title: Contribution of emphysema and small airways in COPD.
abstract: BACKGROUND
  The contribution and role of emphysema and small airways disease in causing expiratory airflow limitation in COPD is controversial.
  
  
  METHODS
  We obtained high-resolution thin-section 2-mm CT scans of the lung for emphysema grading and lung function in 116 consecutively seen COPD outpatients with fixed expiratory airflow limitation. In this group, inflated whole lung(s) were subsequently obtained in 24 patients (23 autopsy, 1 surgery) for morphologic studies and results compared with lung CT. Airway histologic condition was studied in 17 of the 24 patients.
  
  
  RESULTS
  There was fair to weak negative correlation between CT emphysema score and either FEV1/FVC percent (r = -0.51, p = 0.001) or FEV1 percent predicted (r = -0.31, p = 0.001). In only 24 of the 81 patients (30%) with FEV1 less than 50% predicted, the CT emphysema score was 60 or more, indicating severe emphysema. In the 24 patients studied, there was a good correlation (r = 0.86, p = 0.001) between CT and pathologic grade of emphysema. While respiratory bronchioles (RBs) and membranous bronchioles (MBs) demonstrated marked morphologic abnormalities, there was a weak correlation with emphysema grade (for RB, r = 0.36, p = 0.16; for MB, r = 0.41, p = 0.10) or with FEV1 percent predicted (for RB, r = -0.21, p = 0.42; for MB, r = -0.28, p = 0.28). There was no correlation between emphysema and FEV1 percent predicted (r = -0.13, p = 0.54).
  
  
  CONCLUSIONS
  High-resolution CT lung scans are an in vivo surrogate to quantitate moderate to severe morphologic emphysema. Emphysema does not appear to be primarily responsible for severe expiratory airflow limitation in most patients with severe COPD. There was no correlation between severity of small airway histologic condition and emphysema or FEV1 percent predicted. The causes of the lesions responsible for small airways obstruction need to be identified.
authors.affiliation: Department of Medicine, Lakewood Regional Medical Center, School of Medicine, CA, USA.
authors.forename: A F
authors.initials: AF
authors.lastname: Gelb
authors.forename: J C
authors.initials: JC
authors.lastname: Hogg
authors.forename: N L
authors.initials: NL
authors.lastname: Müller
authors.forename: M J
authors.initials: MJ
authors.lastname: Schein
authors.forename: J
authors.initials: J
authors.lastname: Kuei
authors.forename: D P
authors.initials: DP
authors.lastname: Tashkin
authors.forename: J D
authors.initials: JD
authors.lastname: Epstein
authors.forename: J
authors.initials: J
authors.lastname: Kollin
authors.forename: R H
authors.initials: RH
authors.lastname: Green
authors.forename: N
authors.initials: N
authors.lastname: Zamel
authors.forename: W M
authors.initials: WM
authors.lastname: Elliott
authors.forename: L
authors.initials: L
authors.lastname: Hadjiaghai
mesh_terms: D000368:Aged; D004646:Emphysema / Q000150:complications / Q000473:pathology / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008173:Lung Diseases, Obstructive / Q000150:complications / Q000473:pathology / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D012123:Pulmonary Ventilation; D012129:Respiratory Function Tests