The bronchial vasculature is the systemic arterial blood supply to the lung. Although small relative to the pulmonary blood flow, the bronchial vasculature serves important functions and is modified in a variety of pulmonary and airway diseases.Congestion of the bronchial vasculature may narrow the airway lumen in inflammatory airway diseases, and formation of new bronchial vessels (angiogenesis) is implicated in the pathology of a variety of chronic inflammatory, infectious and ischaemic pulmonary diseases. The remarkable ability of the bronchial vasculature to remodel has implications for disease pathogenesis.The contributions of the bronchial vasculature to the pathogenesis of pulmonary disease are reviewed in this article. Eur Respir J 1997; 10: 1173-1180. The bronchial circulation is ideally situated to play an important role in lung defence and in the pathogenesis of a number of airway diseases. The bronchial microvasculature provides nutrient blood flow to the airway epithelium and is important for proper functioning of the mucociliary escalator. Bronchial blood flow is responsive to changes in neural and humoral stimuli and plays a role in conditioning of inspired air. The focus of this review is the potential involvement of the bronchial vasculature in contributing to the pathogenesis of a variety of airway diseases. In particular, we have focused on the possibility of airway narrowing as a consequence of bronchial vascular congestion, and the remarkable proliferative capacity of the bronchial vessels in response to a variety of pulmonary diseases. Bronchial vascular congestionHyperaemia of the bronchial vasculature is often included in descriptions of the pathology of asthma. An example of hyperaemia of the bronchial vasculature is shown in figure 1. This photomicrograph shows a crosssection of a human airway from a patient who died of asthma. The apparent increase in the size and number of vessels inside and outside the smooth muscle layer is clearly visible, suggesting that vascular dilation and proliferation (angiogenesis) could be important components of the airway wall remodelling in asthmatic patients. The airway vasculature is of considerable interest in asthma because it can contribute to the excessive airway narrowing, which is characteristic of this disease. A diagram of an airway ( fig. 2) illustrates the two bronchial vascular plexuses: the peribronchial plexus, located in the adventitial space between the muscle and the surrounding lung parenchyma; and the submucosal vascular plexus, located beneath the epithelial layer. Dilation, exudation or transudation from these vessels could contribute to the excessive airway narrowing observed in asthma. Relaxation of the bronchial vascular smooth muscle and/or an increase in the intravascular pressure will lead to congestion of these vessels. This bronchial vascular congestion could result in a reduction in the area of the airway lumen and/or an increase in the outer diameter of the airway. The latter effect could uncouple the airway smoo...

Tracheobronchial blood flow increases with cold air hyperventilation in the dog. The present study was designed to determine whether the cooling or the drying of the airway mucosa was the principal stimulus for this response. Six anesthetized dogs (group 1) were subjected to four periods of eucapnic hyperventilation for 30 min with warm humid air [100% relative humidity (rh)], cold dry air (-12 degrees C, 0% rh), warm humid air, and warm dry air (43 degrees C, 0% rh). Five minutes before the end of each period of hyperventilation, tracheal and central airway blood flow was determined using four differently labeled 15-micron diam radioactive microspheres. We studied another three dogs (group 2) in which 15- and 50-micron microspheres were injected simultaneously to determine whether there were any arteriovenous communications in the bronchovasculature greater than 15 micron diam. After the last measurements had been made, all dogs were killed, and the lungs, including the trachea, were excised and blood flow to the trachea, left lung bronchi, and parenchyma was calculated. Warm dry air hyperventilation produced a consistently greater increase in tracheobronchial blood flow (P less than 0.01) than cold dry air hyperventilation, despite the fact that there was a smaller fall (6 degrees C) in tracheal tissue temperature during warm dry air hyperventilation than during cold dry air hyperventilation (11 degrees C), suggesting that drying may be a more important stimulus than cold for increasing airway blood flow. In group 2, the 15-micron microspheres accurately reflected the distribution of airway blood flow but did not always give reliable measurements of parenchymal blood flow.

To examine the role of airway wall thickening in the bronchial hyperresponsiveness observed after exposure to cigarette smoke, we compared the airway dimensions of guinea pigs exposed to smoke (n = 7) or air (n = 7). After exposure the animals were anesthetized with urethan, pulmonary resistance was measured, and the lungs were removed, distended with Formalin, and fixed near functional residual capacity. The effects of lung inflation and bronchoconstriction on airway dimensions were studied separately by distending and fixing lungs with Formalin at total lung capacity (TLC) (n = 3), 50% TLC (n = 3), and 25% TLC (n = 3) or near residual volume after bronchoconstriction (n = 3). On transverse sections of extraparenchymal and intraparenchymal airways the following dimensions were measured: the internal area (Ai) and internal perimeter (Pi), defined by the epithelium, and the external area (Ae) and external perimeter (Pe), defined by the outer border of smooth muscle. Airway wall area (WA) was then calculated, WA = Ae - Ai. Ai, Pe, and Ae decreased with decreasing lung volume and after bronchoconstriction. However, WA and Pi did not change significantly with lung volume or after bronchoconstriction. After cigarette smoke exposure airway resistance was increased (P less than 0.05); however, there was no difference in WA between the smoke- and air-exposed groups when the airways were matched by Pi. We conclude that Pi and WA are constant despite changes in lung volume and smooth muscle tone and that airway hyperresponsiveness induced by cigarette smoke is not mediated by increased airway wall thickness.

Cartilage is primarily responsible for maintaining the stability of the large airways; yet very little is known about the mechanical properties of airway cartilage. This work establishes a technique whereby average values for the equilibrium modulus of excised tracheal cartilage rings can be obtained. An apparatus was designed to apply preset deformations to a tracheal segment and to monitor the deforming force. Segments of four human tracheae obtained postmortem and containing three rings were mounted in the apparatus after being stripped of posterior membrane. The load-deformation behavior was analyzed with a model on the basis of thin curved beam theory. Agreement between predicted deformed shapes and those observed was good in three of the four cases and in the case of a short length of longitudinally split rubber tube. The technique is suitable for comparing mechanical properties of cartilage before and after an intervention.

Electrical field stimulation (70 V, 1 ms, 0.2-500 Hz) of human bronchial strips and guinea pig tracheal chains produced contractile and relaxant responses. Contractions were blocked by atropine, 10(-6) M, and tetrodotoxin (TTX), 0.1-1.0 micrograms/ml, demonstrating a cholinergic excitatory neural component. Frequencies causing half-maximal contractile response to field stimulation (EFc 50) were 10 +/- 2 Hz for guinea pig and 13 +/- 1 Hz for human airways. Relaxations were unmasked by atropine 10(-6) M and slightly diminished by propranolol in guinea pig but not human airways, demonstrating a predominantly nonadrenergic inhibitory pathway in both species. Relaxation of intrinsic tone occurred at stimulation frequencies of 1 Hz or more. Frequencies causing half-maximal relaxation (EFi 50) were 3.5 +/- 0.3 Hz for guinea pig trachealis and 38 +/- 6 Hz for human bronchi. Following 1 microgram/ml TTX, EFi 50 values increased to 104 +/- 12 and 70 +/- 14 Hz, respectively. Frequencies of field stimulation that were inhibitable by TTX (less than or equal to 20 Hz) induced greater relaxation in guinea pig than human airways (70 vs. 10% of the maximal relaxation to 10(-2) M theophylline, respectively). The methods of analysis outlined in this study can be used to compare relative degrees of functional innervation between tissues from the same or different species.