Zhou Pengcheng, Yu Wei, Zhang Wensheng, Ma Jianli, Xia Qianming, He Chengshi
Department of Respiratory Medicine, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China; Clinical Medical School, Chengdu University of Traditional Chinese Medicine, Chengdu, China; Department of Respiratory Medicine, Xiaojin County People's Hospital, Xiaojin, China.
Department of Respiratory Medicine, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China; Clinical Medical School, Chengdu University of Traditional Chinese Medicine, Chengdu, China.
Chest. 2025 Apr;167(4):1024-1043. doi: 10.1016/j.chest.2024.11.015. Epub 2024 Nov 22.
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.
慢性阻塞性肺疾病（COPD）相关的呼气期中央气道塌陷（ECAC）是一种常被忽视的良性气道阻塞性疾病，病因复杂，病理和生理机制尚不明确。尽管无创正压通气、气道支架置入和气管支气管成形术等干预措施在治疗COPD相关的ECAC方面已显示出确切疗效，但该疾病的诊断和治疗仍然具有挑战性。本文综述对COPD相关ECAC的流行病学特征、病因、病理生理特点、临床表现、诊断和治疗进行了系统评估和展望。
COPD相关的ECAC是一种具有非典型临床症状、发病率和发病机制不明的良性气道狭窄疾病。支气管镜检查被认为是诊断COPD相关ECAC的金标准技术，动态双相CT成像可作为一种替代性的无创方法。无创通气治疗可长期持续进行。临时性气道支架可缓解急性和重度气管支气管软化。在进行风险效益评估后可考虑长期置入支架。尽管气管支气管成形术对重度气管支气管软化患者有确切的治疗效果，但围手术期并发症仍然是一个严重问题，需要进行长期疗效观察。中医、其他呼气末正压疗法和肺移植已显示出一定潜力，但证据有限。
尽管COPD相关的ECAC正受到广泛关注，但其病理生理机制、诊断和管理仍充满挑战。未来，迫切需要开展以患者为中心结局的不同疗法的随机对照试验、不同干预措施的成本效益分析以及COPD相关ECAC的共识指南。
