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Updated: Aug 29, 2026
Determining Ciliary Function and Membrane Impermeability of the Pseudostratified Lung Airway Epithelium
Published on: February 21, 2025
Airway structure, function and development in health and disease
Thomas H Shaffer1, Marla R Wolfson, Howard B Panitch
1Department of Physiology, Temple University School of Medicine, Philadelphia, PA 19104, USA. tshaffer@astro.ocis.temple.edu
Insights
Immature airways in preterm neonates are vulnerable to damage, increasing risks for bronchopulmonary dysplasia (BPD). Understanding airway mechanics and structure is crucial for developing safer mechanical ventilation strategies.
Area of Science:
- Neonatal respiratory physiology
- Pulmonary medicine
- Pediatric pulmonology
Background:
- Immature airways in neonates are susceptible to damage, with factors like reduced smooth muscle contractility and cartilage immaturity contributing to bronchopulmonary dysplasia (BPD).
- Mechanical ventilation, while standard for preterm infants, can significantly alter the dimensions and mechanical properties of developing airways.
Purpose of the Study:
- To explore the vulnerability of immature airways in preterm neonates.
- To correlate basic laboratory studies of airway ultrastructure with clinical pulmonary function studies.
- To inform the design of less damaging mechanical ventilation protocols for preterm infants.
Main Methods:
- Clinical evaluation of airway function, including tidal breathing measurements (airway resistance, reactivity), forced expiratory flow measurements (maximal expiratory flow at various lung volumes - Vmax), radiography (CT, virtual bronchoscopy), and endoscopy.
- Imaging techniques to assess airway dimensions and cross-sectional area during breathing.
- Proposed basic laboratory studies of airway ultrastructure.
Main Results:
- Airway resistance and reactivity are elevated in infants with BPD.
- Small-airway obstruction in BPD is indicated by reduced Vmax.
- Imaging reveals decreased airway cross-sectional area during exhalation and tracheomegaly in very preterm infants on mechanical ventilation.
Conclusions:
- Immature airway characteristics predispose neonates to BPD.
- Mechanical ventilation impacts preterm airway dimensions and properties.
- Further research correlating airway ultrastructure with clinical function is needed to optimize ventilation strategies and protect developing lungs.
Abstract:
Until they are fully mature, the airways are highly susceptible to damage. Factors that may contribute to vulnerability of immature airways and the occurrence of bronchopulmonary dysplasia (BPD) in preterm neonates include decreased contractility of smooth muscles of the airway, which leads to generation of lower forces, and immaturity of airway cartilage, leading to increased compressibility of developing airways. Mechanical ventilation has little effect on adult airways, but affects the dimensions and mechanical properties of preterm and newborn airways. Techniques for clinical evaluation of airway function include: (i). measurements of airway function during tidal breathing (airway resistance and reactivity are significantly elevated in infants with BPD); (ii). forced expiratory flow measurements [small-airway obstruction in infants with BPD is indicated by markedly reduced maximal volume measurements (Vmax)]; (iii). radiography procedures (plain radiographs, fluoroscopy, computed tomography and virtual bronchoscopy); and (iv). endoscopy procedures (rigid or flexible bronchoscopy, with or without measurement of oesophageal pressure). Imaging has demonstrated an excessively decreased airway cross-sectional area during exhalation in infants with BPD and acquired tracheomegaly in very preterm infants who had received mechanical ventilatory support. To further advance our understanding of how the airways develop, and to design less damaging protocols for mechanical ventilation in preterm neonates, basic laboratory studies of airway ultrastructure need to be performed and the results correlated with clinical pulmonary function studies.
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