THE DETECTION OF SMALL AIRWAYS DISEASE

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Abstract
To investigate the relationship between pulmonary function and disease of the membranous and respiratory bronchioles, 96 patients who required lobectomy for removal of a solitary pulmonary nodule were studied. A subgroup of patients with forced expiratory in 1 (FEV1) > 80% predicted were further analyzed to determine if abnormalities in tests designed to detect peripheral airways disease actually correlated with the pathology found in these airways. Inflammation in both respiratory and membranous bronchioles, goblet cell metaplasia of the epithelium in membraneous bronchioles, and decreasing muscle in the respiratory bronchioles are the pathologic features that are associated with deterioration of the FEV1. When the FEV1 is > 80% of the predicted value, inflammation of the respiratory bronchioles and fibrosis of both membranous and respiratory bronchioles increase with decreasing FEV1. Tests of specialized pulmonary function appear to correlate with epithelial pathologic parameters of membranous bronchioles and inflammation and fibrosis of respiratory bronchioles. When patients with FEV1 > 80% predicted were subdivided according to the number of abnormal tests of small airways function, there was a significant increase in inflammation of the walls of respiratory bronchioles when 2 tests were abnormal and increases in both airway wall and intralumenal inflammatory cells as well as increased wall fibrosis when 3 tests were abnormal. When the FEV1 is > 80% predicted, abnormalities in the tests for small airway disease reflect pathologic changes in the respiratory bronchioles.

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