Can Relapsing Polychondritis Cause Silent Airway Collapse?

Yes, relapsing polychondritis (RP) can damage your airway without causing obvious breathing symptoms right away. Because the disease targets cartilage, it can inflame and weaken the structures of the larynx (voice box), trachea (windpipe), and bronchi (the main tubes leading to your lungs) ^[1].

This damage can progress silently. In a study of 173 RP patients, 66% of those who felt no breathing symptoms still showed some signs of airway abnormalities on a CT scan ^[1]. Another study of 25 patients using PET/CT scans detected active inflammation in the large airways of 28% of asymptomatic individuals ^[2]. It is important to note that an imaging abnormality does not automatically mean you will experience sudden or dangerous airway collapse, but it does show that silent involvement is possible ^[1].

Because of this, it is important to discuss with your doctor whether a baseline airway assessment is appropriate for you, based on your specific history and symptoms ^[3].

How Relapsing Polychondritis Affects the Airway

The airway relies on rings of cartilage to stay open. When RP causes active inflammation (chondritis), it can destroy this supportive cartilage ^[4]. Without proper support, the airway walls become weak and floppy, a condition known as tracheobronchomalacia. This causes the airway to narrow or collapse, particularly when you breathe out (expiratory collapse) ^[4].

Alternatively, repeated cycles of inflammation and healing can cause scar tissue to form (fibrosis), leading to a fixed, rigid narrowing of the airway known as stenosis ^[2].

Subtle Signs to Watch For

Early symptoms of airway involvement are often non-specific and are frequently misdiagnosed as asthma ^[5][6]. These subtle signs include:

• Exertional breathlessness: Feeling short of breath during physical activity or exercise that you could previously handle ^[7].
• A persistent dry cough or throat clearing ^[7].
• Wheezing or asthma-like symptoms ^[5].
• Changes in your voice, such as new hoarseness ^[7].
• Sore throat or noisy breathing ^[7].

If you experience these symptoms, contact your rheumatologist or pulmonologist promptly for an evaluation. If you have been prescribed asthma inhalers, do not stop taking them without medical advice. However, if your symptoms do not improve with your inhalers, it is a reason for reassessment ^[5].

Urgent Warning Signs

It is critical to distinguish between subtle symptoms and severe airway obstruction. Severe airway narrowing or collapse is a life-threatening emergency that requires immediate medical attention ^[8][9].

Call local emergency services immediately (do not drive yourself) if you experience:

• Stridor: A high-pitched, noisy, or squeaky sound when breathing in ^[10].
• Severe breathlessness or a feeling of suffocating ^[9].
• Inability to speak in full sentences.
• Extreme effort required to breathe, such as your chest muscles pulling in sharply with each breath ^[11].
• Cyanosis: A bluish tint to your lips, fingertips, or skin ^[8]. Do not wait for this to appear, as it is a late sign of low oxygen.

Important: Always tell emergency responders and any anesthesia team that you have relapsing polychondritis and are at high risk for airway collapse ^[11][9].

Screening and Detection

The decision to test for airway involvement is individualized. If your doctor recommends screening or if you develop symptoms, the two main evaluation tools are imaging and breathing tests:

• CT Scans: A standard chest X-ray may not show airway collapse. Doctors often use a CT scan of the chest and the part of the windpipe in the neck (cervical trachea). To see if the airway collapses during exhalation, they may take images when you breathe in and when you forcefully breathe out (dynamic expiratory CT) ^[3].
• Pulmonary Function Testing (PFT): These breathing tests measure lung capacity and airflow. A specific part of this test, called a flow-volume loop, can help detect blockages in the central airways ^[10]. However, because PFTs are effort-dependent, they can sometimes appear normal even if you have intermittent airway collapse. A normal test does not completely rule out airway disease ^[10][12].

Bronchoscopy (inserting a small camera into the airway) can also be clinically valuable to directly view the damage ^[3]. However, for people with RP, this procedure carries risks such as airway collapse or difficult ventilation during sedation ^[13][14]. If a bronchoscopy is indicated, it should be carefully planned by an experienced team with appropriate airway and anesthesia support ^[14].

What happens if a test is abnormal?
If tests detect airway involvement, the next step is usually a specialist review. Your care team may recommend treating the active inflammation with medication, setting up a personalized monitoring schedule, or, in severe cases, discussing mechanical options to support the airway.