Tracheobronchomalacia (TBM)

What is tracheobronchomalacia (TBM)?

Tracheobronchomalacia (TRAY-key-oh-bronco-mă-LAY-cia) is a condition where your trachea (windpipe) and your bronchi (the tubes that lead from your trachea to your lungs) are so weak that they collapse and close down when you take a breath or cough. If you have TBM, you may have issues breathing. You may wheeze or cough a lot.

Some people are born with tracheobronchomalacia. This is primary or congenital TBM. But you can also develop it during your lifetime. Healthcare providers may call this secondary or acquired tracheobronchomalacia.

Healthcare providers have treatments to help you manage tracheobronchomalacia symptoms. In some cases, they can do surgery to support your trachea and bronchi.

How common is tracheobronchomalacia?

Based on one study, experts estimate 1 in 2,100 babies are born with tracheobronchomalacia. In other research, experts estimate between 4% and 13% of people with airway problems have TBM. But that’s just an estimate, as providers don’t always make the connection between common respiratory problems and collapsing airways.

What are the symptoms of tracheobronchomalacia?

Symptoms may be different depending on whether you’re born with the condition or develop it over time.

Babies born with TBM may have symptoms that start when they’re 2 to 4 months old. Symptoms may include:

• Stridor.
• Having a hard time breathing when you breastfeed (chest feed) or bottle feed them.
• Persistent cough.
• Frequent colds.
• Frequent respiratory tract infections.

Tracheomalacia symptoms in adults may develop over time and get progressively worse. Symptoms include:

• Difficulty breathing after everyday activities like climbing stairs or walking.
• “Barking” or dry, harsh cough.
• Temporarily losing consciousness during coughing.
• Wheezing.
• Difficulty coughing up mucus.
• Frequent colds.
• Obstructive sleep apnea (OSA).

What causes tracheobronchomalacia?

Tracheobronchomalacia happens when the walls of your trachea and bronchi are weak and collapse when you take a breath. Your trachea is a stiff, flexible tube made of cartilage that carries air in and out of your lungs. Your bronchi move air into your lungs and are lined with tiny hair cells that help move mucus and particles out of your lungs.

Causes of primary/congenital TBM

Primary/congenital tracheobronchomalacia in babies may happen for no known reason (idiopathic TBM). But it may happen if they’re born with conditions, including:

• Vascular rings: Your baby may have a vascular ring because their aorta didn’t form normally during fetal development. The aorta is the main artery that carries oxygenated blood away from your baby’s heart to the rest of their body. If your baby has a vascular ring, their aorta wraps around their trachea to cause tracheobronchomalacia.
• Certain inherited disorders: Hunter syndrome, Hurler syndrome and Ehlers-Danlos syndrome are inherited disorders that may cause tracheobronchomalacia.
• Premature birth: Babies born before 37 weeks of pregnancy may have an increased risk of TBM if their trachea isn’t fully formed.

Causes of secondary/acquired TBM

Several things may cause secondary/acquired tracheobronchomalacia including:

• Certain medical conditions.
• Certain treatments.
• Exposure to certain toxins.

Medical conditions

Adults with tracheobronchomalacia often have the following conditions that can lead to TBM:

• Asthma.
• Bronchitis.
• Obesity.
• Chronic obstructive pulmonary disease (COPD).
• Gastroesophageal reflux disease (GERD). Studies show nearly half of people treated for GERD have TBM.
• Goiters. This is an enlargement on your thyroid, which wraps around your trachea. Goiters can put pressure on your trachea.
• Relapsing polychondritis. This is a rare degenerative disease that causes your cartilage to deteriorate.

Medical treatments

Some medical treatments may cause tracheobronchomalacia:

• Prolonged tracheostomy use. A tracheostomy is a medical treatment to help you breathe by inserting a tube into your trachea.
• Prolonged use of inhaled corticosteroids. Inhaled corticosteroids can treat asthma.
• Prolonged use of intubation and ventilation that injures your airway.

Exposure to toxins

Exposure to the following toxins may increase your risk of TBM:

• Toxic gases such as mustard gas.
• Secondhand smoke.

How is tracheobronchomalacia diagnosed?

A healthcare provider will do a physical examination. If they’re treating your child, they’ll ask you about their symptoms, their overall health and any medical conditions that may be the reason why your child is coughing, wheezing or has trouble breathing.

If you’re having symptoms, your provider will do a physical examination and ask the same sorts of questions. They may ask if you have frequent respiratory infections or other conditions that affect how you breathe.

They may do the following tests:

• Pulmonary function tests: These are tests to see how well air moves in and out of your lungs.
• Bronchoscopy: In this test, your provider checks how narrow your trachea becomes when you take a deep breath or cough.
• Computed tomography (CT) scan: Your provider may order this test to make sure other conditions aren’t causing your symptoms.

How is tracheobronchomalacia treated?

Treatments vary depending on how tracheobronchomalacia affects your or your baby’s ability to breathe. For example:

• Your baby’s healthcare provider may prescribe antibiotics to treat any underlying infections. They may show you ways to breastfeed or bottle feed your baby that don’t affect their ability to breathe.
• They may prescribe medications to help manage your baby’s symptoms.
• They may prescribe pulmonary rehabilitation programs that teach you or your child ways to manage symptoms.
• You may use supportive devices that help you breathe.
• You or your child may need surgery to support weakened tracheas.

Supportive devices for TBM treatment

Several kinds of supportive devices or durable medical equipment treat TBM symptoms. These devices can help you or your child manage symptoms and limit how much tracheobronchomalacia affects your quality of life. Treatments include:

• CPAP or BiPAP^® machines: These machines help to keep your trachea open.
• External percussion vests: TBM can make it hard to cough up mucus. External percussion vests connect to a machine that vibrates very fast, shaking up mucus in your bronchi so you can cough up mucus more easily.
• Nebulizer: Nebulizers change liquid medication into fine droplets that you or your child inhale through a mask or mouthpiece.

Surgery for tracheobronchomalacia

There are several surgical treatments for TBM. They include:

• Bronchoscopy: This is the same procedure that healthcare providers use to diagnose issues with your lungs or airway. In treatment, healthcare providers use a rigid bronchoscope to place a temporary stent in your airway. A stent is a small plastic, rubber or metal tube that holds your airway open. Stents help healthcare providers decide if you need additional surgery.
• Tracheobronchoplasty: This procedure involves sewing mesh to the outside of your trachea. The mesh gives your trachea more structure so it’s less likely to collapse.
• Tracheopexy: This is surgery that attaches the back of your trachea to ligaments in your spine to keep your trachea from collapsing.

Complications of TBM surgery

Tracheobronchoplasty and tracheopexy are major surgeries. Like most surgeries, there may be complications, including:

• Excessive bleeding.
• Blood clots.
• Infection of the surgical site.

If your healthcare provider recommends surgery to treat TBM, they’ll explain the risk of complications.

Can tracheobronchomalacia be prevented?

There’s no way to prevent congenital tracheobronchomalacia in children. Adults can develop TBM over time if they have certain medical conditions or have exposure to secondhand smoke or toxic gases.

Tracheobronchomalacia gets worse over time, so talk to a healthcare provider if you know you have exposure to secondhand smoke, toxic gases or conditions that may increase your risk. You may not be able to keep TBM from happening, but there may be ways to keep it from getting worse.

What can I expect if my child has tracheobronchomalacia?

Your child’s trachea cartilage will become stiffer as they grow up. That means there’s less chance that their trachea and bronchi will collapse and affect their breathing. But often, children with TBM need ongoing medical treatment and support to help them breathe.

What can I expect if I have TBM?

Sometimes, losing weight or treatment may help with TBM symptoms. But TBM in adults is often a chronic (continuing) condition. If you have tracheobronchomalacia, you’ll probably work with a healthcare provider who specializes in airway treatment for the rest of your life.

Studies suggest that surgery helps ease tracheobronchomalacia symptoms right away and for several years after surgery. If you’re like many people with tracheobronchomalacia, you have other medical conditions that affect your overall health. Those conditions can make it more difficult for you to respond to treatment or recover from surgery.

What is the life expectancy for people with tracheobronchomalacia?

People who develop TBM often have other serious medical conditions that may affect their life expectancy. Your healthcare provider is your best source if you want to know if having tracheobronchomalacia could affect how long you’ll live.

Does tracheobronchomalacia go away?

TBM in adults can be life-threatening because it doesn’t go away and gets worse over time. TBM in babies may cause less serious symptoms as they grow up.

How do I take care of myself or my child?

Most children with tracheobronchomalacia will need medical support throughout childhood. For example, you or your child will need treatment like taking medications or using devices that keep your airway clear.

Your child’s pediatrician may schedule regular follow-up appointments to check on your child’s overall health. You may want to ask your child’s pediatrician about ways to protect your child’s overall health, like ways to avoid respiratory infections.

If you have tracheobronchomalacia, here are some suggestions that may be helpful:

• Take care of your health: Many people with TBM also have asthma, COPD or bronchitis. If you do, be sure to follow your treatment plan and your provider’s advice for managing your underlying illness.
• Eat well: Having obesity can make it hard for you to breathe. Getting to or maintaining a weight that’s right for you may help ease breathing issues that TBM can cause.
• Get some regular physical activity: Regular activity may help you manage your weight.
• Avoid secondhand smoke: Studies suggest secondhand smoke exposure increases your risk of developing TBM.

When should I see my healthcare provider?

If you have TBM, you’ll have ongoing medical care and regular medical checkups. Contact your provider if you notice your symptoms like coughing or wheezing get worse.

What questions should I ask my healthcare provider?

You may be surprised to learn issues with your trachea and bronchial tubes are why you or your child has trouble breathing or a barking cough that doesn’t go away. If you or your child receives a TBM diagnosis, you’ll probably want to learn more about it. Here are some questions to get you started:

• Why do I have (or does my child have) tracheobronchomalacia?
• What are the treatment options?
• What are the treatment side effects?
• Will I or my child have to have surgery?
• Can TBM come back after surgery?
• How will this condition affect my child as they grow up?
• Will I or my child always need treatment?

A note from Cleveland Clinic

Tracheobronchomalacia (TBM) can literally take your breath away. If your baby has it, they may struggle to breathe while you breastfeed them. If you have it, you need to stop and catch your breath to finish climbing the stairs. Fortunately, there are many ways to treat TBM and improve breathing. But even with treatment, chances are you’ll need ongoing medical support for the rest of your life. You might be feeling overwhelmed by the prospect of managing a long-term condition. If you are, talk to your healthcare provider. They understand all the special challenges a long-term condition brings and can recommend programs and resources that will help you now and in the future.