What is TBM? Temple Health outlines the symptoms, causes and treatement of the lung condition

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Monday, April 1, 2024
Exploring TBM, an underdiagnosed lung condition
Temple Health is hoping to shed light on how to diagnose and treat tracheobronchomalacia (TBM), a rare lung disorder.

LANCASTER, Pennsylvania (WPVI) -- Getting an accurate diagnosis in lung ailments can be challenging because many have similar symptoms.

And getting the right help for a rare disorder can also be difficult, as one family found.

Bernadette LaGamba dismissed her daughter's worries about her constant coughing.

"I'm stubborn, and was always out in the streets doing my ministry with the homeless," LaGamba recalls.

She couldn't ignore it anymore after it sent her to the ER.

"As soon as I got there, within a few minutes, I couldn't breathe. And that's all I remember," she says.

Doctors at the hospital in Lancaster thought it was pneumonia, but had her airlifted to Hershey Medical Center because her condition was so poor.

Turns out LaGamba had pneumonia, the flu, and acute respiratory distress, brought on by tracheobronchomalacia, or TBM.

Her trachea, or windpipe, had collapsed, choking off airflow.

After six years and many intubations, LaGamba's daughter found Dr. Charles Bakhos, a Temple Health thoracic surgeon with extensive experience in TBM.

"Tracheobronchomalacia is overall under-recognized. It is more common than we think," says Dr. Bakhos.

He points to past studies showing 10-15% of people with chronic COPD also have tracheobronchomalacia.

He says weakness in the front or rear walls of the windpipe and its branches allows it to collapse.

Patients typically have shortness of breath, chronic coughing, some time even gasping for air.

They may also have COPD or asthma.

"Patients can be even sometimes erroneously labeled as having just asthma or COPD," he says.

The weakened cartilage in the trachea can have several causes: congenital conditions, recurrent infections, COPD, smoking - even chronic reflux, if the stomach acid gets into the windpipe.

The first avenue of treatment is to use medications and lifestyle changes to manage the conditions leading to the weakened cartilage.

Surgery to strengthen the trachea is the last resort, because it is a delicate and lengthy process.

"We do so by placing a mesh and sewing the mesh onto the back wall of the windpipe to strengthen it," says Dr. Bakhos.

Dr. Bakhos says with the robotic surgery, patients have less pain and are walking the next day.

But LaGamba's dire condition called for that surgery

The 13-hour procedure last September turned her life around, and she no longer fears of not being able to breathe.

"That first breath was a whole new life for me. And it's getting better and better each day," she says.

"People said I looked like I was in my 30s that I just glowed and was alive and happy," LaGamba says. "He's given me my life back. He's given me my airway back. I am doing 100% better," she says with a big smile.