Department of Pulmonary, Critical Care, and Sleep Medicine, St. Elizabeth's Medical Center, Boston, MA.
Division of Thoracic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
Chest. 2011 Nov;140(5):1162-1168. doi: 10.1378/chest.10-3051. Epub 2011 Aug 25.
Tracheobronchomalacia (TBM) is characterized by excessive collapsibility of the central airways, typically during expiration. TBM may be present in as many as 50% of patients evaluated for COPD. The impact of central airway stabilization on symptom pattern and quality of life is poorly understood in this patient population.
Patients with documented COPD were identified from a cohort of 238 patients assessed for TBM at our complex airway referral center. Pulmonary function testing, exercise tolerance, and health-related quality-of-life (HRQOL) measures were assessed at baseline and 2 to 4 weeks following tracheal stent placement/operative tracheobronchoplasty (TBP). Severity of COPD was classified according to the GOLD (Global Initiative for Chronic Obstructive Lung Disease) staging system.
One hundred three patients (48 women) with COPD and moderately severe to severe TBM were identified. Statistically and clinically significant improvements were seen in HRQOL measures, including the transitional dyspnea index (stent, P = .001; TBP, P = .008), the St. George Respiratory Questionnaire (stent, P = .002; TBP, P < .0001), and the Karnofsky performance score (stent, P = .163; TBP, P < .0001). The improvement appeared greatest following TBP and was seen in all GOLD stages. Clinical improvement was also seen in measured FEV(1) and exercise capacity as assessed by 6-min walk test.
Central airway stabilization may provide symptomatic benefit for patients with severe COPD and concomitant severe airway malacia. Operative airway stabilization appears to impart the greatest advantage. Long-term follow-up study is needed to fully ascertain the ultimate efficacy of both stenting and surgical airway stabilization in this patient group.
气管支气管软化症（TBM）的特征是中央气道过度塌陷，通常在呼气时发生。在评估 COPD 的患者中，多达 50%可能存在 TBM。在这一患者群体中，中央气道稳定对症状模式和生活质量的影响知之甚少。
从我们的复杂气道转诊中心评估的 238 例 TBM 患者队列中确定了患有明确 COPD 的患者。在气管支架放置/手术性气管支气管成形术（TBP）后 2 至 4 周，评估了肺功能测试、运动耐量和健康相关生活质量（HRQOL）测量。根据 GOLD（全球慢性阻塞性肺疾病倡议）分期系统对 COPD 的严重程度进行分类。
确定了 103 例（48 名女性）患有 COPD 和中重度至重度 TBM 的患者。HRQOL 测量指标（包括过渡性呼吸困难指数[支架，P =.001；TBP，P =.008]、圣乔治呼吸问卷[TBP，P =.002；P <.0001]和卡诺夫斯基表现评分[支架，P =.163；TBP，P <.0001]）和运动能力（6 分钟步行试验）均有统计学和临床意义的显著改善。TBP 后改善最大，在所有 GOLD 阶段均可见。
对于严重 COPD 和严重气道软化症并存的患者，中央气道稳定可能提供症状益处。手术气道稳定似乎带来了最大的优势。需要进行长期随访研究，以充分确定支架和手术气道稳定在该患者群体中的最终疗效。
