The trachea, commonly known as the windpipe, is the large tube that delivers air from the upper respiratory tract (the nasal passages, throat, and larynx) to the bronchi (the two large airways that branch off into each lung). In the process, it warms and moisturizes the air and catches debris and microbes before they enter the lungs.
The trachea can become infected, inflamed, or damaged. In rare situations, this can lead to tracheal stenosis, in which the trachea narrows and restricts breathing. Tracheal cancer is an extremely rare form of cancer.
Anatomy
The trachea is part of the lower respiratory tract, along with the lungs, bronchi, bronchioles, and alveoli.
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Structure
In an adult, the trachea is roughly 4 to 5 inches long and 1 inch in diameter. It starts just under the larynx (voice box) and runs down the center of the chest behind the sternum (breast bone) and in front of the esophagus.
The trachea is connected to the larynx via a ring of cartilage known as the cricoid cartilage. As the trachea descends the chest, it is surrounded by 16 to 22 U-shaped rings of cartilage that hold the windpipe open like scaffolding, allowing the flow of air.
The posterior wall of the trachea is not covered by cartilage and is composed of connective tissue and smooth muscle. The muscle will flex and expand when needed, to change the diameter of the trachea.
The trachea ends at the carina, a ridge of cartilage that separates and forms the junction into the bronchi.
Membrane Composition
Lining the trachea are mucosal membranes comprised of epithelial cells, mucus-secreting goblet cells, and hair-like projections called cilia that move foreign particles up and out of the airway.
Within these membranes are submucosal glands, which act as companions to goblet cells by secreting water molecules and mucin (the gel-like component of mucus) onto the tracheal lining.
The trachea is traversed by a network of blood vessels and lymphatic vessels. Blood vessels provide the tissues with oxygen and nutrients and regulate the exchange of heat within the airway. The lymphatic vessels help remove infectious microbes on the surface of the wall of the trachea so they can be isolated and neutralized by the immune system.
Function
The trachea serves as the main passageway through which air passes from the upper respiratory tract to the lungs. As air flows into the trachea during inhalation, it is warmed and moisturized before entering the lungs.
Most particles that enter the airway are trapped in the thin layer of mucus on the trachea walls. These are then moved upwards toward the mouth by cilia, where they can be coughed up or swallowed.
The U-shaped sections of cartilage that line the trachea are flexible and can close and open slightly as the trachealis muscle at the back of the rings contracts and relaxes. Subtle contractions of the trachea occur involuntarily as part of normal respiration.
If any object, liquid, or irritant (like smoke) enters the trachea, the muscles can contract violently, causing coughing to expel the substance.
Contractions can be voluntary as well, as with controlled coughing, which is used to clear the airways in people with chronic obstructive pulmonary disease (COPD) or cystic fibrosis.
How to Tell What a Cough Means
Associated Conditions
The trachea, like all parts of the respiratory system, is vulnerable to inhaled substances that can damage tissue and interfere with breathing. Certain infections and diseases can also affect the trachea.
Choking
Coughing is the body's way to remove foreign substances from the throat, trachea, or lungs. If an object cannot be dislodged from the trachea, choking can occur. Severe choking can prevent oxygen from getting into the lungs, which may lead to syncope (fainting), asphyxiation (suffocation), or death.
Emergency interventions, such as the Heimlich maneuver or a tracheostomy, may be needed to clear the trachea of an obstruction. Non-life-threatening obstructions can be treated with bronchoscopy, in which a flexible scope is inserted into the throat to locate and remove foreign objects.
Treatment and Prevention of Choking
Tracheitis
Tracheitis is inflammation of the trachea. It occurs almost exclusively in children. It is most often associated with a bacterial infection that has spread from the upper respiratory tract. The bacteria Staphylococcus aureus is a common culprit.
Tracheitis is especially worrisome in babies and young children because any inflammation of their small windpipes can lead to blockage and, in some cases, asphyxiation.
Stridor (high-pitched wheezing caused by airway obstruction or restriction) is a common symptom of tracheitis. Croup, laryngotracheobronchitis, an inflammatory/infectious condition that can progress to airway obstruction, can occur as well.
Bacterial tracheitis is typically treated with antibiotics. Severe cases may require intravenous antibiotics as well as intubation and mechanical ventilation to aid with breathing.
What Is an Upper Respiratory Infection?
Tracheoesophageal Fistula
A tracheoesophageal fistula is an abnormal passageway between the trachea and the esophagus that allows swallowed food to enter the trachea and, from there, the lungs. This can lead to choking, gagging, breathing difficulty, and cyanosis (bluish skin due to the lack of oxygen). Aspiration pneumonia can also occur.
A transesophageal fistula is rare and may occur due to trauma, cancer, or a congenital defect that causes the incomplete formation of the esophagus (known as esophageal atresia).
Roughly one of every 4,000 children in the United States is born with a tracheoesophageal fistula. In most cases, it can be treated with surgery.
Tracheal Stenosis
Whenever the trachea is damaged, scarring can develop and cause tracheal stenosis (airway narrowing).
Tracheal stenosis can cause stridor and dyspnea (shortness of breath), especially with physical exertion.
Causes of tracheal stenosis include:
- Goiter
- Sarcoidosis
- Amyloidosis
- Diphtheria and other severe respiratory infections
- Wegener's granulomatosis
- Thyroid cancer
- Lung cancer
- Lymphoma of the chest
Between 1% and 2% of people who undergo intubation and mechanical ventilation will develop tracheal stenosis. People who require prolonged ventilation are at greatest risk.
Stenosis may be treated with stents and tracheal dilation. In severe cases, surgery may be required.
Tracheomalacia
Tracheomalacia is an uncommon condition in which the trachea collapses on itself during breathing and with coughing. It often is a result of prolonged intubation. It is also a complication of COPD, caused by the progressive deterioration of tracheal cartilage caused by chronic inflammation and coughing.
Tracheomalacia can also affect newborns as a result of congenital weakness of tracheal cartilage. Symptoms include stridor, rattling breath sounds, and cyanosis.
- Acquired tracheomalacia may require surgery to correct and support the weakened airway.
- Congenital tracheomalacia rarely requires surgery and usually resolves on its own by the time the child is 2.
Tracheal Cancer
Tracheal cancer is extremely rare, occurring at a rate of approximately one case per every 500,000 people. Most are squamous cell carcinomas caused by cigarette smoking. Cancers that originate in nearby structures, such as the lungs, esophagus, or thyroid gland, can sometimes metastasize (spread) to the trachea.
Benign tumors, including chondromas and papillomas, can also develop in the trachea. Though benign, these can block airways, affect breathing, and trigger stenosis.
The surgical removal of a tracheal tumor is the preferred method of treatment (with or without radiation therapy). Some people may be able to be treated with radiation alone. Chemotherapy with radiation often is used if a tumor cannot be removed.
Treatment and Rehabilitation
Injuries, infections, and diseases of the trachea can cause damage to the airway, sometimes irreparably. Tracheal stenosis is one such case in which the development of fibrosis (scarring) is most often permanent. Once the underlying cause of a tracheal injury is treated, efforts may be made to repair the trachea or support its function.
Chest Physical Therapy
Since most children with tracheomalacia outgrow the condition by the age of 3, treatment efforts will usually be supportive. This includes chest physical therapy (CPT) to maintain proper airway clearance.
Techniques involve chest percussion, vibration/oscillation, deep breathing, and controlled coughing. A humidifier and continuous positive airway pressure (CPAP) device may also be recommended.
CPT also may be recommended for adults with tracheomalacia or anyone who experiences chronic airway obstruction or restriction. Regular exercise, 20 to 30 minutes five times weekly, can also help.
Tracheal Dilation and Stent Placement
In certain cases of tracheal stenosis, a flexible, tube-like instrument called a bougienage may be inserted into the trachea during a bronchoscopy and expanded with a balloon to dilate the airway. A rigid silicone or metal sleeve, called a stent, is then inserted to hold the trachea open.
Tracheal dilation and stent placement are typically used when surgery isn't possible. Most procedures can be done on an outpatient basis and only require a short-acting anesthetic like propofol.
Ablation Therapy
Stenosis can often be treated by destroying retracted scar tissue that narrows the airway. The procedure, called ablation, can release the retracted tissue and improve breathing.
Ablative techniques include laser therapy (using a narrow beam of light), electrocautery (using electricity), cryotherapy (using cold), brachytherapy (using radiation), and argon plasma (using argon gas).
Ablation therapies usually can be performed on an outpatient basis with a mild, short-acting sedative and tend to be successful, although pain, cough, and infection are possible.
Fistula Repair
Tracheoesophageal fistulas almost always require surgical repair to close the hole between the trachea and the esophagus. Although tracheal stenting is sometimes used to plug the gap, the stent can slip and require repositioning or replacement.
Surgery is a more permanent solution. Once the hole is repaired with sutures, a full-thickness skin graft or muscle graft may be used to prevent the reopening of the fistula.
The rate of complications following fistula repair surgery is high—between 32% and 56%. Pneumonia, airway obstruction, wound infection, and reopening of the fistula are the most common complications.
Tracheal Resection
Tracheal resectionand reconstruction (TRR) is an open surgical procedure commonly used to remove tracheal tumors and treat severe post-intubation stenosis or fistulas.
This procedure involves removal of a section of the airway, the cut ends of which are then stitched together with sutures. Reconstruction involves placement of a small piece of cartilage (taken from another part of the body) to rebuild the trachea and keep it well supported.
TRR is considered major surgery and typically requires two to three weeks of recovery. Complications include post-operative stenosis or fistula as well as vocal cord dysfunction.
Tracheal Reconstruction
Techniques such as the Maddern procedure and the REACHER technique are sometimes used to treat stenosis in the upper part of the trachea near the larynx.
These procedures involve removal of diseased tissue combined with a full-thickness skin graft from the thigh.
- The Maddern procedure can be performed transorally (through the mouth).
- The REACHER procedure requires a cervicotomy, is faster than a resection, and has a far shorter recovery time.
Not all surgeons use these techniques. To this end, you may need to seek treatment outside of your immediate area with a specialist ENT-otolaryngologist if one of these approaches is recommended for your condition.
Tracheostomy
Tracheostomy and tracheotomy are surgical procedures in which a breathing tube is inserted into the trachea through an incision in the throat.
- Tracheostomy is a permanent opening in the trachea. It may be used for laryngectomy patients, laryngeal stenosis, and crushing laryngeal injuries. This may also be needed for people with a major spinal cord injury who cannot breathe adequately on their own or those with end-stage lung disease.
- Tracheotomy is a temporary opening into the trachea. A traumatic chest wall injury or epiglottitis may require an emergency tracheotomy. This may also be needed for head and neck cancer patients undergoing radical resections and reconstructions.
These procedures may be used when intubation through the nose or mouth is not possible or when long-term ventilator support is needed.
Frequently Asked Questions
What is the main function of the trachea?
The trachea is a passageway for air from the upper respiratory tract to the lungs. Air that enters the trachea is warmed and moisturized before moving on to the lungs. Mucus on the trachea walls can catch debris or particles. This debris is then transported upward by cilia, tiny hair-like structures that remove it from the airway.
What type of tissue lines the trachea?
Mucosal membranes are the tissues that line the trachea. These tissues are made of epithelial cells that produce mucus to capture debris before it can reach the lungs. Inside the mucosal membranes are submucosal glands, which secrete water and mucin, the components of mucus.
What is the carina?
The carina is a tube of cartilage that forms the end of the trachea. It splits off into the left bronchus and the right bronchus, which lead to each of the lungs.
What causes an incomplete expansion of the lung?
Atelectasis is a condition that causes an incomplete expansion of the lung. It can occur if an airway is blocked, the lungs have pressure applied to them, or if there is a low amount of surfactant in the lungs. Surfactant is a foamy substance that helps keep air sacs open.
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FAQs
What are the functions of the trachea? ›
Your trachea's main function is to carry air in and out of your lungs. Because it's a stiff, flexible tube, it provides a reliable pathway for oxygen to enter your body.
What is the function of trachea quizlet? ›The tracheal is an armored tube that allows air to pass from the pharynx to the lungs. The bronchi are tubes that take air from the trachea into the lungs.
What causes trachea problems? ›Causes of Tracheal Disorders
Infections. Tumors pressing against the trachea. Radiation. Certain autoimmune disorders such as Wegener's granulomatosis, sarcoidosis and amyloidosis.
Answer and Explanation: The correct answer is d. prevent food from entering the lungs.
How is the trachea structured for its function? ›The trachea is composed of about 20 rings of tough cartilage. The back part of each ring is made of muscle and connective tissue. Moist, smooth tissue called mucosa lines the inside of the trachea. The trachea widens and lengthens slightly with each breath in, returning to its resting size with each breath out.
What happens when trachea is blocked? ›In addition to a feeling of fatigue or a general feeling being unwell (malaise), the symptoms of tracheal stenosis typically are: Wheezing, coughing or shortness of breath, including difficulty breathing. A high-pitched squeal coming from your lungs when inhaling.
What happens if you damage your trachea? ›The damage can range from minor vocal cord weakness to fractures of the cartilage structures of the larynx or trachea. These fractures can cause air to escape into the neck and chest, leading to significant respiratory compromise and even death if not diagnosed and treated quickly.
Can you live without your trachea? ›Babies born with this anomaly, called tracheal agenesis, die silently, having never drawn a breath. Only five, and only due to extraordinary surgical intervention, have survived.
Does the trachea function in gas exchange? ›The main function of the trachea is to funnel the inhaled air to the lungs and the exhaled air back out of the body.
What is the function of the trachea and esophagus? ›Your trachea transports air in and out of your lungs, whereas your esophagus transports food and liquid from your throat to your stomach.
How does the trachea help gas exchange? ›
The trachea is the cartilaginous structure that extends from the pharynx to the primary bronchi. It serves to funnel air to the lungs. The alveoli are the sites of gas exchange; they are located at the terminal regions of the lung and are attached to the respiratory bronchioles.
What are trachea issues in adults? ›Tracheal stenosis is a narrowing of the trachea that can cause shortness of breath, cough, wheezing, and stridor (Figure 2). The most common cause is prolonged intubation or tracheostomy, when a tube is used to assist with breathing via a mechanical ventilator.
What type of doctor treats the trachea? ›A pulmonologist diagnoses and treats diseases of the respiratory system. You might hear these healthcare providers called lung doctors, lung specialists or chest doctors. In addition to your lungs, your respiratory system includes your nose, throat, trachea, airways, muscles and blood vessels.
Can you repair the trachea? ›Laryngotracheal (luh-ring-go-TRAY-key-ul) reconstruction surgery widens your windpipe (trachea) to make breathing easier. Laryngotracheal reconstruction involves inserting a small piece of cartilage — stiff connective tissue found in many areas of your body — into the narrowed section of the windpipe to make it wider.
What prevents the trachea? ›The trachea is composed of rings of cartilage that prevent it from collapsing.
What is the function of trachea Why do the walls not collapse? ›The passage of the trachea is lined by C-shaped rings of cartilage which provide structural support to the air passage and prevent it from collapsing.
What is trachea in respiratory system? ›(TRAY-kee-uh) The airway that leads from the larynx (voice box) to the bronchi (large airways that lead to the lungs). Also called windpipe.
Is trachea an organ or tissue? ›Organs of the Respiratory System
In addition to the lungs, these organs include the pharynx, larynx, trachea and bronchi.
Which specialist treats tracheal stenosis? Typically, otolaryngologists (ENT doctors), who are specialists in conditions affecting the ear, nose and throat, treat tracheal stenosis.
What age does trachea collapse? ›Tracheal collapse makes it difficult for air to get to the lungs. Tracheal collapse occurs most frequently in middle-aged to senior dogs (4-14 years), but some younger dogs can also be affected.
What causes tracheal inflammation? ›
Causes. Bacterial tracheitis is most often caused by the bacteria Staphylococcus aureus. It often follows a viral upper respiratory infection.
What does a damaged trachea feel like? ›Mild cases of a collapsed trachea, or tracheomalacia, may have no symptoms at all, but symptoms can develop over time. These include: irregular breathing noises, such as high pitched or rattling sounds. chronic cough.
How do you tell if your trachea is damaged? ›- Coughing up blood.
- Bubbles of air that can be felt underneath the skin of the chest, neck, arms, and trunk (subcutaneous emphysema)
- Difficulty breathing.
A collapsed trachea is an irreversible condition. With severe tracheal collapse, the condition can become a serious, life-threatening problem. Ongoing bouts of severe coughing, respiratory distress and panic can cause further damage.
How long can you live with a trachea? ›The median survival after tracheostomy was 21 months (range, 0-155 months). The survival rate was 65% by 1 year and 45% by 2 years after tracheostomy. Survival was significantly shorter in patients older than 60 years at tracheostomy, with a hazard ratio of dying of 2.1 (95% confidence interval, 1.1-3.9).
How long does it take for the trachea to heal? ›The median tracheostomy healing time was 6.5 (1-22) days. The duration of tracheal cannulation was the only factor significantly correlated with prolonged healing (p=0.03).
Does the trachea carry food and air? ›The trachea carries air directly into the lungs. The arrow shows the path of inspired air through the trachea. The esophagus is shown to the left of the trachea (it has been moved from its normal position dorsal to the trachea). It is the tube that carries food from the mouth to the stomach.
What is the blood supply to trachea? ›The thoracic trachea and carina receive blood from the bronchial arteries arising directly from the aorta (Figure 3). Most commonly, there is a superior, middle and inferior bronchial arteries responsible for bringing blood to the trachea and carina.
Does the trachea transmit air and food? ›Food and liquid pass backward into the esophagus on their way to the stomach. Air passes forward through the larynx and into the trachea, on its way to the lungs. So the lines of travel for air, and for food and liquid, cross over in the oropharynx.
What happens when air reaches the trachea? ›When you inhale through your nose or mouth, air travels down your pharynx (back of your throat), passes through your larynx (voice box) and into your trachea (windpipe). Your trachea is divided into two air passages called bronchial tubes. One bronchial tube leads to your left lung, the other to your right lung.
Why do I feel like my trachea is blocked? ›
The airway can become narrowed or blocked due to many causes, including: Allergic reactions in which the trachea or throat swell closed, including allergic reactions to a bee sting, peanuts and tree nuts, antibiotics (such as penicillin), and blood pressure medicines (such as ACE inhibitors)
Can you tear trachea from coughing? ›A spontaneous tracheal rupture can occur rarely in a child with tracheobronchitis after violent coughing. With clinical suspicion, an initial CT examination and endoscopy should be performed as early as possible. A small, uncomplicated rupture might resolve without surgical intervention.
How is a broken trachea treated? ›Bed rest is recommended for patients treated medically for laryngeal trauma, with the head of the bed elevated 30-45°. Voice rest is recommended to minimize edema, hematoma formation, and subcutaneous emphysema. Humidified air reduces crust formation and transient ciliary dysfunction.
What is the function of the trachea for kids? ›Your trachea is also called your windpipe. It carries air in and out of your lungs.
What happens when your trachea is irritated? ›If the trachea becomes swollen and irritated due to inflammation (tracheitis), it can partially or fully block the airway and make breathing difficult. Other symptoms of tracheitis include a deep cough, high fever, and a noisy breathing sound (stridor).
Can food go down the trachea? ›Aspiration is a medical term for accidentally inhaling your food or liquid through your vocal cords into your airway, instead of swallowing through your food pipe, or esophagus, and into your stomach. Once past the vocal folds, the food or drink enters your windpipe, or trachea, and can pass into your lungs.
Can a broken trachea be fixed? ›Injuries to the trachea often need to be repaired during surgery. Injuries to the smaller bronchi can sometimes be treated without surgery. A collapsed lung is treated with a chest tube connected to suction, which re-expands the lung.
What happens if the trachea is blocked? ›Difficulty breathing, gasping for air, leading to panic. Unconsciousness (lack of responsiveness) Wheezing, crowing, whistling, or other unusual breathing noises indicating breathing difficulty.
Does the trachea help you breathe? ›The trachea is a tube-like structure in the neck and upper chest. It stretches from the larynx, or voice box, to the bronchi and transports air to and from the lungs when a person breathes.
What is the tracheal system in humans? ›The TRACHEA (windpipe) is the passage leading from your pharynx to the lungs. The RIBS are bones supporting and protecting your chest cavity. They move a small amount and help the lungs to expand and contract. The trachea divides into the two main BRONCHI (tubes), one for each lung.
What is the meaning of tracheal system? ›
(TRAY-kee-uh) The airway that leads from the larynx (voice box) to the bronchi (large airways that lead to the lungs). Also called windpipe. Enlarge.