Stridor

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Stridor is an abnormal, high-pitched breath sound (usually inspiratory) that is produced by turbulent airflow through a narrowed airway.
Once stridor is heard, the airway passage is often less than 5mm.
It can be very distressing to the patient or anyone who witnesses it.

Airway obstruction can be anatomical or functional:

Anatomical
- Intraluminal (e.g. tumour, mucus plug)
- Intramural (e.g. laryngeal carcinoma)
- Extramural (e.g. mediastinal lymphadenopathy)
Functional (e.g. recurrent laryngeal nerve palsy)

Recognize and manage stridor early due to risk of eventual total obstruction and asphyxiation.
If it is aligned with the trajectory of illness and goals of care, secure the airway via
- Emergency tracheostomy
- Interventional bronchoscopy (e.g. intra-luminal stenting, ablation)
Chemotherapy or radiotherapy may be considered subsequently if the obstruction is caused by a chemo- or radio- sensitive tumour. An elective tracheostomy may be required before radiotherapy.
Non-invasive management includes
- Sitting patient up-right
- Reduce fluids and nasogastric feeding to manage secretions
- IV/SC Dexamethasone 16-24mg/day to decrease laryngeal oedema (with gastric protection)
- IV/SC opioids for breathlessness
- IV/SC Buscopan for throat secretions
- IV/SC Midazolam for agitation
If stridor is not reversible, please refer to specialist palliative care team and discuss palliative sedation with patient and family.
Good communication and education of patients and family members about what to expect and treatment plans is essential.

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Ma CM. Major Airway Obstruction. HKSPM Newsletter. 2010;April(1):10–11.
Yataco JC, Mehta AC. Upper Airway Obstruction. In Suhail R, ed. ACP Manual of Critical Care Medicine. USA: McGraw-Hill; 2008:388–397.