Treating TBM: Surgeons Provide Rare Expertise for Chronic Lung Condition

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If you’ve had a chest cold, you know how frustrating a bad cough can be, especially when it lingers for days or weeks. Sometimes it can be hard to catch your breath or even carry on a conversation.

But for Sandra Rocha, a cough didn’t just last for days – it lasted decades.

“Throughout the years, the cough was really persistent,” Sandra says.

As a child, her doctors diagnosed her with an allergy to cold temperatures. Desperate for relief, she moved with her family to Florida. But the cough didn’t improve.

After years of suffering, she came across information online about a program at Beth Israel Deaconess Medical Center to treat a little-known disease called tracheobronchomalacia, or TBM, which causes the airways to weaken and collapse. Before long, she was in Boston to meet with BIDMC’s experts, hopeful for an answer at last.

“When we first met her, we had her cough,” says Dr. Sidhu Gangadharan, Chief of Thoracic Surgery and Interventional Pulmonology at BIDMC. “We could hear just from the sound that she very likely had the type of collapsing airway that our treatment takes care of.”

What is TBM?

Normally, the central airways (the trachea and bronchi) remain open when you breathe. With TBM, the airways collapse. The condition is rare and often misdiagnosed as a more common lung condition, such as chronic obstructive pulmonary disease (COPD), asthma, or cystic fibrosis. While its cause is unclear, symptoms include:

• shortness of breath
• labored breathing
• a persistent cough that sounds like a bark
• difficulty clearing phlegm or mucus from the throat
• build-up of secretions in the lungs
• frequent respiratory infections

World-class treatment is here in Boston.

Mild or moderate TBM can be treated in a number of non-surgical ways. For example, certain medical devices or medications can help clear mucus in the airways. Pulmonary rehabilitation can train TBM sufferers to breathe more productively, conserve energy and keep active.

But for more serious cases, surgery is often required. BIDMC is a world leader in surgical TBM treatment, which includes a procedure called tracheobronchoplasty. To determine if this procedure will be a success, doctors first place a temporary stent within the airways to keep passages open. When doctors performed this “stent trial” on Sandra, the results were encouraging.

“Once we made the diagnosis, we proceeded with the next step,” says Dr. Adnan Majid, a BIDMC interventional pulmonologist who treats patients with TBM.  “We placed three stents in her airway and soon after she recovered from anesthesia, she felt like she was a new woman.”

If the temporary stent improves TBM symptoms, it’s a good indication that a tracheobronchoplasty will have a similar effect on a more permanent basis. During this procedure, sections of mesh are placed on the outside of the floppy airway to stabilize it. As the patient heals, scar tissue forms around the mesh, strengthening the airways to prevent them from collapsing. The result is improved breathing and relief from chronic coughing.

Like all TBM surgical patients, Sandra returns to BIDMC yearly so her doctors can continue to monitor her recovery. After undergoing her surgery, her quality of life has improved dramatically.

“I am so grateful to Dr. Majid and Dr. Gangadharan,” Sandra says. “My life now – it’s so incredible.”

For more information on TBM and surgical treatment options at Beth Israel Deaconess Medical Center, visit bidmc.org.