Abstract
Background: The epithelial reticular basement membrane (Rbm) of the airway wall thickens in patients with asthma. However, whether the thickening parallels whole airway wall thickening, which limits airflow, is unknown. The aim of this study was to examine the correlation between the bronchial Rbm thickening and whole airway wall thickening in asthma. In addition, the association of Rbm and whole wall thickening with airflow obstruction was examined.
Methods: Forty nine patients with asthma and 18 healthy control subjects took part in the study. The Rbm thickness was measured in bronchial biopsy specimens and whole airway wall thickness was assessed with high resolution computed tomographic (HRCT) scanning after pretreatment with oral steroids for 2 weeks and inhaled ß2 agonist to minimise reversible changes of the airway walls. The percentage airway wall area (WA%; defined as (wall area/total airway area) x 100) and percentage airway wall thickness (WT%; defined as [(ideal outer diameter – ideal luminal diameter)/ideal outer diameter] x 100) were determined from HRCT scans to assess whole airway wall thickness. Spirometric tests were also performed.
Results: WA% and WT% were higher in patients with asthma than in healthy subjects. Both WA% and WT% were strongly correlated with Rbm thickness. Moreover, these three indices of airway wall thickness were inversely correlated with the percentage of predicted forced expiratory volume in 1 second in patients with asthma.
Conclusions: These findings indicate that Rbm thickening parallels whole airway wall thickening which can cause irreversible airflow obstruction in patients with asthma.
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Selected References
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- Aikawa T., Shimura S., Sasaki H., Ebina M., Takishima T. Marked goblet cell hyperplasia with mucus accumulation in the airways of patients who died of severe acute asthma attack. Chest. 1992 Apr;101(4):916–921. doi: 10.1378/chest.101.4.916. [DOI] [PubMed] [Google Scholar]
- Awadh N., Müller N. L., Park C. S., Abboud R. T., FitzGerald J. M. Airway wall thickness in patients with near fatal asthma and control groups: assessment with high resolution computed tomographic scanning. Thorax. 1998 Apr;53(4):248–253. doi: 10.1136/thx.53.4.248. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Backman K. S., Greenberger P. A., Patterson R. Airways obstruction in patients with long-term asthma consistent with 'irreversible asthma'. Chest. 1997 Nov 5;112(5):1234–1240. doi: 10.1378/chest.112.5.1234. [DOI] [PubMed] [Google Scholar]
- Boulet L. P., Laviolette M., Turcotte H., Cartier A., Dugas M., Malo J. L., Boutet M. Bronchial subepithelial fibrosis correlates with airway responsiveness to methacholine. Chest. 1997 Jul;112(1):45–52. doi: 10.1378/chest.112.1.45. [DOI] [PubMed] [Google Scholar]
- Boulet L., Bélanger M., Carrier G. Airway responsiveness and bronchial-wall thickness in asthma with or without fixed airflow obstruction. Am J Respir Crit Care Med. 1995 Sep;152(3):865–871. doi: 10.1164/ajrccm.152.3.7663797. [DOI] [PubMed] [Google Scholar]
- Chetta A., Foresi A., Del Donno M., Bertorelli G., Pesci A., Olivieri D. Airways remodeling is a distinctive feature of asthma and is related to severity of disease. Chest. 1997 Apr;111(4):852–857. doi: 10.1378/chest.111.4.852. [DOI] [PubMed] [Google Scholar]
- Chetta A., Foresi A., Del Donno M., Consigli G. F., Bertorelli G., Pesci A., Barbee R. A., Olivieri D. Bronchial responsiveness to distilled water and methacholine and its relationship to inflammation and remodeling of the airways in asthma. Am J Respir Crit Care Med. 1996 Mar;153(3):910–917. doi: 10.1164/ajrccm.153.3.8630572. [DOI] [PubMed] [Google Scholar]
- Cho S. H., Seo J. Y., Choi D. C., Yoon H. J., Cho Y. J., Min K. U., Lee G. K., Seo J. W., Kim Y. Y. Pathological changes according to the severity of asthma. Clin Exp Allergy. 1996 Oct;26(10):1210–1219. doi: 10.1111/j.1365-2222.1996.tb00510.x. [DOI] [PubMed] [Google Scholar]
- Chu H. W., Halliday J. L., Martin R. J., Leung D. Y., Szefler S. J., Wenzel S. E. Collagen deposition in large airways may not differentiate severe asthma from milder forms of the disease. Am J Respir Crit Care Med. 1998 Dec;158(6):1936–1944. doi: 10.1164/ajrccm.158.6.9712073. [DOI] [PubMed] [Google Scholar]
- Dunnill M. S., Massarella G. R., Anderson J. A. A comparison of the quantitative anatomy of the bronchi in normal subjects, in status asthmaticus, in chronic bronchitis, and in emphysema. Thorax. 1969 Mar;24(2):176–179. doi: 10.1136/thx.24.2.176. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Ebina M., Takahashi T., Chiba T., Motomiya M. Cellular hypertrophy and hyperplasia of airway smooth muscles underlying bronchial asthma. A 3-D morphometric study. Am Rev Respir Dis. 1993 Sep;148(3):720–726. doi: 10.1164/ajrccm/148.3.720. [DOI] [PubMed] [Google Scholar]
- Ebina M., Yaegashi H., Chiba R., Takahashi T., Motomiya M., Tanemura M. Hyperreactive site in the airway tree of asthmatic patients revealed by thickening of bronchial muscles. A morphometric study. Am Rev Respir Dis. 1990 May;141(5 Pt 1):1327–1332. doi: 10.1164/ajrccm/141.5_Pt_1.1327. [DOI] [PubMed] [Google Scholar]
- Elias J. A., Zhu Z., Chupp G., Homer R. J. Airway remodeling in asthma. J Clin Invest. 1999 Oct;104(8):1001–1006. doi: 10.1172/JCI8124. [DOI] [PMC free article] [PubMed] [Google Scholar]
- James A. L., Paré P. D., Hogg J. C. The mechanics of airway narrowing in asthma. Am Rev Respir Dis. 1989 Jan;139(1):242–246. doi: 10.1164/ajrccm/139.1.242. [DOI] [PubMed] [Google Scholar]
- Jeffery P. K., Godfrey R. W., Adelroth E., Nelson F., Rogers A., Johansson S. A. Effects of treatment on airway inflammation and thickening of basement membrane reticular collagen in asthma. A quantitative light and electron microscopic study. Am Rev Respir Dis. 1992 Apr;145(4 Pt 1):890–899. doi: 10.1164/ajrccm/145.4_Pt_1.890. [DOI] [PubMed] [Google Scholar]
- Kim K. C., McCracken K., Lee B. C., Shin C. Y., Jo M. J., Lee C. J., Ko K. H. Airway goblet cell mucin: its structure and regulation of secretion. Eur Respir J. 1997 Nov;10(11):2644–2649. doi: 10.1183/09031936.97.10112644. [DOI] [PubMed] [Google Scholar]
- King G. G., Müller N. L., Paré P. D. Evaluation of airways in obstructive pulmonary disease using high-resolution computed tomography. Am J Respir Crit Care Med. 1999 Mar;159(3):992–1004. doi: 10.1164/ajrccm.159.3.9805064. [DOI] [PubMed] [Google Scholar]
- Lange P., Parner J., Vestbo J., Schnohr P., Jensen G. A 15-year follow-up study of ventilatory function in adults with asthma. N Engl J Med. 1998 Oct 22;339(17):1194–1200. doi: 10.1056/NEJM199810223391703. [DOI] [PubMed] [Google Scholar]
- Okazawa M., Müller N., McNamara A. E., Child S., Verburgt L., Paré P. D. Human airway narrowing measured using high resolution computed tomography. Am J Respir Crit Care Med. 1996 Nov;154(5):1557–1562. doi: 10.1164/ajrccm.154.5.8912780. [DOI] [PubMed] [Google Scholar]
- Paganin F., Séneterre E., Chanez P., Daurés J. P., Bruel J. M., Michel F. B., Bousquet J. Computed tomography of the lungs in asthma: influence of disease severity and etiology. Am J Respir Crit Care Med. 1996 Jan;153(1):110–114. doi: 10.1164/ajrccm.153.1.8542102. [DOI] [PubMed] [Google Scholar]
- Park J. W., Hong Y. K., Kim C. W., Kim D. K., Choe K. O., Hong C. S. High-resolution computed tomography in patients with bronchial asthma: correlation with clinical features, pulmonary functions and bronchial hyperresponsiveness. J Investig Allergol Clin Immunol. 1997 May-Jun;7(3):186–192. [PubMed] [Google Scholar]
- Roche W. R., Beasley R., Williams J. H., Holgate S. T. Subepithelial fibrosis in the bronchi of asthmatics. Lancet. 1989 Mar 11;1(8637):520–524. doi: 10.1016/s0140-6736(89)90067-6. [DOI] [PubMed] [Google Scholar]
- Watanabe K., Senju S., Toyoshima H., Yoshida M. Thickness of the basement membrane of bronchial epithelial cells in lung diseases as determined by transbronchial biopsy. Respir Med. 1997 Aug;91(7):406–410. doi: 10.1016/s0954-6111(97)90254-7. [DOI] [PubMed] [Google Scholar]