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gold medal Tom Dolan Clears a Narrowed Windpipe Obstacle

The medical demons that US swimmer Tom Dolan has faced in his already successful drive for Olympic gold are well known: exercised-induced asthma (EIA) and a windpipe that is reported to be 20% narrower than normal. Most physician who treat athletes are well-acquainted with EIA, but may be unfamiliar with how to manage patients who have a narrow windpipe (tracheal stenosis).

Tracheal stenosis is rare, says Henry Gong, Jr, MD, chairman of medicine at the Environmental Health Service at Rancho Los Amigos Medical Center in Downey, California. The condition can be congenital or can arise from many causes such as an intubation injury or compression from an enlarged thyroid or tumor. The condition does not go hand-in-hand with EIA. The 20% degree of narrowing reported in Dolan's case is considered mild, says Gong, who is also a professor of medicine in the Division of Pulmonary and Critical Care Medicine in the School of Medicine at the University of Southern California in Los Angeles. "At rest a person might not notice it, but it certainly is a handicap if the amount of exercise is heavy."

The symptoms of tracheal stenosis are similar to those of EIA, says Gong: shortness of breath with activity and, if the narrowing if 50% or more, audible stridor. He says the diagnosis focuses on the patient history and a physical exam that includes screening for wheezing or transmitted stridor from the throat. Breathing tests are done to evaluate diminished air flow on inspiration and expiration. Close-up x-rays of the trachea may be useful, but "with computed tomography of the chest and upper chest you get a nice pretty picture of what's going on there," Gong says. Bronchoscopy can be performed to directly observe the area.

Treatment is generally reserved for severe tracheal stenosis, and involves balloon dilation of the trachea, surgical correction, or laser debridement of scar or granular tissue, Gong says.

Patients who have a fixed obstruction or severe narrowing need to limit their exercise activities; however, there are usually no exercise restrictions for patients who have mild-to-moderate tracheal stenosis. "Patients usually pace themselves," he says, "And unless you're a super athlete, mild tracheal stenosis won't be a big problem."