Small airways disease in mild and moderate chronic obstructive pulmonary disease: a cross-sectional study

Publication date: Available online 4 July 2018Source: The Lancet Respiratory MedicineAuthor(s): Hyun-Kyoung Koo, Dragoş M Vasilescu, Steven Booth, Aileen Hsieh, Orestis L Katsamenis, Nick Fishbane, W Mark Elliott, Miranda Kirby, Peter Lackie, Ian Sinclair, Jane A Warner, Joel D Cooper, Harvey O Coxson, Peter D Paré, James C Hogg, Tillie-Louise HackettSummaryBackgroundThe concept that small conducting airways less than 2 mm in diameter become the major site of airflow obstruction in chronic obstructive pulmonary disease (COPD) is well established in the scientific literature, and the last generation of small conducting airways, terminal bronchioles, are known to be destroyed in patients with very severe COPD. We aimed to determine whether destruction of the terminal and transitional bronchioles (the first generation of respiratory airways) occurs before, or in parallel with, emphysematous tissue destruction.MethodsIn this cross-sectional analysis, we applied a novel multiresolution CT imaging protocol to tissue samples obtained using a systematic uniform sampling method to obtain representative unbiased samples of the whole lung or lobe of smokers with normal lung function (controls) and patients with mild COPD (Global Initiative for Chronic Obstructive Lung Disease [GOLD] stage 1), moderate COPD (GOLD 2), or very severe COPD (GOLD 4). Patients with GOLD 1 or GOLD 2 COPD and smokers with normal lung function had undergone lobectomy and pneumonectomy, and patients with GOLD 4...
Source: The Lancet Respiratory Medicine - Category: Respiratory Medicine Source Type: research