As one of the earliest survivors of the COVID-19 pandemic in Colorado, Ned Steffens thought he was out of the woods in May 2020, when he was released from the hospital after 35 days.
What Steffens didn’t know was that a condition called tracheal stenosis — a narrowing in the trachea, caused by scar tissue created by the breathing tube doctors inserted to counteract the pulmonary symptoms of COVID — was slowly robbing him of his ability to breathe.
“He couldn't catch his breath, and it turned out he had stenosis,” says Robert Meguid, MD, MPH, the professor of cardiothoracic surgery in the University of Colorado Department of Surgery who treated Steffens. “It’s a rare condition, but when we see it, it's usually from a bad reaction or trauma associated with the breathing tube. Tens of thousands of people are intubated in the United States every day for surgical procedures or illness, and getting scar tissue forming in the trachea that blocks up the airway happens, but very rarely.”
Trouble walking up the stairs
For Steffens, now 69, the breathing problems started shortly after he and his wife, Stephanie, returned from Colorado to Spain, where they worked as missionaries with the Evangelical Alliance Mission.
“I didn't have great lungs even before having COVID, but after we got back to Spain in August of 2020, my breathing wasn't working real well, and it was progressively getting worse,” Ned says. “We lived in a two-story place with a basement, and if I walked up one set of stairs, I'd have to sit down. Then one Saturday morning, we were having breakfast, and some phlegm got stuck in that narrow spot in my trachea, and I couldn't get air in or out. I finally coughed it out, then it happened again about two hours later. I said to Stephanie, ‘I don't know what's going on in there, but this isn't good.’”
Steffens went to doctors in Spain, but the treatment wasn’t moving fast enough, and it was getting harder and harder for him to breathe. He and Stephanie returned to Colorado for care, and after a scheduled appointment with an ear, nose, and throat doctor in Boulder, Steffens ended up in the emergency room at UCHealth University of Colorado Hospital, where Meguid discovered that his trachea was 90% closed due to the stenosis.
“He came into the ER, and I took him to the operating room that night and did a bronchoscopy and saw that his airway was narrowed,” Meguid says. “I used a balloon to stretch it open, just to temporize it until we could do something more definitive. Sometimes patients don't need any definitive management done, but he did need to have definitive management.”
Surgical solution
Just under a month later, Meguid and Matthew Clary, MD, associate professor of otolaryngology, performed surgery to cut out the part of Steffens’ airway that was blocked, then sewed the two unaffected areas back together.
“It's akin to a pipe being blocked, and we cut out the blockage and then bring the two ends of the pipe back together to fill the gap,” Meguid says.
Clary says it’s important for both specialties — cardiothoracic surgery and otolaryngology — to work together in complicated airway reconstructions like the one Steffens received.
“This surgery is very involved, and it touches many parts of the body — the chest and the thoracic cavity, as well as the larynx,” Clary says. “That's why we work together as a team —not only can we do the surgery better than we could as solo practitioners, but we also can manage them better pre- and post-surgery. They essentially get two for the price of one, and typically our patients do awesome.”
Recovery and gratitude
That was certainly the case for Steffens, who remained in the hospital for a week after his surgery, most of that time with his chin loosely sewn to his chest.
“They do that because if you tilt your head back while you’re healing, it'll tear the trachea apart,” he says.
After the week of recovery, Meguid went back in to look at Steffens’ trachea with a bronchoscope, to make sure everything looked good, then cut the guardian suture and sent Steffens home.
Now living in Longmont, Colorado, full time, Steffens occasionally pauses when he’s out hiking or walking, grateful for the ability to breathe normally once again.
“Once in a while, when I can take a deep breath in and out, I think, ‘Whoa. I couldn't do that at one point,’” he says. “It's good that that airway is open.”
A COVID-era success story
Meguid says Steffens was far from the only patient who developed tracheal stenosis during the COVID pandemic, even after recent efforts to prevent the condition from occurring.
“There were advancements in the 1990s that changed the breathing tube design to decrease the likelihood of this happening, but there was a high volume of people who had breathing tubes in during the pandemic, especially for a prolonged period of time,” he says. “Patients with COVID also are in a systemic inflammatory state that affects their whole body. The combination of those factors contributes to the development of tracheal stenosis, and that's why we saw an uptick in the frequency of that during that early COVID period.
“Seeing as March 2025 is the fifth anniversary of the beginning of the COVID pandemic,” he adds, “it’s nice to have a story like Ned’s that has a happy ending.”
Featured image: Ned Steffens poses for a photo in Spain.
