ConditionLungs & breathing
Bronchial Stenosis
Bronchial stenosis is a narrowing of one of the bronchi, the large airways that carry air from the windpipe into the lungs. It can be caused by scarring after infection, intubation or lung transplant, by a tumor growing inside or pressing on the airway, or by inflammatory diseases. Symptoms include breathlessness, a wheeze that is often on one side, cough and repeated chest infections. Bronchoscopy confirms it, and treatments include dilating the airway, stents, laser and surgery.
Also called: Bronchostenosis, bronchial narrowing, airway stenosis, bronchial stricture, central airway obstruction
At a glance
- What it is
- Narrowing of a main or lobar bronchus.
- Causes
- Tumors, tuberculosis, scarring after lung transplant or intubation, sarcoidosis, inhaled foreign bodies, granulomatosis with polyangiitis.
- Symptoms
- Breathlessness, one-sided wheeze, cough, recurrent pneumonia in the same area.
- Diagnosis
- CT scan and bronchoscopy.
- Treatment
- Balloon dilation, stents, laser or cryotherapy, and surgery in selected cases.
When to get help
Call 911 or go to the ER
- Severe breathlessness at rest, noisy high-pitched breathing (stridor), or blue lips
- Coughing up more than a few teaspoons of blood
See a doctor within a day or two
- Breathlessness or wheeze that is steadily worsening over days to weeks
- Fever and cough with known airway narrowing, which may mean pneumonia behind the blockage
Book a routine appointment
- A wheeze heard on one side only, or "asthma" that does not respond to inhalers
- Repeated pneumonias in the same part of the lung
- A cough lasting more than 3 weeks, particularly in a smoker
What happens in bronchial stenosis
The trachea divides into the right and left main bronchi, which branch into lobar and smaller airways. A narrowed bronchus limits airflow to the lung beyond it. When the narrowing is severe, mucus is trapped, causing infection, and part of the lung can collapse (atelectasis). Narrowing of the windpipe itself is called tracheal stenosis. Together they are often described as central airway obstruction.
Causes
| Type | Examples |
|---|---|
| Malignant | Lung cancer growing inside the airway, tumors or enlarged lymph nodes pressing from outside, carcinoid tumors, metastases |
| Infection | Endobronchial tuberculosis, fungal infections, histoplasmosis causing fibrosing mediastinitis |
| After procedures | Narrowing at the join after lung transplant (in roughly 1 in 10 recipients), after lung surgery, radiation therapy, prolonged intubation |
| Inflammatory | Sarcoidosis, granulomatosis with polyangiitis, relapsing polychondritis, amyloidosis, inflammatory bowel disease |
| Other | Inhaled foreign body with scarring, burns from smoke inhalation, congenital narrowing |
Symptoms
- shortness of breath, first on exertion, later at rest
- wheezing, often heard more on one side and not improving with inhalers
- persistent cough, sometimes with mucus
- recurrent chest infections or pneumonia affecting the same lobe
- coughing up blood, particularly with tumors
- noisy breathing when narrowing is severe
Because symptoms appear only when the airway is significantly narrowed, and wheeze can be mistaken for asthma, diagnosis is often delayed.
Diagnosis
- CT scan of the chest: shows the location, length and severity of the narrowing and what is causing it. 3D reconstructions and "virtual bronchoscopy" help plan treatment.
- Bronchoscopy: a flexible or rigid scope passed into the airways shows the narrowing directly. Biopsies can identify cancer, infection or inflammation.
- Lung function tests: flow-volume loops may show a characteristic flattened pattern.
- Blood tests and cultures: for TB, vasculitis markers and other causes.
Treatment
Treatment depends on cause, location, length and whether the narrowing is from inside the airway, outside pressure or scarring. It is usually done by interventional pulmonologists or thoracic surgeons.
- Treating the cause: TB medicines, steroids or immunosuppressants for inflammatory disease, chemotherapy or radiation for cancer.
- Balloon bronchoplasty: a balloon passed through the bronchoscope gently stretches the narrowed segment. It often needs repeating.
- Tumor removal: laser, electrocautery, argon plasma coagulation, cryotherapy or mechanical debulking open airways blocked by tumor.
- Airway stents: silicone or metal tubes hold the airway open. They can migrate, block with mucus or cause granulation tissue, so follow-up bronchoscopy is needed.
- Brachytherapy: radiation placed inside the airway for some cancers.
- Surgery: sleeve resection, removing the narrowed segment and joining the healthy ends, for localized benign stenosis or some tumors.
Complications
- obstructive pneumonia and lung abscess
- collapse of a lobe or whole lung
- respiratory failure if narrowing is severe
- stent-related problems
Outlook
Benign narrowing after transplant or infection often responds to dilation and stenting, though repeated procedures are common. Surgery can provide a lasting cure in suitable patients. With cancer, airway treatments relieve breathlessness and improve quality of life, while the overall outlook depends on the cancer.
Frequently asked questions
What is bronchial stenosis?
It is a narrowing of one of the large airways (bronchi) that carry air into the lungs. It can be caused by tumors, infections such as tuberculosis, scarring after lung transplant or intubation, or inflammatory diseases, and it causes breathlessness, wheeze and repeated infections.
What are the symptoms of bronchial stenosis?
Common symptoms are breathlessness, wheezing that may be louder on one side, a persistent cough, repeated pneumonia in the same area of the lung, and sometimes coughing up blood. Severe narrowing can cause noisy breathing at rest.
Can bronchial stenosis be mistaken for asthma?
Yes. Both cause wheeze and breathlessness. Clues pointing to stenosis include a wheeze heard on one side, no improvement with asthma inhalers, and repeated infections in one lung area. A CT scan or bronchoscopy can tell them apart.
How is bronchial stenosis treated?
Treatment includes addressing the cause and opening the airway through a bronchoscope with balloon dilation, laser or cryotherapy, and stents. Some people need surgery to remove the narrowed segment. Cancer-related narrowing may also be treated with chemotherapy or radiation.
Is bronchial stenosis life-threatening?
Mild narrowing may cause few symptoms. Severe narrowing, especially of a main bronchus or with infection behind it, can cause serious breathing problems. Sudden severe breathlessness or noisy breathing needs emergency care.
Sources
This guide was written from current patient and clinical guidance, including:
- American Journal of Respiratory and Critical Care Medicine: Ernst et al., Central Airway Obstruction (2004)
- MedlinePlus: Bronchoscopy
- NHS: Bronchoscopy
- International Society for Heart and Lung Transplantation: Consensus on airway complications after lung transplantation (2018)