Central Airway Obstruction (CAO)

Our Approach to Treatment

Houston Methodist pulmonologists offer the latest medical and surgical interventions for central airway obstruction (CAO), a complex condition that may cause life-threatening breathing problems and significantly impact a patient’s quality of a life. The management of CAO is done by Interventional pulmonologists who work collaboratively with the following specialties: medical and radiation oncologists, anesthesiologists, otolaryngologists and thoracic surgeons.

The Houston Methodist Lung Center in the Texas Medical Center offers a single center of expertise in the diagnosis and management of advanced cases of CAO. 

Our CAO experts specialize in:

 

  • Bronchoscopy, both rigid and flexible, for CAO diagnosis and treatment
  • Resection/debulking/dilation of obstructing lesions with:
  • Laser
  • Cryotherapy
  • Electrocautery/electrodissection 
  • Balloon dilation
  • Airway stent deployment (metallic or plastic) for maintenance of airway patency
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What Is Central Airway Obstruction?

CAO refers to multiple processes or diseases that cause an obstruction of the airways (windpipe) and block air flow.

Causes

CAO can be malignant (cancer-related) or benign (non-cancer related).

Malignant CAO causes include:

 

  • Lung cancer
  • Non-lung cancer (breast, colon, rectal or kidney) that metastasizes or spreads to the airways
  • Cancerous tumors that invade the airways, grow within the airway or develop close enough to the airways to affect it
  • Cancer that extends into the airways

 

Benign CAO causes include:

 

  • Complications from prior intubation (breathing tube placement) or tracheostomy
  • Inflammation (causes range from foreign objects to rheumatologic diseases)Non-cancerous airway growths
  • Infections like tuberculosis or fungal diseases

 

Diagnostics

  • Chest X-ray 
  • CT scan (computed tomography of the chest)
  • Virtual bronchoscopy
  • Bronchoscopy (essential for diagnosing CAO) to determine type, location, size and pathology of lesion

 

Symptoms

  • Shortness of breath
  • Shortness of breath lying flat
  • Cough
  • Coughing up blood
  • Hoarseness
  • Chest discomfort
  • Wheezing
  • Trouble swallowing


Obstructions may not cause symptoms until airflow is severely reduced. Patients with pre-existing lung conditions like COPD may experience symptoms with relatively small obstruction. Sudden shortness of breath may signal an airway blockage caused by a foreign object.

 

Treatments

  • Interventional bronchoscopy
  • Laser 
  • Electrosurgery (electrocautery) uses electric current to heat and destroy tissue
  • Argon plasma coagulation (APC) is a form of electrosurgery used to treat tumors
  • Cryotherapy: uses a freezing agent to treat malignant and nonmalignant CAO
  • Photodynamic therapy (PDT) uses drugs called photosensitizing agents, along with LASER light to kill cancer cells
  • Airway dilation with the rigid bronchoscope or a special balloon
  • Airway stents (silicone, metallic and hybrid)

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