Published ahead of print on October 11, 2004, doi:10.1164/rccm.200405-659OC
Am. J. Respir. Crit. Care Med., Volume 171, Number 1, January 2005, 40-47
A more recent version of this article appeared on January 1, 2005
Submitted on May 21, 2004
Accepted on October 1, 2004
Small Airway Morphometry and Improvement in Pulmonary Function after Lung Volume Reduction Surgery
Victor Kim1*, Gerard J Criner1, Heba Y Abdallah2, John P Gaughan3, Satoshi Furukawa4, and Charalambos C Solomides2
1 Division of Pulmonary and Critical Care Medicine, Department of Medicine, Temple University School of Medicine, Philadelphia, PA, USA,
2 Department of Pathology, Temple University School of Medicine, Philadelphia, PA, USA,
3 Department of Biostatistics, Temple University School of Medicine, Philadelphia, PA, USA,
4 Division of Cardiothoracic Surgery, Temple University School of Medicine, Philadelphia, PA, USA
* To whom correspondence should be addressed. E-mail: kimvic{at}tuhs.temple.edu.
We examined small airways morphometry from resected lung specimens in 25 severe emphysema patients undergoing lung volume reduction surgery (LVRS) and correlated their pathological findings to changes in FEV1 6 months post LVRS. Patients were classified into 2 groups: responders had a >12% and > 200mL change in FEV1 at 6 months, and nonresponders had  12% and/or 200 ml change in FEV1. Epithelial height 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 epithelial height (0.045mm vs. 0.035mm,p=0.025), greater epithelial height 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 to responders. We found a linear relationship between %change in FEV1 and bullous disease, and inverse relationships between %change in FEV1 and interstitial fibrosis, goblet cell hyperplasia, peribronchial fibrosis, and vascular sclerosis. We conclude that small airway morphometry and lung histopathology in severe emphysema patients has an important influence on changes in FEV1 6 months post LVRS.
Key words: Emphysema, Pathology, Surgical, Pulmonary Disease, Chronic Obstructive
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