RELATION BETWEEN SELECTIVE ALVEOLO-BRONCHOGRAMS AND PULMONARY-FUNCTION TESTS IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY-DISEASE

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Abstract
The relation was studied between selective alveolo-bronchograms (SAB) and pulmonary function tests in patients with chronic obstructive pulmonary disease (COPD) other than asthma. The SAB were obtained by the technique reported by Nakamura and coworkers. First, the relation between SAB and morphologic findings was examined in 14 autopsy lungs to confirm the morphologic bases of the shadows. The ring shadows that appeared in the SAB were histologically identified as alveolar ducts in normal lungs and as destroyed parenchymal air spaces in emphysematous lungs. There was a significant correlation between the mean diameter of ring shadow (DR) and the degree of morphologic emphysema (P < 0.001). This correlation indicated a significant degree of emphysema when the DR exceeded 900 .mu.m. The irregularity index of the airway in SAB also showed a significant correlation to the grade of pathologic abnormalities in the airways (P < 0.01). Second, SAB were obtained in 64 patients with COPD in whom pulmonary function tests were performed. In these patients, the DR correlated significantly with most of the pulmonary function tests. This correlation was especially high with transfer factor (DLCO/VA). These 64 patients were divided into 2 groups on the basis of the DR: in group A, DR was more than 900 .mu.m; in group B, it was less than 900 .mu.m. In group A, the DR also showed a significant correlation with DLCO/VA and with diffusing capacity (DLCO); in group B, significant correlations were found in the irregularity index, especially with regard to pulmonary resistance and the ratio of forced expiratory volume in 1 s to vital capacity. Analysis of SAB would be useful in quantitatively evaluating the amount of morphologic emphysema, which would, in turn, provide practical information on the differential diagnosis of emphysema from other COPD, and facilitate the assessment of functional abnormalities. The analysis of SAB would also be useful in the quantitative evaluation of the degree of peripheral airway lesions and then be used in the interpretation of functional abnormalities.