LUNG-DISEASE IN LONG-TERM CIGARETTE SMOKERS WITH AND WITHOUT CHRONIC AIR-FLOW OBSTRUCTION

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Abstract
Despite the established role of cigarette smoking in chronic air-flow obstruction (CAO), only a small proportion of regular cigarette smokers develop significant clinical disease. Emphysema severity and pathologic and morphometric features of the peripheral conducting airways and the muscular pulmonary arteries among 3 groups of older subjects were compared. These groups included lifelong nonsmokers (NSM), regular smokers without severe disease (SM) and smokers with an established CAO diagnosis (SM-CAO). For most pathologic features examined there was an orderly progression in severity when comparing SM to NSM and SM-CAO to SM. Emphysema severity and scores for peripheral airways disease, except for goblet cell metaplasia, better distinguished SM-CAO from SM than did bronchiole lumenal caliber measures. Within the SM-CAO group, the premortem % predicted forced expiratory volume in 1 (FEV1) correlated significantly with emphysema severity (r = 0.74), with average bronchiole diameter (r = 0.54), with the proportion of bronchioles with diameters less than 400 .mu. (r = 0.51), but not with any of the scores for bronchiolar disease. Within this group no small airway morphologic or pathologic feature was an independent ventilatory function predictor beyond that of emphysema alone. When compared with those from NSM, histological sections from SM-CAO lungs contained .apprx. twice as many fully musculrized artery profiles 0-300 .mu. in diameter, the arterial medial muscle layer was doubled in thickness and arterial intimal fibrosis amount was tripled. Changes in muscular pulmonary arteries were highly intercorrelated, both with emphysema severity and peripheral airway disease measures.