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Original Research: COPD |

The Association Between Small Airway Obstruction and Emphysema Phenotypes in COPD*

Won-Dong Kim, MD, FCCP; Sean H. Ling, BSc; Harvey O. Coxson, PhD; John C. English, MD, FCCP; John Yee, MD; Robert D. Levy, MD, FCCP; Peter D. Paré, MD; James C. Hogg, MD, PhD, FCCP
Author and Funding Information

*From the Division of Pulmonary and Critical Care Medicine (Dr. Kim), Department of Internal Medicine, University of Ulsan College of Medicine, Seoul, Republic of Korea; The James Hogg iCAPTURE Center for Cardiovascular and Pulmonary Research, St. Paul’s Hospital (Mr. Ling and Drs. Coxson, Levy, Paré and Hogg), the Department of Surgery (Dr. Yee), and the Department of Pathology (Dr. English), Vancouver General Hospital, University of British Columbia, Vancouver, Canada.

Correspondence to: Won-Dong Kim, MD, FCCP, 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; e-mail: wdkim@amc.seoul.kr



Chest. 2007;131(5):1372-1378. doi:10.1378/chest.06-2194
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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 FEV1.

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 α1-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 FEV1 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.

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