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Sirol Aflah Syazatul S, Piciucchi S, Tomassetti S, Ravaglia C, Dubini A, Poletti V. Cryobiopsy in the diagnosis of bronchiolitis: a retrospective analysis of twenty-three consecutive patients. Sci Rep 2020; 10:10906. [PMID: 32616807 PMCID: PMC7331727 DOI: 10.1038/s41598-020-67938-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 06/10/2020] [Indexed: 12/25/2022] Open
Abstract
Bronchiolitis manifests as a variety of histological features that explain the complex clinical profiles and imaging aspects. In the period between January 2011 and June 2015, patients with a cryobiopsy diagnosis of bronchiolitis were retrospectively retrieved from the database of our institution. Clinical profiles, imaging features and histologic diagnoses were analysed to identify the role of cryobiopsy in the diagnostic process. Twenty-three patients with a multidisciplinary diagnosis of small airway disease were retrieved (14 females, 9 males; age range 31-74 years old; mean age 54.2 years old). The final MDT diagnoses were post-infectious bronchiolitis (n = 5), constrictive bronchiolitis (n = 3), DIPNECH (n = 1), idiopathic follicular bronchiolitis (n = 3), Sjogren's disease (n = 1), GLILD (n = 1), smoking-related interstitial lung disease (n = 6), sarcoid with granulomatous bronchiolar disorder (n = 1), and subacute hypersensitivity pneumonitis (n = 2). Complications reported after the cryobiopsy procedure consisted of two cases of pneumothorax soon after the biopsy (8.7%), which were successfully managed with the insertion of a chest tube. Transbronchial cryobiopsy represents a robust and mini-invasive method in the characterization of small airway diseases, allowing a low percentage of complications and good diagnostic confidence.
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Affiliation(s)
- Syakirin Sirol Aflah Syazatul
- Department of Diseases of the Thorax, G.B. Morgagni Hospital, Forlì, Italy.,Institute of Respiratory Medicine, Kuala Lumpur, Malaysia
| | - Sara Piciucchi
- Radiology Department, G.B. Morgagni Hospital, Forlì, Italy.
| | - Sara Tomassetti
- Department of Experimental and Clinical Medicine, Careggi University Hospital, Florence, Italy
| | - Claudia Ravaglia
- Department of Diseases of the Thorax, G.B. Morgagni Hospital, Forlì, Italy
| | | | - Venerino Poletti
- Department of Diseases of the Thorax, G.B. Morgagni Hospital, Forlì, Italy.,Department of Respiratory Diseases and Allergology, Aarhus University Hospital, Aarhus, Denmark
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2
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Higham A, Quinn AM, Cançado JED, Singh D. The pathology of small airways disease in COPD: historical aspects and future directions. Respir Res 2019; 20:49. [PMID: 30832670 PMCID: PMC6399904 DOI: 10.1186/s12931-019-1017-y] [Citation(s) in RCA: 126] [Impact Index Per Article: 25.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 02/25/2019] [Indexed: 12/16/2022] Open
Abstract
Small airways disease (SAD) is a cardinal feature of chronic obstructive pulmonary disease (COPD) first recognized in the nineteenth century. The diverse histopathological features associated with SAD underpin the heterogeneous nature of COPD. Our understanding of the key molecular mechanisms which drive the pathological changes are not complete. In this article we will provide a historical overview of key histopathological studies which have helped shape our understanding of SAD and discuss the hallmark features of airway remodelling, mucous plugging and inflammation. We focus on the relationship between SAD and emphysema, SAD in the early stages of COPD, and the mechanisms which cause SAD progression, including bacterial colonization and exacerbations. We discuss the need to specifically target SAD to attenuate the progression of COPD.
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Affiliation(s)
- Andrew Higham
- The University of Manchester Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK.
| | - Anne Marie Quinn
- Department of Histopathology, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | | | - Dave Singh
- The University of Manchester Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK.,Medicines Evaluation Unit, The Langley Building, Southmoor Road, Manchester, UK
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3
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Raju SV, Kim H, Byzek SA, Tang LP, Trombley JE, Jackson P, Rasmussen L, Wells JM, Libby EF, Dohm E, Winter L, Samuel SL, Zinn KR, Blalock JE, Schoeb TR, Dransfield MT, Rowe SM. A ferret model of COPD-related chronic bronchitis. JCI Insight 2016; 1:e87536. [PMID: 27699245 DOI: 10.1172/jci.insight.87536] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is the third leading cause of death in the US. The majority of COPD patients have symptoms of chronic bronchitis, which lacks specific therapies. A major impediment to therapeutic development has been the absence of animal models that recapitulate key clinical and pathologic features of human disease. Ferrets are well suited for the investigation of the significance of respiratory diseases, given prior data indicating similarities to human airway physiology and submucosal gland distribution. Here, we exposed ferrets to chronic cigarette smoke and found them to approximate complex clinical features of human COPD. Unlike mice, which develop solely emphysema, smoke-exposed ferrets exhibited markedly higher numbers of early-morning spontaneous coughs and sporadic infectious exacerbations as well as a higher level of airway obstruction accompanied by goblet cell metaplasia/hyperplasia and increased mucus expression in small airways, indicative of chronic bronchitis and bronchiolitis. Overall, we demonstrate the first COPD animal model exhibiting clinical and pathologic features of chronic bronchitis to our knowledge, providing a key advance that will greatly facilitate the preclinical development of novel treatments for this disease.
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Affiliation(s)
| | | | | | | | | | | | | | - J Michael Wells
- Department of Medicine.,UAB Lung Health Center, and.,Gregory Fleming James Cystic Fibrosis Research Center, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Emily Falk Libby
- Department of Medicine.,Gregory Fleming James Cystic Fibrosis Research Center, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Erik Dohm
- Animal Resources Program, Birmingham, Alabama, USA
| | | | | | | | - J Edwin Blalock
- Department of Medicine.,UAB Lung Health Center, and.,Gregory Fleming James Cystic Fibrosis Research Center, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Trenton R Schoeb
- Gregory Fleming James Cystic Fibrosis Research Center, University of Alabama at Birmingham, Birmingham, Alabama, USA.,Department of Genetics, and
| | - Mark T Dransfield
- Department of Medicine.,UAB Lung Health Center, and.,Gregory Fleming James Cystic Fibrosis Research Center, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Steven M Rowe
- Department of Medicine.,UAB Lung Health Center, and.,Gregory Fleming James Cystic Fibrosis Research Center, University of Alabama at Birmingham, Birmingham, Alabama, USA.,Department of Pediatrics.,Department of Cell, Developmental, and Integrative Biology, University of Alabama at Birmingham, Birmingham, Alabama, USA
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4
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Caramori G, Casolari P, Barczyk A, Durham AL, Di Stefano A, Adcock I. COPD immunopathology. Semin Immunopathol 2016; 38:497-515. [PMID: 27178410 PMCID: PMC4897000 DOI: 10.1007/s00281-016-0561-5] [Citation(s) in RCA: 122] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 04/20/2016] [Indexed: 02/06/2023]
Abstract
The immunopathology of chronic obstructive pulmonary disease (COPD) is based on the innate and adaptive inflammatory immune responses to the chronic inhalation of cigarette smoking. In the last quarter of the century, the analysis of specimens obtained from the lower airways of COPD patients compared with those from a control group of age-matched smokers with normal lung function has provided novel insights on the potential pathogenetic role of the different cells of the innate and acquired immune responses and their pro/anti-inflammatory mediators and intracellular signalling pathways, contributing to a better knowledge of the immunopathology of COPD both during its stable phase and during its exacerbations. This also has provided a scientific rationale for new drugs discovery and targeting to the lower airways. This review summarises and discusses the immunopathology of COPD patients, of different severity, compared with control smokers with normal lung function.
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Affiliation(s)
- Gaetano Caramori
- Centro Interdipartimentale per lo Studio delle Malattie Infiammatorie delle Vie Aeree e Patologie Fumo-correlate (CEMICEF; formerly named Centro di Ricerca su Asma e BPCO), Sezione di Medicina Interna e Cardiorespiratoria, Università di Ferrara, Via Savonarola 9, 44121, Ferrara, Italy.
| | - Paolo Casolari
- Centro Interdipartimentale per lo Studio delle Malattie Infiammatorie delle Vie Aeree e Patologie Fumo-correlate (CEMICEF; formerly named Centro di Ricerca su Asma e BPCO), Sezione di Medicina Interna e Cardiorespiratoria, Università di Ferrara, Via Savonarola 9, 44121, Ferrara, Italy
| | - Adam Barczyk
- Katedra i Klinika Pneumonologii, Slaski Uniwersytet Medyczny w Katowicach, Katowice, Poland
| | - Andrew L Durham
- Airways Disease Section, National Heart and Lung Institute, Imperial College London, London, UK
| | - Antonino Di Stefano
- Divisione di Pneumologia e Laboratorio di Citoimmunopatologia dell'Apparato Cardio Respiratorio, Salvatore Maugeri Foundation, IRCCS, Veruno, NO, Italy
| | - Ian Adcock
- Airways Disease Section, National Heart and Lung Institute, Imperial College London, London, UK
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5
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Yew-Booth L, Birrell MA, Lau MS, Baker K, Jones V, Kilty I, Belvisi MG. JAK–STAT pathway activation in COPD. Eur Respir J 2015; 46:843-5. [DOI: 10.1183/09031936.00228414] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 03/17/2015] [Indexed: 11/05/2022]
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6
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Burrowes KS, De Backer J, Smallwood R, Sterk PJ, Gut I, Wirix-Speetjens R, Siddiqui S, Owers-Bradley J, Wild J, Maier D, Brightling C. Multi-scale computational models of the airways to unravel the pathophysiological mechanisms in asthma and chronic obstructive pulmonary disease (AirPROM). Interface Focus 2014; 3:20120057. [PMID: 24427517 DOI: 10.1098/rsfs.2012.0057] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
THE RESPIRATORY SYSTEM COMPRISES SEVERAL SCALES OF BIOLOGICAL COMPLEXITY: the genes, cells and tissues that work in concert to generate resultant function. Malfunctions of the structure or function of components at any spatial scale can result in diseases, to the detriment of gas exchange, right heart function and patient quality of life. Vast amounts of data emerge from studies across each of the biological scales; however, the question remains: how can we integrate and interpret these data in a meaningful way? Respiratory disease presents a huge health and economic burden, with the diseases asthma and chronic obstructive pulmonary disease (COPD) affecting over 500 million people worldwide. Current therapies are inadequate owing to our incomplete understanding of the disease pathophysiology and our lack of recognition of the enormous disease heterogeneity: we need to characterize this heterogeneity on a patient-specific basis to advance healthcare. In an effort to achieve this goal, the AirPROM consortium (Airway disease Predicting Outcomes through patient-specific computational Modelling) brings together a multi-disciplinary team and a wealth of clinical data. Together we are developing an integrated multi-scale model of the airways in order to unravel the complex pathophysiological mechanisms occurring in the diseases asthma and COPD.
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Affiliation(s)
- K S Burrowes
- Department of Computer Science , University of Oxford , Parks Road, Oxford OX1 3QD , UK
| | | | - R Smallwood
- Kroto Research Institute , University of Sheffield , Sheffield , UK
| | - P J Sterk
- Academic Medical Centre , University of Amsterdam , Amsterdam , The Netherlands
| | - I Gut
- Centro Nacional de Analysis Genómica, Fundacio Privada Parc Cientific de Barcelona , Barcelona , Spain
| | | | - S Siddiqui
- Institute for Lung Health , University of Leicester , Leicester , UK
| | - J Owers-Bradley
- School of Physics and Astronomy, University of Nottingham , Nottingham , UK
| | - J Wild
- Unit of Academic Radiology , University of Sheffield , Sheffield , UK
| | - D Maier
- Biomax Informatics AG , Munich , Germany
| | - C Brightling
- Institute for Lung Health , University of Leicester , Leicester , UK
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7
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Abstract
Computed tomography (CT) is the modality of choice for imaging the airways. Volumetric data sets with isotropic spatial resolution based on multidetector thin-section CT with overlapping reconstruction should be used. Chronic obstructive pulmonary disease and asthma are the 2 most common disease entities that are defined by airflow obstruction. The morphologic correlates of airway changes are dilation of the lumen, thickening of the wall, visibility of small airways due to mucus or edema, air trapping, hypoxic vasoconstriction, and collapsibility. To assess air trapping, additional expiratory low-dose scans are recommended. In clinical routine, these findings are visually assessed and should be routinely reported. However, the interobserver variability is high, and there is a clear need for objective software-based measurements. The development of such tools is challenging, and they are just becoming available on a broader scale. Novel techniques based on dual-energy CT aim to measure iodine distribution maps to assess pulmonary perfusion as well as the distribution of inhaled xenon gas to assess the distribution and time course of pulmonary ventilation. However, these techniques are still being investigated in clinical studies. This review will provide an overview of CT for the diagnosis of chronic obstructive pulmonary disease and asthma, its role in phenotyping these diseases, and the measurement of disease severity and functional compromise.
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8
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Ley-Zaporozhan J, van Beek EJ. Imaging phenotypes of chronic obstructive pulmonary disease. J Magn Reson Imaging 2010; 32:1340-52. [DOI: 10.1002/jmri.22376] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
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Abstract
The term "small airway disease" has been used in reference to abnormalities occurring secondary to cigarette smoking in the context of chronic obstructive pulmonary disease (COPD), and the small airways are the major site of obstruction in patients with COPD. The histologic features associated with smoking-related small airway disease are largely nonspecific and overlap with those of other bronchiolitides. The pathogenesis of smoking-related small airway disease is poorly understood; however, insights into the development of airway remodeling and matrix production continue to evolve. The aim of this article will be to review the histologic findings and pathogenesis of smoking-related small airway disease in the context of COPD, and review other small airway disorders affecting cigarette smokers, namely respiratory bronchiolitis and Langerhans cell histiocytosis, and a newly described entity of respiratory bronchiolitis with fibrosis and associated issues with this entity.
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Ley-Zaporozhan J, Kauczor HU. Imaging of Airways: Chronic Obstructive Pulmonary Disease. Radiol Clin North Am 2009; 47:331-42. [DOI: 10.1016/j.rcl.2008.11.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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12
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Martorana PA, Lunghi B, Lucattelli M, De Cunto G, Beume R, Lungarella G. Effect of roflumilast on inflammatory cells in the lungs of cigarette smoke-exposed mice. BMC Pulm Med 2008; 8:17. [PMID: 18755021 PMCID: PMC2533284 DOI: 10.1186/1471-2466-8-17] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2008] [Accepted: 08/28/2008] [Indexed: 12/02/2022] Open
Abstract
Background We reported that roflumilast, a phosphodiesterase 4 inhibitor, given orally at 5 mg/kg to mice prevented the development of emphysema in a chronic model of cigarette smoke exposure, while at 1 mg/kg was ineffective. Here we investigated the effects of roflumilast on the volume density (VV) of the inflammatory cells present in the lungs after chronic cigarette smoke exposure. Methods Slides were obtained from blocks of the previous study and VV was assessed immunohistochemically and by point counting using a grid with 48 points, a 20× objective and a computer screen for a final magnification of 580×. Neutrophils were marked with myeloperoxidase antibody, macrophages with Mac-3, dendritic cells with fascin, B-lymphocytes with B220, CD4+ T-cells with CD4+ antibody, and CD8+T-cells with CD8-α. The significance of the differences was calculated using one-way analysis of variance. Results Chronic smoke exposure increased neutrophil VV by 97%, macrophage by 107%, dendritic cell by 217%, B-lymphocyte by 436%, CD4+ by 524%, and CD8+ by 417%. The higher dose of roflumilast prevented the increase in neutrophil VV by 78%, macrophage by 82%, dendritic cell by 48%, B-lymphocyte by 100%, CD4+ by 98% and CD8+ VV by 88%. The lower dose of roflumilast did not prevent the increase in neutrophil, macrophage and B-cell VV but prevented dendritic cells by 42%, CD4+ by 55%, and CD8+ by 91%. Conclusion These results indicate (i) chronic exposure to cigarette smoke in mice results in a significant recruitment into the lung of inflammatory cells of both the innate and adaptive immune system; (ii) roflumilast at the higher dose exerts a protective effect against the recruitment of all these cells and at the lower dose against the recruitment of dendritic cells and T-lymphocytes; (iii) these findings underline the role of innate immunity in the development of pulmonary emphysema and (iiii) support previous results indicating that the inflammatory cells of the adaptive immune system do not play a central role in the development of cigarette smoke induced emphysema in mice.
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Affiliation(s)
- Piero A Martorana
- Department of Physiopathology and Experimental Medicine, University of Siena, Siena, Italy.
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Kırkıl G, Hamdi Muz M, Seçkin D, Şahin K, Küçük Ö. Antioxidant effect of zinc picolinate in patients with chronic obstructive pulmonary disease. Respir Med 2008; 102:840-4. [DOI: 10.1016/j.rmed.2008.01.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2007] [Revised: 11/20/2007] [Accepted: 01/14/2008] [Indexed: 12/19/2022]
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14
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Ley-Zaporozhan J, Ley S, Kauczor HU. Morphological and functional imaging in COPD with CT and MRI: present and future. Eur Radiol 2007; 18:510-21. [PMID: 17899100 DOI: 10.1007/s00330-007-0772-1] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2007] [Revised: 08/26/2007] [Accepted: 08/31/2007] [Indexed: 11/26/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is one of the leading causes of morbidity and mortality worldwide. COPD is defined by irreversible airflow obstruction. It is a heterogeneous disease affecting the airways (i.e. chronic bronchitis, airway collapse), the parenchyma (i.e. hyperinflation, air trapping and emphysematous destruction) as well as the vasculature (i.e. hypoxic vasoconstriction, rarefication and pulmonary arterial hypertension) with different severity during the course of the disease. These different aspects of COPD can be best addressed by imaging using a combination of morphological and functional techniques. Three-dimensional high-resolution computed tomography (3D-HRCT) is the technique of choice for morphological imaging of the lung parenchyma and airways. This morphological information is to be accomplished by functional information about perfusion, regional lung mechanics, and ventilation mainly provided by MRI. The comprehensive diagnostic possibilities of CT complemented by MRI will allow for a more sensitive detection, phenotype-driven characterization and dedicated therapy monitoring of COPD as presented in this review.
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Affiliation(s)
- Julia Ley-Zaporozhan
- Department of Radiology (E010), German Cancer Research Center, Im Neuenheimer Feld 280, 69120 Heidelberg, Germany.
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New insights on COPD imaging via CT and MRI. Int J Chron Obstruct Pulmon Dis 2007; 2:301-12. [PMID: 18229568 PMCID: PMC2695207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Multidetector-row computed tomography (MDCT) can be used to quantify morphological features and investigate structure/function relationship in COPD. This approach allows a phenotypical definition of COPD patients, and might improve our understanding of disease pathogenesis and suggest new therapeutical options. In recent years, magnetic resonance imaging (MRI) has also become potentially suitable for the assessment of ventilation, perfusion and respiratory mechanics. This review focuses on the established clinical applications of CT, and novel CT and MRI techniques, which may prove valuable in evaluating the structural and functional damage in COPD.
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Rabe KF, Beghé B, Luppi F, Fabbri LM. Update in chronic obstructive pulmonary disease 2006. Am J Respir Crit Care Med 2007; 175:1222-32. [PMID: 17545457 DOI: 10.1164/rccm.200704-586up] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Affiliation(s)
- Klaus F Rabe
- Department of Pulmonology, Leiden University Medical Center, Leiden, The Netherlands
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