Chronic Obstructive Pulmonary Disease (COPD) Expert Forum
bronchomalacia
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bronchomalacia

I underwent tx for breast ca 14 yrs ago and received extensive chemo and xrt. I have pulmonary fibrosis from xrt with a restrictive defect. I was recently dx with small airway malacia after developing obstuctive disease. this was dx by CT. i have been told there really isn't much to be done for this becasue it doesn;t respond to inhalers. sounds like we are keeping our fingers crossed that it doesn't progress. at this point i have "widespread air trapping and diffuse malacia of segmental airways of both lungs".  I am soemwhat SOB on exertion and climbing stairs etc.

is this likely to get worse?
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Small-airway bronchomalacia, in this circumstance, is uncommon and to my knowledge, progressive and refractory to therapy.  However, adult-onset bronchomalacia is often associated with malacia of the trachea and other central airways.  A recent report titled Tracheobronchoplasty for Severe Tracheobronchomalacia:  A Prospective Outcome Analysis by Adnan Majid MD, Jorge Guerrero MD, Sidhu Gangadharan MD, David Feller-Kopman MD FCCP, Phillip Boiselle MD FCCP, Malcolm DeCamp MD FCCP, Simon Ashiku MD, Gaetane Michaud MD FCCP, Felix Herth MD FCCP, and Armin Ernst MD FCCP in CHEST 2008, volume 134, pages 801–807 suggests that these large airways are amenable to “posterior tracheobronchial splinting with polypropylene mesh” which “in experienced hands” can result in “improvement in respiratory symptoms, health-related quality of life, and functional status.”  It is conceivable that, while you may have widespread small airway malacia, a significant portion of your compromised airway function is the result of large, rather than small airway disease.

I suggest that you and your doctors contact one of these investigators Armin Ernst MD at the Division of Cardiothoracic Surgery and Interventional Pulmonology, Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, One Deaconess Rd, Deaconess Building 201, Boston, MA 02215; e-mail: ***@****.  While their approach may not be applicable to your airways, this group may be able to shed light on alternative approaches to your small-airway disease.

If therapy is not feasible, you and your physicians might also want to explore the possibility of lung transplantation.

Good luck.
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