Open AccessUpdate on the roles of distal airways in COPD
Author(s) -
PierreRégis Burgel,
Arnaud Bourdin,
Pascal Chanez,
F. Chabot,
Ari Chaouat,
Thierry Chinet,
Jacques de Blic,
Philippe Devillier,
A. Deschildre,
A. Didier,
Gilles Garcia,
G. Jébrak,
François Laurent,
Hugues Morel,
Thierry Pérez,
Charles Pilette,
N. Roche,
Isabelle Tillie-Leblond,
Sylvia Verbanck,
Daniel Dusser
Publication year - 2011
Publication title -
european respiratory review
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.565
H-Index - 66
eISSN - 1600-0617
pISSN - 0905-9180
DOI - 10.1183/09059180.10010610
Subject(s) - medicine , copd , small airways , airway , inflammation , natural history , infiltration (hvac) , pathology , lung , pulmonary disease , ex vivo , immunology , in vivo , surgery , microbiology and biotechnology , biology , thermodynamics , physics
This review is the summary of a workshop on the role of distal airways in chronic obstructive pulmonary disease (COPD), which took place in 2009 in Vence, France. The evidence showing inflammation and remodelling in distal airways and the possible involvement of these in the pathobiology, physiology, clinical manifestations and natural history of COPD were examined. The usefulness and limitations of physiological tests and imaging techniques for assessing distal airways abnormalities were evaluated. Ex vivo studies in isolated lungs and invasive measurements of airway resistance in living individuals have revealed that distal airways represent the main site of airflow limitation in COPD. Structural changes in small conducting airways, including increased wall thickness and obstruction by muco-inflammatory exudates, and emphysema (resulting in premature airway closure), were important determinants of airflow limitation. Infiltration of small conducting airways by phagocytes (macrophages and neutrophils), dendritic cells and T and B lymphocytes increased with airflow limitation. Distal airways abnormalities were associated with patient-related outcomes (e.g. dyspnoea and reduced health-related quality of life) and with the natural history of the disease, as reflected by lung function decline and mortality. These data provide a clear rationale for targeting distal airways in COPD.