Thorax 68:396-398 doi:10.1136/thoraxjnl-2012-202221
  • Chest clinic
  • Opinion

Middle airway obstruction—it may be happening under our noses

  1. Garun Hamilton1
  1. 1Lung and Sleep Medicine, Monash University and Hospital and Monash Institute of Medical Research (MIMR), Melbourne, Australia
  2. 2Respiratory Medicine, Imperial College, London, UK
  1. Correspondence to Professor Phil G Bardin, Lung and Sleep Medicine, Monash Medical Centre, 246 Clayton Road, Clayton 3168, Melbourne, Victoria 3168, Australia; philip.bardin{at}
  • Received 31 May 2012
  • Accepted 15 June 2012
  • Published Online First 19 July 2012


Background Lower airway obstruction has evolved to denote pathologies associated with diseases of the lung, whereas, conditions proximal to the lung embody upper airway obstruction. This approach has disconnected diseases of the larynx and trachea from the lung, and removed the ‘middle airway’ from the interest and involvement of respiratory physicians and scientists. However, recent studies have indicated that dysfunction of this anatomical region may be a key component of overall airway obstruction, either independently or in combination with lung disease. New diagnostic modalities to effectively diagnose middle airway obstruction are being developed, and it has become feasible to identify and quantify middle airway obstruction.

Conclusion We, therefore, propose adding ‘middle airway obstruction’ to our nomenclature to embed it in diagnostic approaches, and to allow due emphasis on this neglected anatomical region.