Airway Obstruction in Chronic Obstructive Pulmonary Disease

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Abstract
In their article on small-airway obstruction in patients with chronic obstructive pulmonary disease (COPD), Hogg and colleagues (June 24 issue)1 report that the progression of COPD is associated with the luminal accumulation of exudates and inflammatory-cell infiltration. However, the role of hypersecretion and retention of mucus in airway narrowing has not been addressed in detail. Retention of mucus is likely to lead to a major debilitating symptom of COPD. No specific therapy is available to date,2 but a new molecular treatment option that inhibits mucus matrix-forming protein mucin 5AC has recently been proposed.3 Mucin 5AC is present and is increased in expression in the bronchiolar epithelium and lumen in patients with COPD ( Figure 1 ). Mucin 5AC and mucin 5B are the major mucins that are secreted into the lumen in both COPD and asthma.4,5 An assessment of the mucous composition at all stages of COPD should be part of the description of the nature of small-airway obstruction.