How Are ICS and Tracheobronchomalacia Associated?

Longer-term, higher-dose inhaled corticosteroid (ICS) use is significantly associated with tracheobronchomalacia (TBM), according to results of a new analysis.  

To reach this conclusion, the researchers studied data on 153 patients with chronic obstructive pulmonary disease (COPD) and 310 patients with asthma. The patients had all received ICS treatment for at least 3 months. 

Of the 463 patients, 119 had been diagnosed with TBM on the basis of computed tomography imaging, flexible bronchoscopy, or both (≥ 50% reduction in airway lumen).

Compared with the controls, patients with TBM were more likely older, more likely to have gastroesophageal reflux disease, and more likely to be receiving a long-acting β-agonist or a long-acting muscarinic antagonist. In the final multivariable model, TBM was shown to be significantly associated with the type of and number of months on ICS therapy. 

Compared with patients not receiving inhaled steroids, patients receiving high-dose steroids were 3.5 times more likely to have TBM. The likelihood of having TBM was also 3.5 higher among patients receiving low-dose ICS than among patients receiving no steroids. Finally, the odds of TBM were 2.9-fold greater among patients receiving high-dose steroids compared with patients receiving low-dose steroids. 

“The benefit of ICS therapy in COPD and asthma is well established. However, [we] wish to increase awareness among clinicians of an association between ICS use and [TBM],” the researchers wrote. “Currently, approximately 70% of patients with COPD are prescribed ICS, in contrast to approximately 30% as recommended by the Global Initiative for Chronic Obstructive Lung Disease.”

According to the study authors, more research is needed to determine the causality of the association. Until then, the researchers suggest that ICS use be guided by national guidelines for asthma and COPD management.

—Colleen Murphy


Shah V, Husta B, Mehta A, et al. Association between inhaled corticosteroids and tracheobronchomalacia. CHEST. 2020;157(6):1426-1434. doi:10.1016/j.chest.2019.12.023