Abstract
Background: Airway involvement in relapsing polychondritis (RP) is characterized by chondritis of the larynx and tracheobronchial tree. RP often causes tracheobronchomalacia (TBM), which can lead to dynamic airway collapse. TBM can be debilitating and life threatening, and pulmonary intervention is often required.
Objective: To establish a decision protocol for the placement of stents in RP patients with airway involvement.
Methods: This is a retrospective study of 44 RP patients treated at our department from January 2004 to November 2013. The McAdam or Damiani and Levine diagnostic criteria were used to diagnose RP in patients. Our decision protocol is as follows: first, medication therapy are administrated. If medication cannot stabilize the subglottic stenosis and/or TBM, tracheostomy and/or non-invasive positive pressure ventilation (NIPPV) should be performed to prevent dynamic airway collapse. Finally, if the airway cannot be maintained through medication and tracheostomy/NIPPV, stenting is required.
Results: Thirty-six of 44 RP patients developed airway involvements. Twenty-two RP patients were confirmed with TBM by chest CT and/or bronchoscopy.Six RP patients required tracheostomy. Ten RP patients required stenting with ultraflex stents and 1 underwent bifurcated silicone stent placement. TBM developed in the tracheobronchial tree of all RP patients, and 3 to 5 ultraflex stents were required to keep tracheobronchial patency. Ultraflex stents were successfully implanted at the flow-limiting segments (choke points).
Conclusion: Ultraflex stents were suitable for the central airway in RP patients with TBM. It is important to implant stents at the exact area of the flow-limiting segment.
- © 2014 ERS