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All of the following are effective treatments for respiratory distress associated with tracheomalacia EXCEPT:

A. Ipratropium bromide


C. Tracheal intubation with positive pressure ventilation

D. Albuterol


The answer is D. Albuterol will usually make tracheomalacia worse. Infants with chondromalacia of the trachea or bronchus will usually present with noisy breathing and persistent "respiratory congestion" during infancy. If the respiratory distress is severe, intubation may be required. Intubation and positive pressure stent the collapsible central airways and improve air flow. Non-invasive ventilation (CPAP/BiPAP) will work in a similar manner. Because β-agonists act by relaxing smooth muscle they may exacerbate the symptoms. Ipratropium bromide appears to be an alternative efficacious therapy for symptomatic children with tracheomalacia and bronchomalacia. It is unclear why this works in some patients.



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