title: The association between small airway obstruction and emphysema phenotypes in COPD.
abstract: BACKGROUND
  Airflow limitation in COPD is due to a variable combination of small airway obstruction and centrilobular emphysema (CLE) and/or panlobular emphysema (PLE), but the relationship between these three different phenotypes is poorly understood. This study compares the severity of small airway obstruction in both forms of emphysema and determines its relationship with FEV(1).
  
  
  METHODS
  We compared the lung histology of nonsmoking control subjects without emphysema (n = 10) to that of patients with CLE (n = 30) and PLE with (n = 8) and without alpha(1)-antitrypsin (AAT) deficiency (n = 11). The degree of airspace enlargement was measured using the mean interalveolar wall distance (IAWD) [mean linear intercept, Lm], and the evenness of airspace destruction was assessed by the coefficient of variation (CV) of the IAWD. The severity of small airway obstruction was determined by dividing total wall area by the length of the basement membrane to obtain wall thickness.
  
  
  RESULTS
  Lm was greater in all three subgroups of emphysema than in control subjects, and in AAT deficiency than in PLE or CLE. The CV of IAWD was greater in AAT deficiency and CLE than in control subjects and in CLE than in AAT deficiency or PLE. Although small airway wall thickness was greater in CLE and PLE with AAT deficiency than in control subjects, the association between wall thickness and both Lm and FEV(1) was observed only in CLE.
  
  
  CONCLUSIONS
  Small airway wall thickening occurs in CLE and PLE with AAT deficiency but is more closely associated with degree of emphysema and airflow limitation in CLE.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Pungnap-dong, Songpa-gu, Seoul 138-736, Republic of Korea. wdkim@amc.seoul.kr
authors.forename: Won-Dong
authors.initials: WD
authors.lastname: Kim
authors.forename: Sean H
authors.initials: SH
authors.lastname: Ling
authors.forename: Harvey O
authors.initials: HO
authors.lastname: Coxson
authors.forename: John C
authors.initials: JC
authors.lastname: English
authors.forename: John
authors.initials: J
authors.lastname: Yee
authors.forename: Robert D
authors.initials: RD
authors.lastname: Levy
authors.forename: Peter D
authors.initials: PD
authors.lastname: Paré
authors.forename: James C
authors.initials: JC
authors.lastname: Hogg
mesh_terms: D000328:Adult; D000368:Aged; D000402:Airway Obstruction / Q000209:etiology / Q000473:pathology*; D016022:Case-Control Studies; D004646:Emphysema / Q000150:complications / Q000473:pathology*; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008168:Lung / Q000473:pathology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010641:Phenotype; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000473:pathology*; D012720:Severity of Illness Index; D013147:Spirometry; D019896:alpha 1-Antitrypsin Deficiency / Q000150:complications / Q000473:pathology