• Pengcheng Zhou, Wei Yu, Wensheng Zhang, Jianli Ma, Qianming Xia, and Chengshi He.
• Department of Respiratory Medicine, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan province, P. R. China; Clinical Medical School, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan province, P. R. China; Xiaojin county people's hospital. Electronic address: zhoupengcheng@cdutcm.edu.cn.
• Chest. 2024 Nov 21.

Topic ImportanceChronic obstructive pulmonary disease (COPD)-associated expiratory central airway collapse (ECAC) is a frequently overlooked benign airway obstructive disease, with complex causes and unclear pathological and physiological mechanisms. Although interventions such as noninvasive positive pressure ventilation, airway stenting, and tracheobronchoplasty have shown definite efficacy in the treatment of COPD-associated ECAC, the diagnosis and treatment of this disease remain challenging. This article provides a systematic evaluation and outlook of the epidemiology, etiology, pathophysiology, clinical manifestations, diagnosis, treatment of COPD-associated ECAC.Review FindingsCOPD-associated ECAC is a benign airway narrowing disease with atypical clinical symptoms and unknown incidence and pathogenesis. Bronchoscopy is considered the gold standard technique for diagnosis of COPD-associated ECAC, with dynamic biphasic CT as an alternative noninvasive method. Noninvasive ventilation treatment can be continued long-term. Temporary airway stents can alleviate acute and severe TBM. long-term stent implantation can be considered after a risk-benefit assessment. Although TBP has a definite therapeutic effect in patients with severe TBM, perioperative complications remain a serious issue, and its long-term efficacy observation is required. TCM, other PEP therapies, and lung transplantation have shown potential with limited evidence.SummaryAlthough COPD -associated ECAC is attracting considerable attention, its pathophysiological mechanisms, diagnosis, and management are full of challenges. In the future, RCTs on different therapies using patient-centered outcomes, cost-effective analysis on different interventions, and consensus guidelines on COPD-associated ECAC are urgently needed.Copyright © 2024. Published by Elsevier Inc.

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