Management of Central Airway Obstruction

Publication Date: July 17, 2024
Last Updated: July 18, 2024

Summary of Recommendations

For patients with suspected central airway obstruction (CAO), we recommend a comprehensive history and physical examination with a focus on the respiratory system, a computerized tomography of the chest, and appropriate laboratory investigations pertinent to non-malignant CAO and preoperative assessment. (U, CC)
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For patients with symptomatic malignant or non-malignant CAO, we suggest therapeutic bronchoscopy as an adjunct to systemic medical therapy and/or local radiation. (C, VL )
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For patients with symptomatic malignant or non-malignant CAO, we suggest the use of rigid bronchoscopy over flexible bronchoscopy for therapeutic interventions. (C, VL )
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For patients with symptomatic malignant or non-malignant CAO, we suggest the use of general anesthesia/deep sedation over moderate sedation for therapeutic bronchoscopy. (C, VL )
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For patients with symptomatic malignant or non-malignant CAO undergoing rigid therapeutic bronchoscopy with general anesthesia, we suggest the use of either jet ventilation or controlled/ spontaneous assisted ventilation. (C, VL )
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For patients with symptomatic malignant or non-malignant CAO with endobronchial disease, we suggest the use of tumor or tissue excision and/or ablation to help achieve airway patency. (C, VL )
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For patients with non-malignant CAO with stenosis undergoing therapeutic bronchoscopy, we suggest airway dilation be performed either alone or in combination with other therapeutic modalities. (C, VL )
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For patients with symptomatic malignant or non-malignant CAO, we suggest stent placement if other therapeutic bronchoscopic and systemic treatments have failed and when feasible for the underlying disorder. (C, VL )
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For patients with malignant or non-malignant CAO with stent placement, we suggest either routine surveillance bronchoscopy or bronchoscopy when patients are symptomatic. (C, VL )
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For patients with malignant or non-malignant CAO undergoing therapeutic bronchoscopy, we suggest either using or holding local bronchoscopic therapy. (C, VL )
Remark: Local bronchoscopic treatment is defined as a non-ablative bronchoscopic therapy that may reduce the recurrence or progression of an endobronchial disorder.
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For patients with non-malignant CAO, we suggest either open surgical resection or therapeutic bronchoscopy. (C, VL )
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For malignant CAO patients with endobronchial tumor, we suggest either surgical resection or therapeutic bronchoscopy for relief of initial obstruction. (C, VL )
Remarks: There is limited evidence to suggest surgical benefit for non-carcinoid malignant CAO because of advanced locoregional or metastatic disease. Surgery with curative intent might be considered in patients with CAO related to a localized primary lung and airway cancer, including carcinoid.
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Recommendation Grading

Disclaimer

The information in this patient summary should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.

Overview

Title

Management of Central Airway Obstruction

Authoring Organization

American College of Chest Physicians

Publication Month/Year

July 17, 2024

Last Updated Month/Year

July 22, 2024

Supplemental Implementation Tools

Document Type

Guideline

Country of Publication

US

Document Objectives

Central airway obstruction (CAO), seen in a variety of malignant and non-malignant airway disorders, is associated with a poor prognosis. The management of CAO is dependent on provider training and local resources, which may make the clinical approach and outcomes highly variable. We reviewed the current literature and provided evidence-based recommendations for the management of CAO. Therapeutic bronchoscopy can improve the symptoms, quality of life, and survival of patients with malignant and non-malignant CAO. Multi-modality therapeutic options, including rigid bronchoscopy with general anesthesia, tumor/tissue debridement, ablation, dilation, and stent placement should be utilized when appropriate. Therapeutic options and outcomes are dependent on the underlying etiology of CAO. A multidisciplinary approach and shared decision-making with the patient are strongly encouraged.

Inclusion Criteria

Male, Female, Adolescent, Adult, Child, Infant, Older adult

Health Care Settings

Hospital, Outpatient, Operating and recovery room

Intended Users

Nurse, nurse practitioner, physician, physician assistant

Scope

Management

Diseases/Conditions (MeSH)

D000402 - Airway Obstruction

Keywords

Central airway obstruction, airway stenosis, tracheal stenosis

Source Citation

Https://doi.org/10.1016/j.chest.2024.06.3804