Elsevier

Respiratory Medicine

Volume 96, Issue 2, February 2002, Pages 67-80
Respiratory Medicine

Review
The role of small airways in lung disease

https://doi.org/10.1053/rmed.2001.1216Get rights and content
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Abstract

The small airways constitute one of the least understood areas of the lungs. They play a role in many lung diseases, and small airway pathology results in significant morbidity. New approaches to their evaluation may provide insights into this major area of lung disease. Asthma is well recognized as a disease of both large and small airways. Physiological and pathological evidence, from techniques such as post-mortem tissue histological analysis, induced sputum and transbronchial biopsies, has reinforced the concept of the involvement of the entire bronchial tree in the inflammatory process in asthma. In addition to describing the airway pathology in asthma, this review focuses on the pathogenesis and role of small airway obstruction in other diseases, including chronic obstructive pulmonary disease (COPD), idiopathic pulmonary fibrosis (IPF), sarcoidosis and obliterative bronchiolitis (OB). COPD is characterized by the presence of airflow obstruction resulting from lesions in the small airways. In addition, features compatible with small airways disease are common in IPF, sarcoidosis and OB. Recent advances in pulmonary imaging, such as high-resolution computed tomography (HRCT) and magnetic resonance imaging (MRI) with hyperpolarized3 He, have allowed non-invasive reproducible measurements of structure–function relationships to be made for the small airways. These techniques have great potential for diagnosing changes in small airway function and for assessing responses to treatment. New insights into the contribution of small airways to a range of lung diseases may lead to the development of therapies targeted at this part of the bronchial anatomy.

Keywords

asthma
interstitial lung disease
obliterative bronchiolitis
chronic obstructive pulmonary disease
small airways.

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Correspondence should be addressed to: Prof. Rory J. Shaw, Hammersmith Hospitals Trust, Du Cane Road, London W12 0HS, U.K. Fax: 020 8383 3361; E-mail: [email protected]