Tracheomalacia

We took this little love bug to the doctor again yesterday morning, as she continued having labored breathing. They sent us to the hospital to be admitted for 24 hours of observation. She did great...oxygen levels were stable and she remained happy and alert the whole time. And when she goes to sleep, her breathing is completely normal and clear! The doctors here confirmed what I was thinking: she has laryngomacia/tracheomalacia. We will be following up with a pediatric pulmonologist next week. Here is more information on this condition:

Tracheomalacia or tracheobronchomalacia is a chronic condition in which there is a weakening of the walls of the airway (trachea, bronchi or both).  This causes the airway to collapse at the affected site during breathing and may be worse with exercise, crying, coughing or upper respiratory infections.  Airway obstruction from tracheomalacia can make it very difficult to breath and in severe cases the patient may need mechanical assisted ventilation through a temporary breathing tube (intubation) or a tracheostomy.  A tracheostomy is an opening surgically created in the neck by which to breathe, usually with a tube in place and is for long term management although can be surgically taken down once the child grows out of the tracheomalacia. 

Tracheomalacia can be congenital (the patient was born with it) or acquired (it has occurred because of something else).  Acquired tracheomalacia may be the result of prolonged intubation or tracheostomy, chronic respiratory infections, chronic respiratory diseases or trauma to the airway.

SYMPTOMS

-Stridor or loud upper airway wheezing or barking; “noisy breathing”

-Breathing sounds improve with repositioning, decrease activity or during sleep

-Fast respiratory or breathing rate

-Difficulty breathing with retractions or tugging of the chest muscles for breathing

-Difficulty eating or bottling

-Poor weight gain

-Frequent respiratory infections

TREATMENT

After the diagnosis of tracheomalacia is made, the most effective and safest treatment is allowing time to pass ("tincture of time"). Some have recommended that before considering a surgical approach, other therapies, including noninvasive ventilation, should be used, given the transient nature of the disorder.

Bronchodilators do not help and sometimes worsen the tracheomalacia. The tone of the smooth muscle helps stent the airway. Administering a beta-agonist relaxes the smooth muscle and may worsen collapse of the airway.

If the child is having difficulty with retained secretions, chest physiotherapy may be helpful.

If gastroesophageal reflux is present, appropriate pharmacotherapy should be considered.

On occasion, systemic corticosteroids are used when the baby has increased symptoms during an acute respiratory tract infection. These drugs should be reserved for episodes in which the tracheomalacia interferes with the child's oral intake or disposition or when the child develops respiratory difficulty.

If the child is making more noise but is otherwise doing well, steroids can usually be avoided.

One group showed that positive expiratory pressure during an illness improved the cough flow rates in children with tracheomalacia, making the chest physical therapy and cough itself more effective. Continuous positive airway pressure or bilevel positive airway pressure provided by means of tight-fitting face or nasal mask, endotracheal tube, or tracheostomy tube can provide relief from severe obstruction.