Lower airway collapse: Revisiting the definition and clinicopathologic features of canine bronchomalacia.

Bronchomalacia (BM) is an inconsistently defined term in dogs, impairing understanding of clinical presentation, therapeutic response and prognosis. Herein the authors propose to clarify the definition of canine bronchomalacia (CBM) as regional to diffuse dynamic airway collapse of segmental and/or subsegmental bronchi with associated clinical signs due to airflow limitation. In contrast to tracheal collapse, mainstem bronchial collapse, and in some cases lobar collapse, CBM requires advanced imaging. Common co-morbid conditions (e.g., chronic bronchitis, mitral valve degenerative disease, etc.) should be identified during a comprehensive diagnostic evaluation. Current empiric treatments advocated in absence of clinical trials documenting efficacy in the dog warrant evaluation, as some (e.g., bronchodilators) may have detrimental effects in certain types of airway collapse in humans. There is no direct treatment for CBM, as defined above, but non-specific therapies and targeted treatment of co-morbid disease may improve clinical signs and quality of life. In this manuscript, the authors provide a review of the different types of airway collapse focusing on CBM, reviewing their definition and etiology, proposing a classification scheme, and discussing clinical signs, diagnostic testing, and treatment. Future studies should focus on both improving understanding of the etiology and natural disease progression of CBM and treatment trials.

Successful repair of critical bronchial stenosis with coexisting bronchomalacia and congenital heart defects in infants by slide bronchoplasty.

Isolated bronchial stenosis in infancy is rare, difficult to manage and becomes more complex when associated with congenital heart defects. Given the small luminal diameter and the proximity of the lung parenchyma to the bronchial lesion in infants, reconstruction of the bronchial stenosis is surgically challenging. We present 2 infant cases having isolated critical bronchial obstruction with congenital heart defects, which were successfully managed by primary one-stage slide bronchoplasty with concomitant heart repair. Both cases had excellent results after the surgery and did well at home without requiring respiratory support.

Tracheal and airway collapse in dogs.

Tracheal and airway collapse (bronchomalacia) are common causes of chronic cough in middle-aged to older dogs where weakening of cartilage within the respiratory system leads to narrowing of airways, coughing, wheezing, and other secondary effects. Successful treatment involves correct identification of the problem, recognition of concurrent problems, and appropriate medical therapy. Surgical and noninvasive treatment options are becoming readily available, and it is important to understand indications for such procedures.

Clinical evaluation and endoscopic classification of bronchomalacia in dogs.

BACKGROUND: Little information is available about the association between bronchomalacia and historical or clinicopathologic data. Also, studies applying an endoscopic classification scheme that differentiates between static and dynamic bronchial collapse and based on a scoring system are lacking. OBJECTIVES: To describe the clinical presentation of bronchomalacia in dogs, to classify endoscopic findings, and to evaluate associations among historical, clinicopathologic data, and endoscopic findings. ANIMALS: Fifty-nine client-owned dogs with an endoscopic diagnosis of bronchomalacia. METHODS: In this retrospective study, medical records were analyzed and video documentation was reviewed to assign a score to endoscopic findings. Univariate analysis was performed on categorical variables organized in contingency tables, and a stepwise logistic regression model was used for multivariate analysis. RESULTS: Of the 59 dogs included in the study, 2 were affected by static bronchial collapse (SBC), 35 by dynamic bronchial collapse (DBC), and 22 by both SBC and DBC. The association between SBC and DBC was more frequently seen in the dogs with higher body weight, pulmonary hypertension, a bronchial type of radiographic pattern, and nodularity at endoscopic examination. Thirty-one dogs were presented with tracheomalacia and bronchomalacia; an association emerged between these concurrent disorders in dogs living indoors. Multivariate analysis of the endoscopic scores showed a correlation between DBC severity and cough duration. CONCLUSION AND CLINICAL IMPORTANCE: Results of this study provide evidence for 2 different types of bronchial collapse. Endoscopic scoring scheme has proved to be promising in the bronchomalacia classification, although further evaluation of its applicability in larger canine populations is needed.

Canine bronchomalacia: a clinicopathological study of 18 cases diagnosed by endoscopy.

Canine bronchomalacia (BM) is characterized by weakness leading to collapse of the bronchial wall. A prospective study of 18 affected dogs (age range: 1-15 years) was undertaken to characterize the clinicopathological and histological features of BM. Poodles and Yorkshire terriers were commonly affected. Half of the dogs were overweight or obese. The clinical presentation was a mild, wheezing, chronic cough and pulmonary crackles were heard in 28% of the dogs. Compatible radiographic changes were present in 61% of the dogs. Using bronchoscopy, both lungs were affected in half of the animals, whereas in the others the disease appeared to affect predominantly the left lung. Analysis of bronchoalveolar lavage fluid and biopsies of bronchial mucosa revealed pure or mixed neutrophilic inflammation. Underlying infectious bronchitis was considered possible in 56% of the dogs. It was concluded that canine BM may present as an isolated clinical entity associated with infection and/or inflammation.

Interventional bronchoscopy from bench to bedside: new techniques for central and peripheral airway obstruction.

This article discusses how basic scientific concepts, based on a greater understanding of airway physiology, support the development and dissemination of multidimensional classification systems for tracheal stenosis, expiratory central airway collapse, and innovative interventional bronchoscopic procedures for patients with asthma and chronic obstructive pulmonary disease.