Can RP Airway Stents and Tracheostomies Cause Complications?

Airway stents and tracheostomies may be needed to relieve severe obstruction or support breathing in patients with relapsing polychondritis (RP) ^[1]. RP can cause fixed narrowing of the airway (stenosis) or dynamic weakness and collapse of the airway walls (tracheobronchomalacia) ^{[2] [3]}.

While these devices improve breathing, they treat a specific mechanical problem; they do not stop the underlying autoimmune disease ^[2]. Patients and their care teams must be vigilant in managing the devices, monitoring for new areas of airway damage, and continuing medical treatments (like immunosuppressants) directed by their rheumatologist or pulmonologist to control the RP ^[4].

Understanding Your Device

The risks and care steps differ depending on the type of device you have:

• Airway Stents: A stent is a tube (usually silicone or metal) placed inside the airway to prop open a specific collapsed or narrowed segment.
• Tracheostomy: A tracheostomy is a surgically created opening in the neck with a tube inserted to provide an alternate breathing route, bypassing the upper airway.

Because complications and care needs differ, you should follow an individualized plan created by your airway team.

Complications with Airway Stents

Living with a stent means managing how your airway reacts to a foreign object. While proactive care can help, recognized risks include:

• Mucus Plugging: Stents disrupt the body’s natural ability to sweep mucus out of the lungs. The buildup of thick mucus (mucostasis) is very common ^[5]. Over time, many patients experience chronic cough and mucus production ^[6]. If mucus becomes too thick, it can form a plug that blocks the airway ^[7].
• Granulation Tissue and Restenosis: The airway often reacts to a stent by producing excessive scar tissue (granulation tissue) ^[5]. This tissue can grow over the edges of a stent, causing the airway to narrow again (restenosis) ^[8]. When this happens, patients may require repeated procedures, such as laser therapy, balloon dilation, or additional stents ^[9].
  (Note: In small historical studies of RP patients with stents, mucostasis was seen in up to 69% and granulation tissue in up to 85% of patients ^[5]. These numbers reflect findings in specific groups, not your exact personal probability).
• Device Migration and Failure: Airway stents can shift out of their intended position (migration) ^[10]. Rarely, devices can fracture or cause tearing of the airway wall (perforation), which requires emergency repair ^[11].
• Persistent Disease: A stent only props open the specific section it covers. RP can continue to attack cartilage in other areas, leading to new narrowing or collapse elsewhere ^[2].

Complications with Tracheostomy

Tracheostomies carry their own set of specific risks and ongoing care needs:

• Infection and Pneumonia: The stoma (neck opening) and the tube bypass natural infection barriers, increasing the risk for tracheostomy-site infections, airway colonization, and pneumonia ^[12].
• Tracheostomy Dependence: Because RP can cause structural damage to airway cartilage, removing a tracheostomy tube (decannulation) can be difficult ^[13]. Success depends on the extent of the disease, airway stability, and secretion control. One small study found that 30% of tracheostomized RP patients were successfully decannulated, though outcomes vary widely based on individual health ^[13].
• Stoma and Cuff Complications: Issues can include skin breakdown around the stoma, accidental tube dislodgement (accidental decannulation), and injury to the airway wall from the tube’s inflatable cuff (if present) ^[14].

Device Care and Maintenance

Because these devices alter how your airway functions, maintenance is required to prevent blockages and infections. Do not attempt to force a suction catheter, change a tube, or alter your care routine unless you have received hands-on training from a respiratory therapist or clinician.

• Individualized Humidification: A tracheostomy bypasses the nose and mouth, which normally warm and moisturize air. Your team may recommend specific artificial humidification to keep lung secretions thin and prevent dangerous mucus plugs ^[7].
• Suctioning and Cleaning: Suctioning clears mucus you cannot cough up. However, unnecessary or overly deep suctioning can cause airway trauma, bleeding, low oxygen, or spasms ^[15]. If you have a tracheostomy, cleaning or replacing the inner tube (inner cannula) depends on your specific tube type and manufacturer ^[16]. Always follow your written, individualized care plan.

Follow-Up and Monitoring

Continuous, individualized monitoring is essential, even when you feel well. Testing depends on your symptoms, device type, and prior findings.

• Imaging and Breathing Tests: Your specialist may order lung function tests (spirometry) to measure airflow, or specialized CT scans ^[17]. A CT scan that takes images while you forcefully breathe out (dynamic expiratory imaging) is a tool sometimes used to check for airway collapse ^[17].
• Bronchoscopy: Using a camera to look directly into the lungs (bronchoscopy) is often necessary to check for mucus plugs, granulation tissue, or a shifted device ^[17]. Because the procedure can cause bronchospasm, laryngospasm, airway swelling, or transient worsening of airflow, it should be performed by an experienced airway or anesthesia team who carefully weigh the risks and have an emergency plan ^[18].

Warning Signs and Emergency Plan

Work with your doctor to create a one-page written action plan that includes your baseline oxygen levels and emergency contacts.

Call emergency services (911) immediately if you experience:

• Rapidly worsening shortness of breath, severe wheezing, or a high-pitched whistling sound when breathing (stridor) ^[1].
• An inability to ventilate or pass a suction catheter down your tracheostomy tube (which may mean a severe mucus plug or displaced tube) ^{[19] [14]}.
• Heavy or ongoing bleeding from the airway or stoma ^[20].
• A sudden drop in your oxygen saturation, bluish lips or skin (cyanosis), or a feeling of asphyxia ^{[1] [21]}.

Contact your airway team urgently (same-day) if you experience:

• A small, new amount of blood-tinged sputum.
• Signs of infection, such as a new fever, chills, chest pain, redness or drainage around a stoma, or mucus that becomes foul-smelling, purulent (yellow/green), or unusually thick ^[12].
• A gradual but noticeable increase in coughing, shortness of breath, or the need to suction more frequently.