Bilevel positive airway pressure in tracheobronchomalacia

A subsequent dynamic non-contrast CT scan of thorax showed expiratory collapse of tracheal and bilateral bronchial lumen, demonstrating tracheobronchomalacia (TBM) and reasonable airway patency achieved with application of BPAP (figure 2). TBM is often confirmed by dynamic chest CT imaging or bronchoscopic examination of the airways during respiration.1 Treatment is directed towards keeping the airway patent, achieved by either CPAP, airway stenting or surgical measures such as tracheobronchoplasty or tracheostomy.1 2 Among them, CPAP or BPAP, being a non-invasive intervention, appears to be the preferred approach, especially in elderly patients with multiple comorbidities, and ensures positive airway pressure both during inspiration and expiration.2 The latter is essential, as airway collapse in TBM is primarily expiratory. Patient’s perspective I was having recurrent hospital admissions for respiratory symptoms over the last 6 years, often requiring intensive care unit (ICU) admission and high pressure mask (NIV).