Excessive dynamic airway collapse: A condition behind the veil

Excessive dynamic airway collapse (EDAC) is characterized by weakness in the posterior membranous wall of the airway, which results in more than 50% narrowing of the central airway lumen during expiration. EDAC differs from tracheobronchomalacia, which involves the weakening of the cartilage rather than the membranous wall. EDAC poses a diagnostic challenge due to overlapping symptoms with chronic obstructive pulmonary disease and asthma, including dyspnea, cough, and wheezing. The diagnosis of EDAC relies on dynamic airway imaging techniques, including bronchoscopy, dynamic computed tomography, dynamic magnetic resonance imaging, and endobronchial ultrasound, to assess airway collapse during expiration. Pulmonary function testing helps in ruling out obstructive lung disease. Treatment includes medical management of underlying comorbidities, pulmonary rehabilitation, and, in severe cases, bronchoscopy-guided stenting of the airway or tracheobronchoplasty. This mini-review discusses pathophysiology, diagnostic challenges, and evolving treatment strategies for EDAC, highlighting the need for increased clinical awareness and targeted therapies.