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All That Wheezes Is Not Asthma

  • Christopher Gilbert
Published/Copyright: July 1, 2013
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Journal of Osteopathic Medicine
From the journal Journal of Osteopathic Medicine Volume 113 Issue 7

A 37-year old man was evaluated for severe asthma. Computed tomography of the chest revealed diffuse, end-expiratory tracheal narrowing (images A and B), suggesting severe tracheobronchomalacia. End-inspiration (image A) showed a slightly crescent-shaped yet widely patent trachea (red arrow). At end-expiration (image B), the trachea (red arrow) demonstrated severe dynamic collapse. In images A and B, the esophagus is identified (blue arrow). Tracheobronchomalacia was confirmed bronchoscopically (images C and D). During inspiration, a relatively normal tracheal diameter and distally visible main carina were seen (image C). During forced expiration (image D), flattening of the cartilaginous tracheal rings anteriorly and anterior bowing of the posterior tracheal wall occurred, producing airway collapse. The main carina was no longer visible secondary to near complete closure of the airway. Silicone Y stent placement improved symptoms and spirometric values, prompting tracheobronchoplasty evaluation.

Tracheobronchomalacia is characterized by excessive dynamic airway collapse due to weakening of tracheal or bronchial cartilaginous support. The true incidence of tracheobronchomalacia remains undefined; however, patients' symptoms are commonly misclassified as asthma or chronic bronchitis.1 Diagnosis is confirmed with radiographic imaging and bronchoscopy. Suspected tracheobronchomalacia requires referral and evaluation by trained interventional pulmonologists, thoracic surgeons, or both.

From Penn State Milton S. Hershey Medical Center in Pennsylvania. Dr Gilbert holds a master's degree in pharmacolgy
Address correspondence to Christopher Gilbert, DO, MS, Department of Pulmonary, Allergy, and Critical Care Medicine, Bronchoscopy and Interventional Pulmonology, Mail Code H0141, 500 University Dr, Hershey, PA 17033-0850. E-mail:

  1. Financial Disclosures: None reported.

Reference

1 Carden KA Boiselle PM Waltz DA Ernst A . Tracheomalacia and tracheobronchomalacia in children and adults: an in-depth review. Chest. 2005;127(3):984-1005.10.1378/chest.127.3.984Search in Google Scholar PubMed

Received: 2012-11-17
Revised: 2012-12-16
Accepted: 2013-01-02
Published Online: 2013-07-01
Published in Print: 2013-07-01

© 2013 The American Osteopathic Association

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

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https://doi.org/10.7556/jaoa.2013.009
Creative Commons
BY-NC-ND 4.0

Articles in the same Issue

  1. Letters to the Editor
  2. Updated Recommendations for HIV Screening
  3. Osteopathic Training for MDs
  4. Corrections
  5. Corrections
  6. AOA Communication
  7. Official Call (Reprint)
  8. Proposed Amendments to the AOA Constitution and the AOA Code of Ethics (Reprint)
  9. Original Contribution
  10. The Short-Term Effect of a Lymphatic Pump Protocol on Blood Cell Counts in Nursing Home Residents With Limited Mobility: A Pilot Study
  11. Effects of Concurrent Low Back Conditions on Depression Outcomes
  12. Training Mothers in Infant Cardiopulmonary Resuscitation With an Instructional DVD and Manikin
  13. Review
  14. Recent Advances in the Management of Hereditary Angioedema
  15. Special Communication
  16. A Research Primer: Basic Guidelines for the Novice Researcher
  17. Case Report
  18. Osteopathic Manipulative Treatment for Facial Numbness and Pain After Whiplash Injury
  19. The Somatic Connection
  20. Osteopathic Manipulative Treatment Is Efficacious for Management of Chronic Low Back Pain
  21. Further Demonstration of the Benefit of Osteopathic Manipulative Therapy in Pediatric Care
  22. Manual Therapy Is Beneficial for Cervical Radiculopathy
  23. Multimodal Chest Physiotherapy Is Beneficial for Patients Receiving Ventilation
  24. Visceral Manipulation Is Shown to Reduce Postoperative Ileus in an Animal Model
  25. Osteopathic Manipulative Therapy Affects the Position of Internal Organs in Humans
  26. Clinical Images
  27. All That Wheezes Is Not Asthma
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