The Nature of Small-Airway Obstruction in Chronic Obstructive Pulmonary Disease

doi:10.1056/NEJMoa032158

A correction has been published: N Engl J Med 2004;351(13):1367.

Volume 350:2645-2653		June 24, 2004		Number 26

The Nature of Small-Airway Obstruction in Chronic Obstructive Pulmonary Disease

James C. Hogg, M.D., Fanny Chu, B.Sc., Soraya Utokaparch, B.Sc., Ryan Woods, M.Sc., W. Mark Elliott, Ph.D., Liliana Buzatu, M.D., Ruben M. Cherniack, M.D., Robert M. Rogers, M.D., Frank C. Sciurba, M.D., Harvey O. Coxson, Ph.D., and Peter D. Paré, M.D.

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by Barnes, P. J.

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ABSTRACT

Background Chronic obstructive pulmonary disease (COPD) is amajor public health problem associated with long-term exposureto toxic gases and particles. We examined the evolution of thepathological effects of airway obstruction in patients withCOPD.

Methods The small airways were assessed in surgically resectedlung tissue from 159 patients — 39 with stage 0 (at risk),39 with stage 1, 22 with stage 2, 16 with stage 3, and 43 withstage 4 (very severe) COPD, according to the classificationof the Global Initiative for Chronic Obstructive Lung Disease(GOLD).

Results The progression of COPD was strongly associated withan increase in the volume of tissue in the wall (P<0.001)and the accumulation of inflammatory mucous exudates in thelumen (P<0.001) of the small airways. The percentage of theairways that contained polymorphonuclear neutrophils (P<0.001),macrophages (P<0.001), CD4 cells (P=0.02), CD8 cells (P=0.038),B cells (P<0.001), and lymphoid aggregates containing follicles(P=0.003) and the absolute volume of B cells (P=0.03) and CD8cells (P=0.02) also increased as COPD progressed.

Conclusions Progression of COPD is associated with the accumulationof inflammatory mucous exudates in the lumen and infiltrationof the wall by innate and adaptive inflammatory immune cellsthat form lymphoid follicles. These changes are coupled to arepair or remodeling process that thickens the walls of theseairways.

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From the University of British Columbia, the Centre for Cardiovascular and Pulmonary Research, and St. Paul's Hospital, Vancouver, Canada (J.C.H., F.C., S.U., R.W., W.M.E., L.B., H.O.C., P.D.P.); the National Jewish Research and Medical Center, Denver (R.M.C.); and the University of Pittsburgh Medical Center, Pittsburgh (R.M.R., F.C.S.).

Address reprint requests to Dr. Hogg at Rm. 166, McDonald Research Wing, St. Paul's Hospital, 1081 Burrard St., Vancouver, BC V6Z 1Y6, Canada, or at jhogg{at}mrl.ubc.ca.

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Airway Obstruction in Chronic Obstructive Pulmonary Disease
Chung K. F., Caramori G., Groneberg D. A., Lamela J., Vega F., Blanco J., Hogg J. C., Barnes P. J.
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N Engl J Med 2004; 351:1459-1461, Sep 30, 2004. Correspondence

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