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Central airway obstruction

Last reviewed: 4 Apr 2025
Last updated: 19 Dec 2024

Summary

Definition

History and exam

Key diagnostic factors

  • shortness of breath
  • cough
  • hemoptysis
  • wheeze
  • stridor
Full details

Other diagnostic factors

  • hoarseness
  • orthopnea
  • dysphagia
  • chest pain
  • anxiety
  • tachypnea
  • tachycardia
  • accessory muscle use
  • cyanosis
  • crackles
Full details

Risk factors

  • lung cancer
  • primary airway malignancy
  • smoking
  • artificial airways
  • tracheobronchial stents
  • transtracheal oxygen catheters
  • lung transplantation
  • neurocognitive and neuromuscular disorders
  • relapsing polychondritis
  • granulomatosis with polyangiitis (formerly known as Wegener granulomatosis)
  • tracheobronchomalacia
  • endobronchial infections
  • extrathoracic and distant malignancies
Full details

Diagnostic tests

1st tests to order

  • chest x-ray
Full details

Tests to consider

  • bronchoscopy (flexible and/or rigid)
  • CT chest
  • MRI of chest
  • flow-volume loops (FVL)
  • spirometry
Full details

Emerging tests

  • endobronchial ultrasound (EBUS)

Treatment algorithm

ACUTE

acute presentation

subacute presentation

Contributors

Authors

Assistant Professor of Medicine

Department of Internal Medicine

Division of Pulmonary, Allergy & Critical Care Medicine

Duke University Hospital

Durham

NC

Disclosures

CXG declares that she has no competing interests.

Clinical Associate

Department of Medicine

Duke University Hospital

Durham

NC

Disclosures

MD declares that he has no competing interests.

Dr Coral X. Giovacchini and Dr Michael Dorry would like to gratefully acknowledge Dr Jose Fernando Santacruz, a previous contributor to this topic.

Disclosures

JFS is a consultant for Boston Scientific and is the author of several studies referenced in this topic.

Peer reviewers

Adjunct Assistant Professor

University of Utah

Director

Pulmonary & Critical Care Research

IHC Urban South Intermountain Utah Valley Pulmonary Clinic

Provo

UT

Disclosures

KMS declares that he has no competing interests.

Clinical Director

Acute Medicine

Associate Medical Director

Consultant Emergency Medicine

Guy's and St Thomas' NHS Foundation Trust

Clinical Lead and Consultant

Accident Emergency Medicine

St Thomas' Hospital

London

UK

Disclosures

AP declares that he has no competing interests.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Murgu SD, Egressy K, Laxmanan B, et al. Central Airway Obstruction: Benign Strictures, Tracheobronchomalacia, and Malignancy-related Obstruction. Chest. 2016 Aug;150(2):426-41.Full text  Abstract

Bolliger CT, Mathur PN, Beamis JF, et al. ERS/ATS statement on interventional pulmonology. European Respiratory Society. Eur Respir J. 2002;19:356-373.Full text  Abstract

Mahmood K, Frazer-Green L, Gonzalez AV, et al. Management of central airway obstruction: an American College of Chest Physicians clinical practice guideline. Chest. 18 Jul 2024 [Epub ahead of print].Full text  Abstract

Rosell A, Stratakos G. Therapeutic bronchoscopy for central airway diseases. Eur Respir Rev. 2020 Nov 18;29(158):190178.Full text  Abstract

Ernst A, Silvestri GA, Johnstone D. Interventional pulmonary procedures: guidelines from the American College of Chest Physicians. Chest. 2003;123:1693-1717. Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
  • Central airway obstruction images
  • Differentials

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    • Pneumonia
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  • Guidelines

    • ACR appropriateness criteria: tracheobronchial disease
    • Management of central airway obstruction
    More Guidelines
  • Patient information

    Bronchoscopy

    More Patient information
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