Table of contents
Central airway obstruction
What's new
Updated 2024 ACCP guidelines for the management of central airway obstruction.
Background
Overview
Definition
Malignant CAO is the narrowing or complete blockage of the trachea, mainstem bronchi, or bronchus intermedius due to malignant tumors.
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Pathophysiology
The pathophysiology of malignant CAO involves the growth of a malignant tumor within the central airways, leading to impaired airflow. This obstruction can cause a ventilation-perfusion mismatch, leading to hypoxemia. In severe cases, complete obstruction can lead to atelectasis of the affected lung segment or lobe, post-obstructive pneumonia, and respiratory failure.
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Epidemiology
It is estimated that 20-30% of patients with lung cancer will experience airway obstruction-associated complications, including dyspnea, atelectasis, and pneumonia.
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Risk factors
The main risk factor is a history of malignancy, especially lung cancer, but it can also include esophageal, thyroid, head and neck, and primary mediastinal tumors.
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Disease course
The clinical course of malignant CAO typically involves symptoms such as dyspnea, stridor, wheezing, cough, and hemoptysis. Symptoms can be exertional in the mild or early stages and become severe and present at rest over time.
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Guidelines
Key sources
The following summarized guidelines for the evaluation and management of central airway obstruction are prepared by our editorial team based on guidelines from the American College of Chest Physicians (ACCP 2024,2013), the World Association for Bronchology and Interventional Pulmonology (WABIP 2024), and the European Society of Medical Oncology (ESMO 2023).
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Diagnostic investigations
Initial evaluation: as per ACCP 2024 guidelines, elicit a comprehensive history, perform a physical examination focusing on the respiratory system, and obtain a chest CT and appropriate laboratory investigations pertinent to non-malignant CAO and preoperative assessment in patients with suspected CAO.
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Therapeutic procedures
Therapeutic bronchoscopy, indications: as per ACCP 2024 guidelines, consider performing therapeutic bronchoscopy as an adjunct to systemic medical therapy and/or local radiation in patients with symptomatic malignant or non-malignant CAO.
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More topics in this section
Therapeutic bronchoscopy (tumor excision)
Therapeutic bronchoscopy (endoscopic dilation)
Therapeutic bronchoscopy (technical considerations)
Airway stenting
EBRT
Surgical interventions
Surgical resection
As per ACCP 2024 guidelines:
Consider performing open surgical resection or therapeutic bronchoscopy in patients with non-malignant CAO.
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Consider performing either surgical resection or therapeutic bronchoscopy for relief of initial obstruction in patients with malignant CAO with endobronchial tumor.
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