Airway basement membrane perimeter in human airways is not a constant; potential implications for airway remodeling in asthma

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Abstract
Many studies that demonstrate an increase in airway smooth muscle in asthmatic patients rely on the assumption that bronchial internal perimeter ( Pi) or basement membrane perimeter ( Pbm) is a constant, i.e., not affected by fixation pressure or the degree of smooth muscle shortening. Because it is the basement membrane that has been purported to be the indistensible structure, this study examines the assumption that Pbm is not affected by fixation pressure. Pbm was determined for the same human airway segment ( n = 12) fixed at distending pressures of 0 cmH2O and 21 cmH2O in the absence of smooth muscle tone. Pbm for the segment fixed at 0 cmH2O was determined morphometrically, and the Pbm for the same segment, had the segment been fixed at 21 cmH2O, was predicted from knowing the luminal volume and length of the airway when distended to 21 cmH2O (organ bath-derived Pi). To ensure an accurate transformation of the organ bath-derived Pi value to a morphometry-derived Pbm value, had the segment been fixed at 21 cmH2O, the relationship between organ bath-derived Pi and morphometry-derived Pbm was determined for five different bronchial segments distended to 21 cmH2O and fixed at 21 cmH2O ( r2 = 0.99, P < 0.0001). Mean Pbm for bronchial segments fixed at 0 cmH2O was 9.4 ± 0.4 mm, whereas mean predicted Pbm, had the segments been fixed at 21 cmH2O, was 14.1 ± 0.5 mm ( P < 0.0001). This indicates that Pbm is not a constant when isolated airway segments without smooth muscle tone are fixed distended to 21 cmH2O. The implication of these results is that the increase in smooth muscle mass in asthma may have been overestimated in some previous studies. Therefore, further studies are required to examine the potential artifact using whole lungs with and without abolition of airway smooth muscle tone and/or inflation.