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 requires a team approach with pulmonologists, medical and radiation oncologists, anesthesiologists, head and neck surgeons, thoracic surgeons and interventional pulmonologists. 

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
  
  

Definition
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

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.

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
  
  

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)