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Introduction <p>Excessive Dynamic Airway Collapse (EDAC) remains inconsistently diagnosed due to variable thresholds and overlapping terminology. The FEMOS (Functional status, Extent, Morphology, Origin, Severity) classification is the most comprehensive multidimensional framework for central airway collapse, yet its application in EDAC has not been systematically evaluated.</p> Methods &amp; results <p>A descriptive systematic review was conducted following PRISMA guidelines, including 16 EDAC studies published from 2005 to 2023 (<i>N</i> = 1270). Methodological quality, assessed using the JBI Critical Appraisal Tools, was moderate, with most studies being case series lacking consecutive recruitment. Diagnostic thresholds ranged from ≥ 50% to ≥ 75%, and 64.3% (<i>n</i> = 9/14) of post-2010 studies continued using the &gt; 50% criteria despite evidence of physiological false positives. Anatomical reporting showed predominant involvement of the distal trachea (68.8%) and main bronchi (87.5%), with asthma and COPD commonly reported. Objective cross-sectional area (CSA) quantification was used in 37.5% of studies, while FEMOS was applied in only 18.8%. Other key gaps included the absence of a “Mixed” EDAC–TBM category and limited longitudinal reporting (56.3%).</p> Conclusion <p>Given this heterogeneity, we propose a pilot refinement of the FEMOS framework incorporating a physiologically relevant ≥ 70% collapse threshold measured using objective CSA or AP-diameter, along with anatomical site markers (S, M, D, R, L), morphological subtype abbreviations (TBM-C, TBM-S, TBM-Ci), and a “Mixed” EDAC–TBM category. Together with a provisional post-treatment follow-up model, it aims to reduce heterogeneity in future EDAC research. However, it remains unvalidated and should not be considered definitive guidance; interpretation should therefore remain cautious.</p>

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Excessive dynamic airway collapse and the FEMOS classification: a descriptive systematic review and framework proposal

  • 期刊论文

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  • 发表日期：

    2026年3月7日

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  • Nor Amizan Mohd Sabri,
  • Masaany Mansor,
  • Syarifah Nafisah Syed Hamzah,
  • Norazila Abd Rahim

摘要

Introduction

Excessive Dynamic Airway Collapse (EDAC) remains inconsistently diagnosed due to variable thresholds and overlapping terminology. The FEMOS (Functional status, Extent, Morphology, Origin, Severity) classification is the most comprehensive multidimensional framework for central airway collapse, yet its application in EDAC has not been systematically evaluated.

Methods & results

A descriptive systematic review was conducted following PRISMA guidelines, including 16 EDAC studies published from 2005 to 2023 (N = 1270). Methodological quality, assessed using the JBI Critical Appraisal Tools, was moderate, with most studies being case series lacking consecutive recruitment. Diagnostic thresholds ranged from ≥ 50% to ≥ 75%, and 64.3% (n = 9/14) of post-2010 studies continued using the > 50% criteria despite evidence of physiological false positives. Anatomical reporting showed predominant involvement of the distal trachea (68.8%) and main bronchi (87.5%), with asthma and COPD commonly reported. Objective cross-sectional area (CSA) quantification was used in 37.5% of studies, while FEMOS was applied in only 18.8%. Other key gaps included the absence of a “Mixed” EDAC–TBM category and limited longitudinal reporting (56.3%).

Conclusion

Given this heterogeneity, we propose a pilot refinement of the FEMOS framework incorporating a physiologically relevant ≥ 70% collapse threshold measured using objective CSA or AP-diameter, along with anatomical site markers (S, M, D, R, L), morphological subtype abbreviations (TBM-C, TBM-S, TBM-Ci), and a “Mixed” EDAC–TBM category. Together with a provisional post-treatment follow-up model, it aims to reduce heterogeneity in future EDAC research. However, it remains unvalidated and should not be considered definitive guidance; interpretation should therefore remain cautious.