COPD-Associated Expiratory Central Airway Collapse: Current Concepts and New Perspectives.

Abstract

COPD-associated expiratory central airway collapse (ECAC) is a frequently overlooked benign airway obstructive disease with complex causes and unclear pathologic and physiologic mechanisms. Although interventions such as noninvasive positive pressure ventilation, airway stenting, and tracheobronchoplasty have shown definite efficacy in the treatment of COPD-associated ECAC, the diagnosis and treatment of this disease remain challenging. This review provides a systematic evaluation and outlook on the epidemiologic features, causes, pathophysiologic characteristics, clinical manifestations, diagnosis, and treatment of COPD-associated ECAC. COPD-associated ECAC is a benign airway narrowing disease with atypical clinical symptoms and unknown incidence and pathogenesis. Bronchoscopy is considered the gold standard technique for diagnosis of COPD-associated ECAC, with dynamic biphasic CT imaging as an alternative noninvasive method. Noninvasive ventilation treatment can be continued on a long-term basis. Temporary airway stents can alleviate acute and severe tracheobronchomalacia. Long-term stent implantation can be considered after a risk to benefit assessment. Although tracheobronchoplasty has a definite therapeutic effect in patients with severe tracheobronchomalacia, perioperative complications remain a serious issue, and long-term efficacy observation is required. Traditional chinese medicine, other positive expiratory pressure therapies, and lung transplantation have shown potential with limited evidence. Although COPD-associated ECAC is attracting considerable attention, its pathophysiologic mechanisms, diagnosis, and management are full of challenges. In the future, randomized controlled trials on different therapies using patient-centered outcomes, cost-effective analysis on different interventions, and consensus guidelines on COPD-associated ECAC will be urgently needed.