Airway collapse

Airway collapse, also known as tracheobronchomalacia (TBM), is a condition that causes your airways to close when you cough or take a breath. Cartilage usually helps your airways hold their shape, narrowing only slightly when you breathe out or cough. But in an airway collapse, the cartilage has a different shape or is weaker, causing the airway to narrow too much or close completely when you breathe.

Penn Medicine’s pulmonary specialists have the expertise to evaluate and treat chronic airway diseases like airway collapse. Because this disorder may be related to other conditions, you benefit from having access to our specialists across disciplines. Our experts can coordinate your care and design a treatment plan to help relieve your symptoms and address any underlying disorders.

TBM can affect both the trachea (windpipe) and bronchi (tubes that connect your windpipe to your lungs). But sometimes airway collapse only impacts the windpipe, called tracheomalacia, or only the bronchi, called bronchomalacia. Both conditions involve a weakness of the cartilage.

In some cases, the muscle in the windpipe is weak and narrows the airway, a disorder known as excessive dynamic airway collapse (EDAC). Your pulmonary specialist can talk to you about what’s happening in your airways to cause your symptoms.

Symptoms can vary between babies and adults. Babies with TBM may start to have these symptoms when they’re 2 to 4 months old:

• A whistling noise when breathing, known as stridor
• Trouble breathing while breastfeeding or bottle feeding
• A cough that doesn’t go away
• Repeated colds and respiratory tract infections

Adults with airway collapse may have these symptoms:

• Trouble breathing while walking, climbing stairs, or exercising
• Wheezing
• Dry cough that may sound like a bark
• Trouble coughing up mucus
• Regular infections
• Obstructive sleep apnea

There are two types of airway collapse. When you’re born with a weak trachea and bronchi, it's known as primary or congenital TBM. This type of airway collapse is diagnosed in babies. You can also develop airway collapse during your lifetime if you have other conditions like a chronic lung disease. This type is known as secondary or acquired TBM.

Congenital TBM can be caused by premature birth before 37 weeks of pregnancy, an aorta that didn’t form correctly while in the womb, or inherited diseases like Hunter syndrome, Hurler syndrome, or Ehlers-Danlos syndrome. Airway collapse can also happen for no apparent reason.

Acquired TBM can be caused by medical conditions like asthma, bronchitis, obesity, chronic obstructive pulmonary disease (COPD), gastroesophageal reflux disease (GERD), goiters, or relapsing polychondritis. You can also experience airway collapse if you’ve had tracheostomy surgery or if you’ve been on a ventilator for an extended amount of time. Using inhaled corticosteroids for a long time can also affect the stiffness of your airways and lead to airway collapse.

If you have a baby with airway collapse, you can learn how to adjust feedings to improve your baby’s breathing. A nebulizer, medication, and pulmonary rehabilitation can help manage symptoms. Your child’s cartilage may get stiffer with age and stop collapsing, but some children need ongoing care or surgery. If you’re an adult with airway collapse, you can learn to manage your symptoms with pulmonary rehabilitation, continuous positive airway pressure (CPAP), and devices that help you cough up mucus. Treatments also include medications, surgery—such as tracheobronchoplasty, airway stenting, or tracheopexy—that helps keep your airways open, and therapy for any underlying conditions.

Penn Pulmonology’s specialists have expertise in complex respiratory diseases like TBM and EDAC. Our pulmonary experts use noninvasive and minimally invasive diagnostic techniques whenever possible to evaluate you for a collapsed trachea or bronchi. This allows your health care team to see your airways, give you an accurate diagnosis, and plan surgery if you need it. The advanced technology and treatments at Penn Medicine mean you’ll get the care that’s right for you.