Overview Tracheobronchomalacia (TBM) is increasingly recognised as a significant diagnosis in patients diagnosed with “severe asthma”. Continuous Positive Airway Pressure (CPAP) is used as first line treatment to stent the airway in TBM patients in order to clear mucus and prevent irritation, inflammation and bacterial overgrowth thereby reducing the number of exacerbations experienced by patients. However, there is currently no published data which evaluates whether this intervention has an impact on outcomes in. This study describes a cohort of patients referred to a regional centre for severe asthma patients, who were subsequently diagnosed with TBM and analyses the impact of CPAP on exacerbations caused by TBM.
Methods 20 TBM patients were identified at the North West Lung Centre in University Hospital South Manchester (UHSM) through clinics and department databases. Patient case notes and general practice medication prescriptions were used to obtain data on antibiotic and steroid prescriptions as well as hospital admissions (one year before and one after treatment). Exacerbations were analysed pre- and post-CPAP. Patient demographics were also recorded and compared to the cohort in the national severe asthma registry.
Results TBM patients were found to have increased weight and BMI compared to the cohort described in the national severe asthma registry; weight 92.4 ± 28.8 in TBM compared to 81.2 ± 19.9 and BMI 35.5 ± 8.1 compared to 28.0. Analysis of CPAP data showed that with an average of 6 hours of CPAP daily at average pressures of 11 cm H2O significantly reduced the number of annual exacerbations experienced by over 50% for antibiotic and steroid prescriptions and significantly more for hospital admissions. Figure 1 shows the reduction in exacerbations in the year following the initiation of CPAP compared to the year before.
Conclusions The severe asthma cohort with TBM are likely to have an increased weight and BMI. CPAP is an effective treatment option for TBM patients whilst awaiting the availability of more definitive surgical options and reduces antibiotic and steroid prescriptions as well as hospital admissions. It is recommended that all symptomatic TBM patients are considered for CPAP and monitored for exacerbations thereafter.