Bronchostenosis

Bronchostenosis is a chronic narrowing of the bronchi, the tubes that carry air into your lungs. This narrowing can make breathing difficult and lead to repeated lung infections, requiring ongoing medical care and lifestyle adjustments to maintain quality of life.

Table of contents

• What is bronchostenosis?
• What causes bronchostenosis?
• Symptoms and signs
• How is bronchostenosis diagnosed?
• Treatment options
• Living with bronchostenosis

bronchial stenosis, chronic narrowing of a bronchus

What is bronchostenosis?

Bronchostenosis is a condition where the bronchi (the tubes that carry air from your windpipe into your lungs) become chronically narrowed^[1]. The term comes from “broncho,” referring to the airways, and “stenosis,” meaning narrowing. This narrowing can affect different parts of your breathing passages, from the large central airways down to smaller branches within your lungs^[2].

When your airways narrow, it becomes harder for air to flow in and out of your lungs. This can make breathing difficult and prevent mucus from being cleared properly from your airways. When mucus builds up, bacteria can grow more easily, leading to repeated infections that cause further damage to the airways^[1].

• Bronchi (airways)
• Lungs
• Trachea (windpipe)

What causes bronchostenosis?

Bronchostenosis can develop from several different causes. Understanding what led to the narrowing of your airways helps your doctor choose the best treatment approach.

One of the most common causes is endobronchial tuberculosis, a form of tuberculosis that affects the airways directly. Even after successful treatment of the tuberculosis infection, scarring can cause the airways to narrow permanently. Studies show that bronchial narrowing can develop in a large percentage of people with endobronchial tuberculosis, sometimes appearing within the first few months of illness^[3][9].

Another important cause is sarcoidosis, a disease where small collections of inflammatory cells form in various organs, most commonly the lungs. When sarcoidosis affects the airways, it can lead to narrowing through inflammation inside the bronchial walls or from pressure caused by enlarged lymph nodes pressing on the airways from outside^[1].

Additional causes of bronchostenosis include prolonged use of breathing tubes (especially in intensive care), previous lung transplant surgery, radiation therapy for cancer treatment, inhaled chemicals or toxic substances, and certain autoimmune diseases^[10][16]. In some cases, bronchostenosis may be present from birth as a congenital condition^[16].

A rare cause is anthracostenosis, which happens when inhaling coal dust or biomass smoke over many years leads to deposits of black carbon particles in the airways along with narrowing^[4].

Symptoms and signs

The symptoms of bronchostenosis depend on where the narrowing occurs and how severe it is. Some people may have mild symptoms or none at all, while others experience significant breathing problems.

The most common symptom is a persistent cough that may produce mucus. Many people with bronchostenosis also experience dyspnoea (shortness of breath), especially when physically active. When the narrowing is severe or affects the upper airways near the windpipe, it can cause stridor (a high-pitched whistling sound when breathing)^[3][9].

Other symptoms can include wheezing (a whistling sound when breathing out), repeated chest infections that keep coming back, and coughing up blood in some cases. Some people also experience fatigue and general tiredness as their body works harder to breathe^[5].

When bronchostenosis leads to complete or near-complete blockage of an airway, it can cause atelectasis (collapse of part of the lung). This means that section of lung can no longer fill with air properly. In the case report of a woman with sarcoidosis, narrowing of her right middle lobe bronchus led to complete collapse of that section of her lung^[1].

It’s important to note that stridor typically only appears when the airway diameter in an adult becomes narrowed to approximately 6 millimeters or less, indicating severe narrowing^[9].

How is bronchostenosis diagnosed?

Diagnosing bronchostenosis requires several tests to see inside your airways and lungs. Your doctor will start with your medical history and a physical examination, listening to your chest with a stethoscope to detect any abnormal breathing sounds.

Imaging tests play a crucial role in diagnosis. A chest X-ray may show signs of bronchostenosis, such as lung collapse or other changes, but it cannot always detect airway narrowing clearly. Computed tomography (CT) scans, especially high-resolution CT scans, provide much more detailed images of the airways and are considered the gold standard for diagnosing bronchostenosis^[1].

Modern CT technology can do more than just take pictures. Advanced software can create three-dimensional images of your airways and even produce “virtual bronchoscopy” images that show what the inside of your airways looks like without actually inserting a camera. These techniques help doctors study the narrowed area along its entire length, measure the thickness of the bronchial wall, and examine structures outside the airways that might be pressing on them^[1].

Bronchoscopy is a procedure where a thin, flexible tube with a light and camera (called a bronchoscope) is passed through your nose or mouth down into your airways. This allows the doctor to look directly at the inside of your airways and see the narrowing. During bronchoscopy, the doctor can also take small tissue samples (biopsies) for laboratory testing to determine the cause of the narrowing^[6][7].

Additional tests might include sputum cultures to identify any bacteria or fungi causing infections, and lung function tests to measure how well you can breathe^[5].

Treatment options

Treatment for bronchostenosis aims to keep your airways open, prevent infections, and help you breathe more easily. The specific treatments your doctor recommends depend on what caused the narrowing, where it is located, and how severe it is.

Medical treatment

If an underlying condition like tuberculosis or sarcoidosis caused your bronchostenosis, treating that condition is essential. For tuberculosis, this means completing the full course of antibiotics as prescribed. For sarcoidosis, treatment may include medications to reduce inflammation^[1][3].

However, even with proper treatment of the underlying disease, the narrowing often does not reverse because scar tissue has already formed. Once bronchial narrowing develops from conditions like endobronchial tuberculosis, it is usually permanent despite effective treatment of the infection itself^[3][9].

Bronchoscopic procedures

Several procedures can be performed through a bronchoscope to open narrowed airways. Balloon dilation involves inserting a small deflated balloon into the narrowed area and then inflating it to stretch the airway open. This procedure can be repeated if the narrowing returns^[3][9][10].

Some doctors use a medication called mitomycin-C applied directly to the narrowed area during balloon dilation. This medication helps prevent scar tissue from reforming, which can make the treatment last longer. In one reported case, a young woman with multiple areas of narrowing from tuberculosis was successfully treated with balloon dilation combined with topical mitomycin-C, avoiding the need for stents or surgery^[3][9].

Other bronchoscopic options include using lasers to remove scar tissue and placing stents (small tubes made of silicone or metal) inside the airway to hold it open^[10].

Surgical treatment

When bronchoscopic procedures are not effective or appropriate, surgery may be necessary. Surgical options include bronchoplasty (repairing the bronchus) or sleeve resection (removing the narrowed section and reconnecting the healthy parts of the airway)^[14].

Traditional tracheal or bronchial resection surgery involves removing the narrowed segment entirely and joining the healthy sections together. This type of surgery requires careful evaluation to ensure it is the right choice for each patient^[10].

Living with bronchostenosis

Living with bronchostenosis requires ongoing care and lifestyle adjustments to maintain your quality of life and prevent complications.

Airway clearance

One of the most important aspects of managing bronchostenosis is keeping your airways clear of mucus. When mucus builds up in narrowed airways, it increases the risk of infection. A respiratory physiotherapist can teach you specific breathing techniques and exercises to help clear mucus from your lungs. These airway clearance techniques should be performed regularly, typically twice daily, even when you feel well^[19].

Preventing infections

People with bronchostenosis are at higher risk for lung infections. To reduce this risk, wash your hands frequently, especially before eating or taking medications. Get vaccinated against influenza (flu) each year and receive the pneumococcal vaccination to protect against pneumonia. Avoid people who are sick when possible, and stay away from cigarette smoke, which can irritate your airways and increase infection risk^[18][19].

Staying active

Regular physical activity is important even though you may feel short of breath. Exercise actually helps strengthen your breathing muscles and can improve your ability to clear mucus from your lungs. Start slowly and gradually increase your activity level. Many people benefit from pulmonary rehabilitation, a structured program that combines exercise training with education about managing lung conditions^[19].

Healthy lifestyle choices

If you smoke, quitting is one of the best things you can do for your lungs. Smoking damages your airways further and increases your risk of infections. Eating a healthy, balanced diet with plenty of fruits, vegetables, and protein helps your body fight infections and maintain strength. Drinking enough water throughout the day helps keep mucus thinner and easier to clear^[19][22].

Managing symptoms

Learn to recognize signs that your condition may be worsening, such as increased cough, more mucus production, change in mucus color, increased shortness of breath, or fever. Contact your doctor promptly if you notice these changes, as early treatment of infections can prevent more serious complications^[18].

Regular follow-up

Ongoing medical care is essential. Keep all scheduled appointments with your healthcare providers so they can monitor your condition and adjust treatments as needed. Some people with bronchostenosis require repeated bronchoscopic procedures over time to keep their airways open^[3][9].