Management of patients with confirmed large airway collapse

<bold>Background:</bold> Large airways collapse (LAC) is defined as ≥50% reduction in large airway diameter visualised either on dynamic CT or during bronchoscopy. Case series have suggested a benefit of continuous positive airway pressure (CPAP) in patients with LAC. We aim to describe the diagnosis, management and exacerbation burden in our LAC population. <bold>Methods:</bold> Patients with confirmed LAC were included. Demographic and clinical characteristics, including mode of diagnosis, treatment and number of exacerbations with antibiotics with or without steroids in the last 12 months (Jan 2023 to Jan 2024) were collected. Continuous data was summarised with medians and interquartile range (IQR). <bold>Results:</bold> 71 patients [female 83%, median age 59 years (IQR 50,68)] with LAC [evidenced by CT in 83% (n=59), bronchoscopy in 10% (n=7), both in 7% (n=5)] were identified. 48% were on specific treatment for LAC (13 hypertonic saline, 16 CPAP, 5 hypertonic saline and CPAP). Overall median annualised exacerbation risk (AER) was 2 (IQR 0,4). AER for those on no treatment was 2 (IQR 0,4). AER for those on hypertonic saline alone was 4 (IQR 1,5). AER for those on CPAP and hypertonic saline was 3 (IQR 0,4). AER for those on CPAP alone was 0.5 (IQR 0,3). AER for those on CPAP with or without hypertonic saline was 1 (IQR 0,4). <bold>Conclusion:</bold> Patients treated with hypertonic saline alone did not have a reduction in AER. Those treated with CPAP did. CPAP treatment for LAC warrants further investigation.