Effect of PEEP mask on cough in patients with tracheobronchomalacia

Tracheobronchomalacia (TBM) is a condition characterized by excessive collapse of the trachea and mainstem bronchi, often resulting in chronic cough and dyspnea. Though associated with obesity and increasingly recognized as a contributor to unexplained respiratory symptoms, TBM remains underdiagnosed and challenging to manage. Standard treatments are limited in effectiveness and often invasive, including airway stenting or surgical tracheobronchoplasty. Noninvasive strategies such as continuous positive airway pressure (CPAP) are effective, but expensive and impractical for on-demand use. In an open-label, single-arm feasibility study, we enrolled ten participants with TBM diagnosed via computed tomography (CT) or bronchoscopy and chronic cough unresponsive to standard therapies. However, one participant was lost to follow-up. Participants used the PEEP mask during acute coughing episodes over a 4-week study period. Quality of life (QoL) was assessed using multiple validated instruments, with the Leicester Cough Questionnaire (LCQ) as the primary outcome. Airway physiology was assessed with spirometry, impulse oscillometry, and dynamic CT imaging. Use of the PEEP mask was associated with a statistically and clinically significant improvement in LCQ scores (+2.53, 90% CI: 0.48-4.57, p=0.025), exceeding the minimum clinically important difference (MCID). Secondary QoL metrics showed similar improvements. CT imaging demonstrated substantial reductions in airway collapsibility with mask use, particularly in the mainstem bronchi. These structural improvements showed moderate correlation with QoL gains. This feasibility study suggests that on-demand use of a PEEP mask is acceptable to patients with TBM and is associated with short-term improvements in cough-related quality of life and airway collapsibility during application. These findings require confirmation in controlled trials.