Mild Emphysema Is Associated with Reduced Elastic Recoil and Increased Lung Size but Not with Air-Flow Limitation

Abstract

Thirty-nine excised human lungs were examined to identify early changes in the small airways, their size distribution, and their elastic recoil in relation to mild degrees of emphysema. Elastic recoil measurement, single-breath nitrogen (SBN2) tests, and FEV1 were obtained from 18 lungs with no emphysema and 21 emphysematous lungs with no greater than Grade 5 emphysema score. The mean number of alveolar attachments per brochiole was determined from all the bronchioles cut in cross section. When the 2 groups of lungs were compared, the percentage of predicted elastic recoil of the nonemphysematous lungs was significantly greater at 50, 70, 80, and 90% of TLC than in the mildly emphysematous lungs. The TLC of the emphysematous lungs (% of predicted) was also significantly greater than in the nonemphysematous lungs. Pigment of the small airways was the only pathologic feature that was significantly greater in the emphysematous lungs than in the nonemphysematous lungs. Size distribution in the small airways was similar except for the airways zero to 0.2 mm, which were more frequent in the emphysematous lungs. When data from both groups were combined, elastic recoil was shown to be related to both the number of alveolar attachments (p less than 0.03) and the mean diameter of the small airways (p less than 0.01). We conclude that structural and functional changes in lungs with mild emphysema include reduced elastic recoil, increased lung size, and some size distribution changes in the small airways. Mild emphysema is not associated with air-flow limitation.

Influence of Lung Parenchymal Destruction on the Different Indexes of the Methacholine Dose-Response Curve in COPD Patients

“…10,11,14 A PV curve can be obtained with relatively simple techniques but has the disadvantage of being an invasive test. The reproducibility of estimates, especially of KE, was reported to be good, at least for healthy adults.…”

“…10 -13 The most reliable test for lung elasticity is the direct estimation of quasi-static esophageal pressure-volume (PV) curves. 10,11,14 The destruction of parenchymal tissue also is shown by the impairment of carbon monoxide (CO) transfer. [15][16][17][18] We performed these lung function tests in COPD patients who smoked, who fulfilled the established clinical and functional criteria for COPD, and who also had a provocative concentration of a substance (histamine) causing a 20% fall in FEV 1 (PC 20 ) of Յ 8 mg/mL.…”

Managing Severe COPD: Addressing the Challenges with Latest Trends and Treatment Options (Part I: Pharmacological Management)

“…• Patients with chronic bronchitis or emphysema, or both, who do not have evidence of airflow obstruction on spirometry, are not considered to have COPD [21,22]. However, since cough and sputum are abnormal in these patients (even though the lung functions are normal), they were classified as patients at risk for developing COPD, and hence categorised as GOLD Stage 0, in the original GOLD classification [23].…”

The Study of Association between Helicobacter pylori (H. pylori) and Chronic Obstructive Pulmonary Disease (COPD)

“…Triple therapy should be used in areas where clarithromycin resistance is low (<15 percent). However, when clarithromycin resistance is high (≥15 percent), quadruple therapy should be used to treat H. pylori [52,54,60,61,46].…”

“…progressive, permanent inflammation of the respiratory system, which has been accepted as a systemic disease, and those correlating H. pylori with respiratory functions are scarce. Moreover, a high prevalence of COPD has been found in patients with peptic ulcer [54]. In our study, we investigated the relation of COPD to H. pylori seroprevalence and whether this relation correlates with the severity of the disease, measured by respiratory function tests.…”