Choke point physiology in airway stenting: A case presentation and discussion

Background: The point in the airway that allows the smallest maximal flow is known as the "choke point". The tube law describes the velocity of the expired air, which cannot exceed the wave-speed. Flow limitation during forced expiration is affected by the relationship between the transmural pressure (Ptm) and cross-sectional area (A) of the airway. Wave speed is dependent on the stiffness of the airway wall, as well as on the cross-section of the airway itself (dA/dPtm). Methods: Airway stenting at the wave-speed, flow-limiting segment (choke point) is assessed by using a catheter, via the working channel of a stereoscopic bronchoscope, to measure the difference between lateral pressure and pleural pressure. Results: Based on the wave-speed concept of maximal expiratory flow limitation, stenting at the choke point increased the cross-sectional area and supported the weakened airway wall, thus improving expiratory flow limitation and relieving dyspnea. Conclusion: To ensure correct stent positioning and thus optimal functional benefit, it is important to locate the exact position of tracheobronchial stenosis. (C) 2016 The Japanese Respiratory Society. Published by Elsevier B.V. All rights reserved.