic imaging techniques such as low-contrast volume bronchography, computed tomography or magnetic resonance imaging. Lung function testing can provide supportive evidence but is not diagnostic. Management may be medical or surgical, depending on the nature and severity of the lesions, but the evidence base for any therapy is limited. While medical options that include bronchodilators, anti-muscarinic agents, mucolytics and antibiotics (as well as treatment of comorbidities and associated conditions) are used, there is currently little evidence for benefit. Chest physiotherapy is commonly prescribed, but the evidence base is poor. When symptoms are severe, surgical options include aortopexy or posterior tracheopexy, tracheal resection of short affected segments, internal stents and external airway splinting. If respiratory support is needed, continuous positive airway pressure is the most commonly used modality either via a face mask or tracheostomy. Parents of children with tracheobronchomalacia report diagnostic delays and anxieties about how to manage their child's condition, and want more information. There is a need for more research to establish an evidence base for malacia. This European Respiratory Society statement provides a review of the current literature to inform future study.
    Original languageEnglish
    Article number1900382
    Pages (from-to)1-19
    Number of pages19
    JournalEuropean Respiratory Journal
    Volume54
    Issue number3
    DOIs
    Publication statusPublished - 1 Sep 2019

    Fingerprint

    Bronchomalacia
    Tracheomalacia
    Tracheobronchomalacia
    Bronchography
    Expectorants
    Cone-Beam Computed Tomography
    Continuous Positive Airway Pressure
    Tracheostomy
    Bronchodilator Agents
    Respiratory Sounds
    Bronchoscopy
    Masks
    Cough
    Cholinergic Agents
    Stents
    Comorbidity
    Respiration
    Thorax
    Anxiety
    Parents

    Cite this

    Wallis, C., Alexopoulou, E., Antón-Pacheco, J. L., Bhatt, J. M., Bush, A., Chang, A. B., ... Priftis, K. (2019). ERS statement on tracheomalacia and bronchomalacia in children. European Respiratory Journal, 54(3), 1-19. [1900382]. https://doi.org/10.1183/13993003.00382-2019
    Wallis, Colin ; Alexopoulou, Efthymia ; Antón-Pacheco, Juan L. ; Bhatt, Jayesh M. ; Bush, Andrew ; Chang, Anne B. ; Charatsi, Anne Marie ; Coleman, Courtney ; Depiazzi, Julie ; Douros, Konstantinos ; Eber, Ernst ; Everard, Mark ; Kantar, Ahmed ; Masters, Ian B. ; Midulla, Fabio ; Nenna, Raffaella ; Roebuck, Derek ; Snijders, Deborah ; Priftis, Kostas. / ERS statement on tracheomalacia and bronchomalacia in children. In: European Respiratory Journal. 2019 ; Vol. 54, No. 3. pp. 1-19.
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    abstract = "Tracheomalacia and tracheobronchomalacia may be primary abnormalities of the large airways or associated with a wide variety of congenital and acquired conditions. The evidence on diagnosis, classification and management is scant. There is no universally accepted classification of severity. Clinical presentation includes early-onset stridor or fixed wheeze, recurrent infections, brassy cough and even near-death attacks, depending on the site and severity of the lesion. Diagnosis is usually made by flexible bronchoscopy in a free-breathing child but may also be shown by other dynamic imaging techniques such as low-contrast volume bronchography, computed tomography or magnetic resonance imaging. Lung function testing can provide supportive evidence but is not diagnostic. Management may be medical or surgical, depending on the nature and severity of the lesions, but the evidence base for any therapy is limited. While medical options that include bronchodilators, anti-muscarinic agents, mucolytics and antibiotics (as well as treatment of comorbidities and associated conditions) are used, there is currently little evidence for benefit. Chest physiotherapy is commonly prescribed, but the evidence base is poor. When symptoms are severe, surgical options include aortopexy or posterior tracheopexy, tracheal resection of short affected segments, internal stents and external airway splinting. If respiratory support is needed, continuous positive airway pressure is the most commonly used modality either via a face mask or tracheostomy. Parents of children with tracheobronchomalacia report diagnostic delays and anxieties about how to manage their child's condition, and want more information. There is a need for more research to establish an evidence base for malacia. This European Respiratory Society statement provides a review of the current literature to inform future study.",
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    Wallis, C, Alexopoulou, E, Antón-Pacheco, JL, Bhatt, JM, Bush, A, Chang, AB, Charatsi, AM, Coleman, C, Depiazzi, J, Douros, K, Eber, E, Everard, M, Kantar, A, Masters, IB, Midulla, F, Nenna, R, Roebuck, D, Snijders, D & Priftis, K 2019, 'ERS statement on tracheomalacia and bronchomalacia in children', European Respiratory Journal, vol. 54, no. 3, 1900382, pp. 1-19. https://doi.org/10.1183/13993003.00382-2019

    ERS statement on tracheomalacia and bronchomalacia in children. / Wallis, Colin; Alexopoulou, Efthymia; Antón-Pacheco, Juan L.; Bhatt, Jayesh M.; Bush, Andrew; Chang, Anne B.; Charatsi, Anne Marie; Coleman, Courtney; Depiazzi, Julie; Douros, Konstantinos; Eber, Ernst; Everard, Mark; Kantar, Ahmed; Masters, Ian B.; Midulla, Fabio; Nenna, Raffaella; Roebuck, Derek; Snijders, Deborah; Priftis, Kostas.

    In: European Respiratory Journal, Vol. 54, No. 3, 1900382, 01.09.2019, p. 1-19.

    Research output: Contribution to journalArticleResearchpeer-review

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    AU - Antón-Pacheco, Juan L.

    AU - Bhatt, Jayesh M.

    AU - Bush, Andrew

    AU - Chang, Anne B.

    AU - Charatsi, Anne Marie

    AU - Coleman, Courtney

    AU - Depiazzi, Julie

    AU - Douros, Konstantinos

    AU - Eber, Ernst

    AU - Everard, Mark

    AU - Kantar, Ahmed

    AU - Masters, Ian B.

    AU - Midulla, Fabio

    AU - Nenna, Raffaella

    AU - Roebuck, Derek

    AU - Snijders, Deborah

    AU - Priftis, Kostas

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    Wallis C, Alexopoulou E, Antón-Pacheco JL, Bhatt JM, Bush A, Chang AB et al. ERS statement on tracheomalacia and bronchomalacia in children. European Respiratory Journal. 2019 Sep 1;54(3):1-19. 1900382. https://doi.org/10.1183/13993003.00382-2019