Are you also short of breath? Do you have a persistent cough? This could be Tracheobronchomalacia (TBM)

Do you sometimes find it hard to breathe when you walk up a flight of stairs or even walk a little faster? Or do you feel like your little one is having a little trouble breathing when you breastfeed? Are you also worried about things like a persistent cough or a strange sound coming from inside your chest? Although there are many causes for these things, such as asthma, today we are going to talk about a condition that none of us have heard much about, but which can be very important. That is Tracheobronchomalacia, or TBM for short.

Simply put, what is Tracheobronchomalacia (TBM)?

Although this may seem like a long and strange word, its meaning is very simple. Tracheobronchomalacia (TBM) is a condition in which the walls of the trachea and the bronchi, two main parts of our respiratory system, become weak, causing these tubes to constrict and close when we breathe, especially when we exhale or cough.

Imagine that our windpipe is like a plastic pipe that carries water. If the walls of this pipe are strong, there is no problem when the water flows through. But if the walls of the pipe are very thin and weak, the water can get stuck in the pipe when it flows quickly, right? That's what happens in TBM. When the strong parts called cartilage in the walls of the windpipe and trachea weaken, these tubes get stuck and blocked when the air moves back and forth quickly. That's when it becomes difficult to breathe, coughing occurs, and a sound comes from the chest.

This condition can be congenital (Congenital TBM) , meaning a baby is born with this weakness. For others, it can be acquired (Acquired TBM), meaning it can develop during life due to other diseases, treatments, or other external causes.

What are the symptoms of TBM?

These symptoms may vary slightly depending on whether the condition is congenital or acquired. Let's look at the symptoms of both separately.

Why does this TBM situation occur?

As we discussed earlier, the reasons for this can be divided into two categories.

1. Primary/Congenital TBM

There are several reasons why a baby may be born with this condition:

• Idiopathic TBM: Some babies may be born with weakened cartilage in the trachea for no apparent reason.
• Vascular Rings: This occurs when a baby's main blood vessel (aorta) from the heart forms incorrectly and wraps around the trachea as it grows in the womb. This blood vessel presses on the trachea, causing it to weaken.
• Some genetic diseases: Rare, inherited conditions such as Hunter syndrome, Hurler syndrome, and Ehlers-Danlos syndrome can weaken the body's cartilage. This can also affect the airways.
• Premature birth: Babies born before 37 weeks may be at increased risk of TBM because their airways are not fully developed.

2. TBM that occurs during life (Secondary/Acquired TBM)

There are many reasons why this condition can occur in an adult.

How does the doctor diagnose this disease exactly?

If you or your child has these symptoms, the best thing to do is to see a doctor. The doctor will examine you thoroughly and ask you and your child about your symptoms. They will ask you a lot of questions, such as whether you often get colds and whether you have other respiratory illnesses.

After that, several tests can be done to confirm this disease.

• Pulmonary Function Tests: This tests how well your lungs can take in and out air.
• Bronchoscopy: This is the most important and accurate test to confirm TBM. In this, a thin, camera-equipped tube is inserted through the mouth or nose to examine the inside of the windpipe and bronchi. The doctor can see how much the windpipe is blocked by asking you to breathe in and cough.
• CT scan (Computed Tomography Scan): This can take detailed pictures of the chest. This can help determine if the TBM is caused by something else or if there is a change in the shape of the airway.

What are the treatments for this?

Treatment options vary depending on how much TBM has affected you or your child. Not everyone will need surgery.

1. Medicines and support equipment

• Treatment for infections: If your baby has frequent respiratory infections, you may be given medications such as antibiotics .
• Breastfeeding techniques: If your baby is having trouble breathing while breastfeeding, your doctor or nurse will teach you how to change positions to make breathing easier.
• Pulmonary Rehabilitation: This involves teaching breathing exercises to manage symptoms.
• CPAP or BiPAP® machines: These are also used for people who have sleep apnea. They deliver air at a certain pressure through a mask that fits over the face, helping to keep the airway open and not obstructed.
• External Percussion Vests: It can be difficult to cough up mucus when you have TBM. This is a device that you wear like a garment. When connected to a machine, it vibrates rapidly, loosening the mucus in your chest, making it easier to cough up.
• Nebulizer: A device that turns liquid medication into a fine mist that can be inhaled through a mask. This can deliver the medication directly to the lungs.

2. Surgery

In some severe cases, surgery may be necessary.

• Bronchoscopy and stent placement: A diagnostic bronchoscopy can also be used as a treatment. In this procedure, a small plastic or metal tube (stent) is inserted into the airway to keep the blockage open. These are usually temporary.
• Tracheobronchoplasty: This is a surgical procedure in which a mesh-like structure is placed on the outside of the windpipe and sewn into place. This mesh provides extra strength to the windpipe, reducing its constriction.
• Tracheopexy: This surgery involves sewing the weakened back wall of the windpipe to strong ligaments in the spine. This prevents the part from collapsing inward when you breathe.

Because these are major surgeries, there are risks such as excessive bleeding, blood clots, and wound infection . If surgery is recommended, your doctor will explain all of this to you thoroughly.

How to live with TBM condition?

If a child has TBM:

As the child grows older, the cartilage in the airways becomes stronger. Therefore, the symptoms may gradually decrease. However, in most cases, medical supervision and some treatment are required throughout childhood. It is very important to protect the child from frequent respiratory infections.

If an adult has TBM:

TBM in adults is usually a chronic condition that can get worse over time . Symptoms can be managed by weight loss and other medical conditions. Surgery can be effective. However, many people with TBM also have other conditions, such as asthma and COPD, so they need to be monitored by a respiratory specialist for the rest of their lives.

Can this situation be prevented?

There is no way to prevent congenital TBM. However, there are some things you can do to reduce the risk of TBM in adults.

• Avoid smoking and being around people who smoke.
• If you have conditions like asthma, COPD, or GERD, take the appropriate treatment for them and control the disease well.
• Maintain a healthy weight.
• If your job involves exposure to toxic gases, follow appropriate safety procedures.

If you have a persistent cough or difficulty breathing, don't just assume it's a cold, but definitely see a doctor and get checked out. The sooner the disease is diagnosed, the better the chances of getting good results from treatment.

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