Small airway pathology and bronchoreversibility in advanced emphysema
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Updated: Jun 13, 2026

Automated Measurement of Pulmonary Emphysema and Small Airway Remodeling in Cigarette Smoke-exposed Mice
Published on: January 16, 2015
Victor Kim1, Rita M Pechulis, Mohammad Abuel-Haija
1Division of Pulmonary and Critical Care Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania, United States. victor.kim@tuhs.temple.edu
Background:
Poorly reversible airflow obstruction is a hallmark feature of chronic obstructive pulmonary disease (COPD). However, some COPD patients demonstrate significant bronchodilator reversibility (BDR). The pathologic features associated with the presence or absence of this phenomenon are not known.
Methods:
We analyzed 67 patients with advanced upper lobe predominant emphysema who underwent lung volume reduction surgery and divided them into 2 groups: the reversible group [BD(+)] had a >12% and >200 mL increase in FEV(1) or FVC with bronchodilator; the irreversible group [BD(-)] had a
Results:
Despite similar baseline characteristics, the BD(+) group had a smaller EH (0.036 mm vs. 0.042 mm, p = 0.005) and EH/BMP (0.012 vs. 0.014, p = 0.007), and a greater SMWA/BMA (0.491 vs. 0.430, p = 0.034) compared to the BD(-) group. In addition, EA trended to be smaller in the BD(+) group when compared to the BD(-) group (0.160 mm(2) vs. 0.184 mm(2), p = 0.06). In a subset of patients with consistent patterns of BDR on serial testing, the BD(+) group had greater SMWA/BMA (0.518 vs. 0.433, p = 0.049) and TWA/BMA (1.405 vs. 1.266, p = 0.036) compared to the BD(-) group.
Conclusions:
Small airway smooth muscle mass may play a role in determining BDR in severe emphysema.
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