Stent placement can improve symptoms in some patients with tracheobronchomalacia (TBM). Co-morbid conditions such as COPD or asthma are common among these patients. Ability to predict who would improve with central airway stabilization will assist with better patient selection for stent placement.
All patients that had stent placement for tracheobronchomalacia were prospectively evaluated. Prior to the procedure, all patients underwent subjective testing with St. George Respiratory Questionnaire (SGRQ) and Karnofski Index (KI) and objective testing with spirometry, DLCO and a 6-minute walk test. Within two weeks of the procedure, the patients were evaluated for improvement in symptoms. Subjective and objective measures were compared between the groups that reported improvement in symptoms following stent placement and those that reported no improvement in symptoms.
Ninety one patients with confirmed TBM underwent silicone stent placement to stabilize the central airways. Eighty percent of the patients had pre-existing COPD or asthma and dyspnea was the most common presenting symptom (89% of patients). Seventy-two (79%) patients reported improvement in symptoms following airway stabilization with stents. No statistically significant difference was seen between the groups with age, body mass index, presence of COPD or asthma and baseline FEV1, DLCO, 6 MWT or KI. Only baseline SGRQ showed a statistically significant difference between the two groups with patients having higher scores being more likely to report improvement with airway stabilization (p=0.02).
The majority of patients with documented, severe and symptomatic TBM improve following airway stabilization with silicone stents. Subjective evaluations, spirometric indices and 6-MWT performed at baseline do not predict the likelihood of benefit from stent placement, except for SGRQ scores where patients with higher scores are more likely to improve following stent placement.
A trial with stent placement for airway stabilization is necessary in patients with TBM in order to assess for improvement in symptoms. Improvement needs to be documented.
Chakravarthy Reddy, No Financial Disclosure Information; No Product/Research Disclosure Information