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HIGHLIGHTED TOPICS
Airway Hyperresponsiveness: From Molecules to Bedside

SELECTED CONTRIBUTION

Small airway morphology and lung function in the transition from normality to chronic airway obstruction

²Dipartimento di Medicina Interna, Università di Genova, 16132 Genova; ¹Clinica di Malattie dell'Apparato Respiratorio, IRCCS Policlinico S. Matteo, Università di Pavia, 27100 Pavia; ³Dipartimento di Medicina Clinica e Sperimentale, Sezione di Malattie dell'Apparato Respiratorio, Università di Padova, 35128 Padova; and ⁴Centro di Ricerca per l'Asma e la BPCO, Università di Ferrara, 44100 Ferrara, Italy

Submitted 5 November 2002 ; accepted in final form 10 February 2003

This study investigated the relationships between pathological changes in small airways (<6 mm perimeter) and lung function in 22 nonasthmatic subjects (20 smokers) undergoing lung resection for peripheral lesions. Preoperative pulmonary function tests revealed airway obstruction [ratio of forced expiratory volume in 1 s to forced vital capacity (FEV₁/FVC) < 70%] in 12 subjects and normal lung function in 10. When all subjects were considered together, total airway wall thickness was significantly correlated with FEV₁/FVC (r² = 0.25), reactivity to methacholine (r² = 0.26), and slope of linear regression of FVC against FEV₁ values recorded during the methacholine challenge (r² = 0.56). Loss of peribronchiolar alveolar attachments was significantly associated (r² = 0.25) with a bronchoconstrictor effect of deep inhalation, as assessed from a maximal-to-partial expiratory flow ratio <1, but not with airway responses to methacholine. No significant correlation was found between airway smooth muscle thickness and lung function measurements. In conclusion, this study suggests that thickening of the airway wall is a major mechanism for airway closure, whereas loss of airway-to-lung interdependence may contribute to the bronchoconstrictor effect of deep inhalation in the transition from normal lung function to airway obstruction in nonasthmatic smokers.

smoking; airway hyperresponsiveness; airway closure; deep inhalation; interdependence

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