Recently, I wrote an article about a condition called central airway collapse, which I had noted many years ago at the dawn of fiberoptic evaluation of the airways.  I never published these observations, and now wish I had.

In general, the condition is now called excessive central airway collapse or ECAC.  This includes two conditions, something called TMB, or tracheobronchomalacia, referring to a defect in the cartilage of the trachea which allows it to collapse in response to cough and certain breathing maneuvers. The other is excessive dynamic airway collapse (EDAC) and is caused by the loss of muscle and connective tissue fibers at the back of the trachea, which causes the central airway to collapse shut, especially when coughing.  TBM is less common, but EDAC is often mistaken for chronic bronchitis and chronic cough.

One new and interesting finding is that excessive central airway collapse is associated with a high incidence of gastrointestinal reflux disease or GERD.  In a recent study 49% of patients with ECAC had reflux and aggressive treatment helped with the cough frequently associated with the reflux.

Cough is a common symptom, and finding the exact cause can often be challenging.  Determining if a patient has any of these central airway collapse issues usually requires an evaluation by fiberoptic bronchoscopy.  GERD can often be diagnosed clinically by the patient’s presenting symptoms, but can sometimes require further testing and the help of a gastroenterologist who may suggest more sophisticated testing including esophagogastroendoscopy.