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Central airway obstruction
What's new
Updated 2025 ACCP guidelines for the management of central airway obstruction .
Background
Overview
Definition
Malignant CAO is the narrowing or complete blockage of the trachea, mainstem bronchi, or bronchus intermedius due to malignant tumors.
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Pathophysiology
The pathophysiology of malignant CAO involves the growth of a malignant tumor within the central airways, leading to impaired airflow. This obstruction can cause a ventilation-perfusion mismatch, leading to hypoxemia. In severe cases, complete obstruction can lead to atelectasis of the affected lung segment or lobe, post-obstructive pneumonia, and respiratory failure.
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Epidemiology
It is estimated that 20-30% of patients with lung cancer will experience airway obstruction-associated complications, including dyspnea, atelectasis, and pneumonia.
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Risk factors
The main risk factor is a history of malignancy, especially lung cancer, but it can also include esophageal, thyroid, head and neck, and primary mediastinal tumors.
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Disease course
The clinical course of malignant CAO typically involves symptoms such as dyspnea, stridor, wheezing, cough, and hemoptysis. Symptoms can be exertional in the mild or early stages and become severe and present at rest over time.
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Guidelines
Key sources
The following summarized guidelines for the evaluation and management of central airway obstruction are prepared by our editorial team based on guidelines from the American College of Chest Physicians (ACCP 2025,2013), the World Association for Bronchology and Interventional Pulmonology (WABIP 2024), and the European Society of Medical Oncology (ESMO 2023).
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