Central Airway Obstruction A Narrative Review of Etiology Clinical Manifestations and Diagnosis

Central airway obstruction (CAO) is a potentially serious condition caused by malignant or nonmalignant processes narrowing the trachea or main bronchi. Its nonspecific manifestations may resemble common pulmonary diseases, delaying diagnosis. This narrative review summarizes the etiology, clinical manifestations, and diagnostic evaluation of CAO. Literature searches were conducted in PubMed/MEDLINE and Google Scholar using terms related to CAO, airway stenosis, tracheobronchomalacia, pulmonary function tests, computed tomography, and bronchoscopy. Publications from 2017 to 2025 were prioritized, alongside relevant foundational studies and clinical guidelines. Literature was selected based on relevance to CAO etiology, clinical presentation, and diagnostic methods. Malignant causes, particularly lung cancer, and nonmalignant conditions, including post-intubation stenosis, inflammatory disorders, benign airway lesions, and tracheobronchomalacia, contribute to CAO. Common manifestations include dyspnea, cough, wheezing, stridor, and reduced exercise tolerance. Pulmonary function tests may indicate airflow limitation but cannot reliably exclude CAO. Computed tomography characterizes the location and extent of obstruction, while bronchoscopy enables direct visualization and tissue sampling. These modalities provide complementary information. Accurate diagnosis requires integrating clinical findings, pulmonary function tests, computed tomography, and bronchoscopy. Further prospective research is needed to standardize diagnostic criteria and improve severity assessment.