J Respir Indo Vol. 42 No. 4 October 2022 341 Therapeutic Bronchoscopy in Benign Central Airway Obstruction Mia Elhidsi, Budi Prasetio Nugroho, Wahju Aniwidyaningsih Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Indonesia Abstract Benign central airway obstruction (BCAO) may occur in patients with post-intubation, tracheostomy, tuberculosis and non-tuberculosis infections, tracheal wall abnormalities, endobronchial benign tumors, vascular abnormalities, benign thyroid tumors and external mechanical compression. The management of BCAO is based on the underlying disease and requires multidisciplinary joint decisions from interventional pulmonology, thoracic surgery, radiology and anesthesia. Therapeutic bronchoscopy for the management of BCAO emergencies includes balloon dilation, stents and lasers. Keywords: Therapeutic bronchoscopy, BCA (BCAO), balloon dilation, stents, laser Corresponding Author: Mia Elhidsi | Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Indonesia Submitted: September 25 th , 2020 Accepted: June 21 st , 2022 Published: October 30 th , 2022 J Respirol Indones. 2022 Vol. 42 No. 4: 341–6 https://doi.org/10.36497/jri.v40i3.361 Creative Commons Attribution- NonCommercial 4.0 International License INTRODUCTION Benign central airway obstruction (BCAO) may occur in patients after intubation, tracheostomy, tuberculosis infection, surgery, sarcoidosis, polychondritis, and benign endobronchial tumors tracheobronchomalacia (TBM), external mechanical compression, transplantation and idiopathic. 1–3 BCAO requires multidisciplinary collaboration, including radiologists, thoracic surgery, interventional pulmonologists, and anesthesiologists. 2 Bronchoscopy and its devices can serve as therapeutic tools, external radiation, and chemotherapy. 1 Examination of major airway disorders, including oropharynx, larynx, vocal cords, and tracheobronchitis system, and their management can use a rigid bronchoscope with a flexible bronchoscope. 2,4 This narrative review explores the variants of BCAO and therapeutic bronchoscopy in management of BCAO. DEFINITION AND CLASSIFICATION OF CENTRAL AIR TRACT OBSTRUCTION Central airway obstruction is occlusion of >50% of the trachea, main bronchi, intermedius bronchi, and lobar bronchi. 3 Histological anatomy of the trachea consists of 4 layers, namely the deep mucosal layer, submucosal layer, muscle and cartilage, and adventitia layer, including lymph nodes and connective tissue (Figure 1). Figure 1. Trachea anatomy, horseshoe-shaped cartilaginous ring on the anterior-lateral tracheal wall. 3 Literature Review