Medication Summary

After the diagnosis of tracheomalacia is made, the most effective and safest treatment is the passage of time. Bronchodilators (eg, albuterol) usually do not help and may worsen tracheomalacia in some infants. The tone of the smooth muscle presumably stents the airway in some babies. Administering a beta-agonist relaxes these muscles and may worsen airway collapse.

Class Summary

These agents have anti-inflammatory properties and cause profound and varied metabolic effects. They modify the body's immune response to diverse stimuli.

Babies who have respiratory difficulties during a concomitant upper respiratory tract infection may respond favorably to systemic corticosteroids. If the baby is noisier than usual but acting and eating normally, do not use medications.

Prednisolone (Orapred, Prelone, Pediapred)

View full drug information

May decrease inflammation by reversing increased capillary permeability and suppressing polymorphonuclear (PMN) activity. Available in tab and syr; prednisolone syr tastes better than prednisone syr.

Prednisone (Deltasone, Meticorten, Orasone)

View full drug information

May decrease inflammation by reversing increased capillary permeability and suppressing PMN activity.

Yang D, Cascella M. Tracheomalacia. StatPearls [Internet]. 2023 Jan. [QxMD MEDLINE Link]. [Full Text].
Jamal N, Bent JP, Vicencio AG. A neurologic etiology for tracheomalacia?. Int J Pediatr Otorhinolaryngol. 2009 Jun. 73(6):885-7. [QxMD MEDLINE Link].
Boogaard R, Huijsmans SH, Pijnenburg MW, et al. Tracheomalacia and bronchomalacia in children: incidence and patient characteristics. Chest. 2005 Nov. 128(5):3391-7. [QxMD MEDLINE Link].
Okata Y, Hasegawa T, Bitoh Y, Maeda K. Bronchoscopic assessments and clinical outcomes in pediatric patients with tracheomalacia and bronchomalacia. Pediatr Surg Int. 2018 Jan. 34 (1):55-61. [QxMD MEDLINE Link].
Valerie EP, Durrant AC, Forte V, et al. A decade of using intraluminal tracheal/bronchial stents in the management of tracheomalacia and/or bronchomalacia: is it better than aortopexy?. J Pediatr Surg. 2005 Jun. 40(6):904-7; discussion 907. [QxMD MEDLINE Link].
Thomas R, Chang A, Masters IB, Grimwood K, Marchant J, Yerkovich S, et al. Association of childhood tracheomalacia with bronchiectasis: a case-control study. Arch Dis Child. 2022 Jun. 107 (6):565-9. [QxMD MEDLINE Link]. [Full Text].
Boiselle PM, Ernst A. Tracheal morphology in patients with tracheomalacia: prevalence of inspiratory lunate and expiratory "frown" shapes. J Thorac Imaging. 2006 Aug. 21(3):190-6. [QxMD MEDLINE Link].
Wallis C, Alexopoulou E, Antón-Pacheco JL, et al. ERS statement on tracheomalacia and bronchomalacia in children. Eur Respir J. 2019 Sep. 54 (3):[QxMD MEDLINE Link]. [Full Text].
Kamran A, Zendejas B, Jennings RW. Current concepts in tracheobronchomalacia: diagnosis and treatment. Semin Pediatr Surg. 2021 Jun. 30 (3):151062. [QxMD MEDLINE Link].
Snijders D, Barbato A. An Update on Diagnosis of Tracheomalacia in Children. Eur J Pediatr Surg. 2015 Aug. 25 (4):333-5. [QxMD MEDLINE Link].
Vinograd I, Filler RM, Bahoric A. Long-term functional results of prosthetic airway splinting in tracheomalacia and bronchomalacia. J Pediatr Surg. 1987 Jan. 22(1):38-41. [QxMD MEDLINE Link].
Yalcin E, Dogru D, Ozcelik U, et al. Tracheomalacia and bronchomalacia in 34 children: clinical and radiologic profiles and associations with other diseases. Clin Pediatr (Phila). 2005 Nov-Dec. 44(9):777-81. [QxMD MEDLINE Link].
Vinograd I, Keidar S, Weinberg M, Silbiger A. Treatment of airway obstruction by metallic stents in infants and children. J Thorac Cardiovasc Surg. 2005 Jul. 130(1):146-50. [QxMD MEDLINE Link].
Austin J, Ali T. Tracheomalacia and bronchomalacia in children: pathophysiology, assessment, treatment and anaesthesia management. Paediatr Anaesth. 2003 Jan. 13(1):3-11. [QxMD MEDLINE Link].

Media Gallery

Slide tracheoplasty and left PA sling repair. Procedure performed by Giles Peek MD, FRCS, CTh, FFICM, The Children’s Hospital at Montefiore, Bronx, NY.
This shows the trachea during inspiration and expiration. Tracheal collapse of more than 50% during expiration is diagnostic of tracheomalacia.

of 2

Author

Emily Concepcion, DO Fellow, Department of Pediatric Pulmonology, State University of New York Downstate Medical Center

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Chief Editor

Girish D Sharma, MD, FCCP, FAAP Professor of Pediatrics, Rush Medical College; Director, Section of Pediatric Pulmonology and Rush Cystic Fibrosis Center, Rush Children's Hospital, Rush University Medical Center

Girish D Sharma, MD, FCCP, FAAP is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, American Thoracic Society, Royal College of Physicians of Ireland

Disclosure: Nothing to disclose.

Additional Contributors

Michael R Bye, MD Professor of Clinical Pediatrics, State University of New York at Buffalo School of Medicine; Attending Physician, Pediatric Pulmonary Division, Women's and Children's Hospital of Buffalo

Michael R Bye, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, American Thoracic Society

Disclosure: Nothing to disclose.

Susanna A McColley, MD Professor of Pediatrics, Northwestern University, The Feinberg School of Medicine; Director of Cystic Fibrosis Center, Head, Division of Pulmonary Medicine, Children's Memorial Medical Center of Chicago

Susanna A McColley, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, American Sleep Disorders Association, American Thoracic Society

Disclosure: Received honoraria from Genentech for speaking and teaching; Received honoraria from Genentech for consulting; Partner received consulting fee from Boston Scientific for consulting; Received honoraria from Gilead for speaking and teaching; Received consulting fee from Caremark for consulting; Received honoraria from Vertex Pharmaceuticals for speaking and teaching.

Acknowledgements

Heidi Connolly, MD Associate Professor of Pediatrics and Psychiatry, University of Rochester School of Medicine and Dentistry; Director, Pediatric Sleep Medicine Services, Strong Sleep Disorders Center

Heidi Connolly, MD is a member of the following medical societies: American Academy of Pediatrics, American Thoracic Society, and Society of Critical Care Medicine

Disclosure: Nothing to disclose.