Malignant Central Airway Obstruction

  • Gaëtane MichaudEmail author


Central airway obstruction by malignancy usually occurs in situations where there is greater than 50 % obstruction of one of the main stem bronchi, trachea, or bronchus intermedius. Approximately 1/3 of patients with lung cancer present with obstruction. The general approach to these patients is first to stabilize them clinically, then consider the cause. Depending on the etiology and location of the tumor resulting in the obstruction, the management may include debulking techniques and/or airway stenting. The decision regarding the most appropriate therapeutic intervention is based upon review of the diagnostic imaging, the endoscopic appearance, and the responsiveness of the tumor to other therapeutic modalities including surgery, radiation, and chemotherapy. If the patient and the medical conditions are such that the patient is deemed an appropriate candidate for endoscopic management, then the general approach includes devitalizing the tumor followed by debridement, hemostasis of the tumor base, and then consideration of stent.


Airway Obstruction Adenoid Cystic Carcinoma Airway Patency Central Airway Rigid Bronchoscope 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Suggested Reading

  1. 1.
    Miyazawa TY, Yamakido M, Ikeda S, Furukawa K, Takiguchi Y, Tada H, Shirakusa T. Implantation of ultraflex nitinol stents in malignant tracheobronchial stenoses. Chest. 2000;118(4):959–65.PubMedCrossRefGoogle Scholar
  2. 2.
    Hollingsworth H. Wheezing and stridor. Clin Chest Med. 1987;8(2):231–40.PubMedGoogle Scholar
  3. 3.
    Chen K, Varon J, Wenker O. Malignant airway obstruction: recognition and management. J Emerg Med. 1;16:83–92.CrossRefGoogle Scholar
  4. 4.
    Schuumans MM, Michaud GC, Diacon AH, Bolliger CT. Use of an ultrathin bronchoscope in the assessment of central airway obstruction. Chest. 2003;124(2):735–9.CrossRefGoogle Scholar
  5. 5.
    National Cancer Institute. Surveillance epidemiology and end results. 2010.Google Scholar
  6. 6.
    Regnard J, Fourquier P, Levasseur P. Results and prognostic factors in resections of primary tracheal tumors: a multicenter retrospective study. J Thorac Cardiovasc Surg. 1996;111(4):808–14.PubMedCrossRefGoogle Scholar
  7. 7.
    Lee KS, Lunn W, Feller-Kopman D, Ernst A, Hatabu H, Boiselle PM. Multislice CT evaluation of airway stents. J Thorac Imaging. 2005;20(2):81–8.PubMedCrossRefGoogle Scholar
  8. 8.
    Miller RD, Hyatt RE. Evaluation of obstructing lesions of the trachea and larynx by flow-volume loops. Am Rev Respir Dis. 1973;108(3):475–81.PubMedGoogle Scholar
  9. 9.
    Oviatt PL, Stather DR, Michaud G, MacEachern P, Tremblay A. Exercise capacity, lung function and quality of life after interventional bronchoscopy. J Thorac Oncol. 2010;123(1):222–4.Google Scholar
  10. 10.
    Brodsky J. Bronchoscopic procedures for central airway obstruction. J Cardiothorac Vasc Anesth. 2003;17(5):638–46.PubMedCrossRefGoogle Scholar
  11. 11.
    Druz WS, Sharp JT. Activity of respiratory muscles in upright and recumbent humans. J Appl Physiol. 1981;51(6):1552–61.PubMedGoogle Scholar
  12. 12.
    Hautmann H, Gamarra F, Pfeifer K, Huber R. Fiberoptic bronchoscopic balloon dilatation in malignant tracheobronchial disease indications and results. Chest. 2001;120(1):43–9.PubMedCrossRefGoogle Scholar
  13. 13.
    van Boxem TJ, Westerga J, Venmans B, Postmus P, Sutedja T. Tissue effects of bronchoscopic electrocautery. Chest. 2000;117(3):887–91.PubMedCrossRefGoogle Scholar
  14. 14.
    Tremblay A, Michaud G, Urbanski S. Hot biopsy forceps in the diagnosis of endbronchial lesions. Eur Respir J. 2007;29(1):108–11.PubMedCrossRefGoogle Scholar
  15. 15.
    Morice R, Ece T, Ece F, Keus L. Endobronchial argon plasma coagulation for treatment of hemoptysis and neoplastic airway obstruction. Chest. 2001;119(3):781–7.PubMedCrossRefGoogle Scholar
  16. 16.
    Reddy C, Majid A, Michaud G, Feller-Kopman D, Eberhardt R, Herth F, Ernst A. Gas embolism following bronchoscopic argon plasma coagulation. Chest. 2008;134(5):1066–9.PubMedCrossRefGoogle Scholar
  17. 17.
    Mehta AC, Golish J, Ahmad M. Lasers in medicine: a clinician guide to the physics. J Respir Dis. 1987;8:37–44.Google Scholar
  18. 18.
    Diaz-Jimenez JP, Martinez-Ballarin JE, Llunell A, Farrero E, Rodriguez A, Castro MJ. Efficacy and safety of photodynamic therapy versus Nd-YAG laser resection in NSCLC with airway obstruction. Eur Respir J. 1999;14:800–5.PubMedCrossRefGoogle Scholar
  19. 19.
    Reddy C, Michaud G, Majid A, Herth F, Ernst A. Photodynamic therapy in the management of endobronchial metastatic lesions from renal cell carcinoma. J Bronchol Inter Pulmonol. 2009;16:245–9.CrossRefGoogle Scholar
  20. 20.
    Asimakopoulos G, Beeson J, Evans J, Maiwand MO. Cryosurgery for malignant endobronchial tumors: analysis of outcome. Chest. 2005;127:2007–14.PubMedCrossRefGoogle Scholar
  21. 21.
    Mathur P, Wolf KM, Busk M, Briete M, Datzman M. Fiberoptic bronchoscopic cryotherapy in the management of tracheobronchial obstruction. Chest. 1996;110:718–23.PubMedCrossRefGoogle Scholar
  22. 22.
    Vergnon JM, Schmitt T, Alamartine E, Barthelemy JC, Fournel P, Emonot A. Initial combined cryotherapy and irradiation for unresectable non-small cell lung cancer. Preliminary results. Chest. 1992;102:1436–40.PubMedCrossRefGoogle Scholar
  23. 23.
    Escobar-Sacrostan JA, Granda-Orive JI, Gutierrez Jimenez T, Delgado JM, Rodero Banos A, Saez Valls R. Endobronchial brachytherapy in the treatment of malignant lung tumours. Eur Respir J. 2004;24:348–52.CrossRefGoogle Scholar
  24. 24.
    Sutedja T, Baris G, Schaake-Koning C, Van Zandwijk N. High dose rate brachytherapy in patients with local recurrences after radiotherapy of non-small cell lung cancer. Int J Radiat Oncol Biol Phys. 1992;24:551–3.PubMedCrossRefGoogle Scholar
  25. 25.
    Chang L, Horvath J, Peyton W, Ling S. High dose rate afterloading intraluminal brachytherapy in malignant airway obstruction of lung cancer. Int J Radiat Oncol Biol Phys. 1994;28:589–96.PubMedCrossRefGoogle Scholar
  26. 26.
    Dumon JF, Cavaliere S, Diaz-Jimenez JP, Vergnon JM. Seven years experience with the Dumon prosthesis. J Bronchol. 1996;3:6–10.CrossRefGoogle Scholar
  27. 27.
    Noppen M, Pierard D, Meysman M, Claes I, Vincken W. Bacterial colonization of central airway after stenting. Am J Respir Crit Care Med. 1999;160:672–7.PubMedCrossRefGoogle Scholar
  28. 28.
    Alazemi S, Lunn W, Majid A, Berkowitz D, Michaud G, Feller-Kopman D, Herth F, Ernst A. Outcomes, health-care resources use, and costs of endoscopic removal of metallic airway stents. Chest. 2010;138:350–6.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.Division on Pulmonary and Critical Care MedicineYale New Haven HospitalNew HavenUSA

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