Management of large airway problems

Endobronchial intervention has an established role in the management of a variety of benign and malignant conditions which lead to large airway compromise. Traditionally, this specialty fell within the remit of thoracic surgery but with increasing awareness and training some physicians are now engaging in this practice. Although patients with large airway compromise can be successfully managed in many instances using fibreoptic bronchoscopy under local anaesthesia, such practice may in part reflect lack of familiarity and training with rigid bronchoscopy. Rigid bronchoscopy under general anaesthesia in a multidisciplinary setting provides a safe, efficient and controlled environment to successfully manage practically any large airway problem which requires either emergency or semi-elective intervention. With increasing advances in anaesthetic and bronchoscopic techniques there are virtually no contraindications to the procedure, and morbidity and mortality rates are very low. Broadly speaking, endobronchial intervention is indicated for patients with a variety of conditions producing intrinsic or extrinsic airway obstruction or for those with airway defects which may or may not communicate with the oesophagus. Endobronchial techniques are available for foreign body retrieval, dilatation, tissue destruction and for endobronchial stenting. Endobronchial intervention can be curative or palliative, or may complement other treatments. It may be an alternative to formal airway surgery for selected patients, including those with medical comorbidities which contraindicate surgery.