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Published ahead of print on October 11, 2004, doi:10.1164/rccm.200405-659OC
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American Journal of Respiratory and Critical Care Medicine Vol 171. pp. 40-47, (2005)
© 2005 American Thoracic Society
doi: 10.1164/rccm.200405-659OC

Original Article

Small Airway Morphometry and Improvement in Pulmonary Function after Lung Volume Reduction Surgery

Victor Kim, Gerard J. Criner, Heba Y. Abdallah, John P. Gaughan, Satoshi Furukawa and Charalambos C. Solomides

Division of Pulmonary and Critical Care Medicine, Department of Medicine, and the Departments of Biostatistics, Pathology, and Cardiothoracic Surgery, Temple University School of Medicine, Philadelphia, Pennsylvania

Correspondence and requests for reprints should be addressed to Gerard J. Criner, M.D., Division of Pulmonary and Critical Care Medicine, Temple Lung Center, Temple University Hospital, 777 Parkinson Pavilion, 3401 North Broad Street, Philadelphia, PA 19140. E-mail: crinerg{at}tuhs.temple.edu

We examined small airway morphometry from resected lung specimens in 25 patients with severe emphysema undergoing lung volume reduction surgery (LVRS) and correlated their pathologic findings to changes in FEV1 6 months after LVRS. Patients were classified into two groups: responders had a more than 12% and a more than 200-ml change in FEV1 at 6 months, and nonresponders had 12% or less and/or 200 ml or less change in FEV1. Epithelial height (EH) and perimeters and areas of peribronchial smooth muscle, epithelium, and subepithelial space were measured quantitatively. The degrees of interstitial fibrosis, vascular sclerosis, goblet cell hyperplasia, squamous metaplasia, chronic inflammation, peribronchial fibrosis, and bullous disease were assessed semiquantitatively. Despite similar baseline characteristics, nonresponders had a greater EH (0.045 vs. 0.035 mm, p = 0.025), greater EH adjusted for basement membrane perimeter (0.040 vs. 0.011, p = 0.016), greater epithelial area adjusted for basement membrane area (0.561 vs. 0.499, p = 0.040), and less bullous disease (1.7 vs. 2.6, p = 0.011) compared with responders. We found a linear relationship between percentage change in FEV1 and bullous disease and inverse relationships between percentage change in FEV1 and interstitial fibrosis, goblet cell hyperplasia, peribronchial fibrosis, and vascular sclerosis. We conclude that small airway morphometry and lung histopathology in patients with severe emphysema have an important influence on changes in FEV1 6 months after LVRS.

Key Words: emphysema • pathology, surgical • pulmonary disease, chronic obstructive/pa (pathology) • pulmonary surgical procedures • respiratory function tests




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