A prospective observational study of 74 patients undergoing flexible bronchoscopy (Jan 2023–Mar 2025) evaluated clinical, functional, and endoscopic features of dynamic airway collapse (EDAC/tracheobronchomalacia) by severity, and developed a diagnostic-therapeutic algorithm including CPAP.
Dynamic airway collapse ≥50% was found in 67.6% of patients; most met the stricter ≥70% threshold for clinically significant disease. Higher collapse severity correlated with higher BMI (r=0.28, p=0.015) and CPAP initiation (r=0.326, p=0.0046). Of CPAP-treated patients, 88.2% reported clinical improvement. Notably, 58.5% of those with significant collapse had normal spirometry, and OSA prevalence was 84%.
Single-center prospective cohort with only 74 patients, limiting generalizability. The proposed diagnostic-therapeutic algorithm has not been externally validated. No significant correlation between AHI and collapse severity limits conclusions about OSA as a driver of disease.
Normal spirometry does not rule out clinically significant dynamic airway collapse—bronchoscopy is needed for diagnosis. A severity-based threshold (≥70%) rather than the traditional ≥50% cut-off better guides treatment decisions, and CPAP should be considered in eligible patients, with most reporting symptom improvement.
