Small airways in idiopathic pulmonary fibrosis. Comparison of morphologic and physiologic observations

J. D. Fulmer, W. C. Roberts, E. R. Von Gal, Ronald Crystal

Research output: Contribution to journalArticle

76 Citations (Scopus)

Abstract

18 patients with idiopathic pulmonary fibrosis were studied to determine if they had morphologic evidence of small airways disease and if physiologic testing could predict morphologic findings. In the presence of normal airway function by standard physiologic studies (forced expiratory volume in 1 s/forced vital capacity and airway resistance by plethysmography), dynamic compliance, maximum expiratory flow-volume curves, and maximum flow-static recoil curves were measured to detect physiologic alterations consistent with small airways abnormalities. These physiologic data were then compared with estimates of small airways diameter made in lung biopsy specimens. 94% (17 of 18) of the patients had peribronchiolar fibrosis or peribronchiolar inflammation or bronchiolitis. 67% (12 of 18) had an overall estimate of small airways diameter of 'narrowed', whereas 33% (6 of 18) had airways that overall were 'not narrowed'. 59% (10 of 17) had frequency-dependent dynamic compliance, 50% (9 of 18) had abnormal maximum expiratory flow-volume curves, and 39% (7 of 18) had abnormal maximum flow-static recoil curves. Comparisons between morphologic and physiologic data revealed a significant correlation between the results of dynamic compliance and the overall estimate of small airways diameter (P = 0.001), and the results of maximum flow-volume curves and the overall estimate of small airways diameter (P = 0.009); there was no significant correlation between the results of maximum flow-static recoil curves and the overall estimate of small airways diameter (P = 0.1). The results of this study suggest that: idiopathic pulmonary fibrosis is a disease of small airways as well as alveoli; dynamic compliance and the maximum expiratory flow-volume curve can predict the overall status of small airways diameter in idiopathic pulmonary fibrosis; and whereas the maximum flow-static recoil curve predicts the overall estimate of small airways diameter in most patients with this disease, it is the least sensitive of these 3 monitors of small airways.

Original languageEnglish
Pages (from-to)595-610
Number of pages16
JournalJournal of Clinical Investigation
Volume60
Issue number3
Publication statusPublished - 1 Dec 1977
Externally publishedYes

Fingerprint

Idiopathic Pulmonary Fibrosis
Compliance
Bronchiolitis
Airway Resistance
Plethysmography
Vital Capacity
Forced Expiratory Volume
Fibrosis
Inflammation
Biopsy
Lung

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Small airways in idiopathic pulmonary fibrosis. Comparison of morphologic and physiologic observations. / Fulmer, J. D.; Roberts, W. C.; Von Gal, E. R.; Crystal, Ronald.

In: Journal of Clinical Investigation, Vol. 60, No. 3, 01.12.1977, p. 595-610.

Research output: Contribution to journalArticle

@article{07c614fea99e49f6abe7f8b02b68c9d5,
title = "Small airways in idiopathic pulmonary fibrosis. Comparison of morphologic and physiologic observations",
abstract = "18 patients with idiopathic pulmonary fibrosis were studied to determine if they had morphologic evidence of small airways disease and if physiologic testing could predict morphologic findings. In the presence of normal airway function by standard physiologic studies (forced expiratory volume in 1 s/forced vital capacity and airway resistance by plethysmography), dynamic compliance, maximum expiratory flow-volume curves, and maximum flow-static recoil curves were measured to detect physiologic alterations consistent with small airways abnormalities. These physiologic data were then compared with estimates of small airways diameter made in lung biopsy specimens. 94{\%} (17 of 18) of the patients had peribronchiolar fibrosis or peribronchiolar inflammation or bronchiolitis. 67{\%} (12 of 18) had an overall estimate of small airways diameter of 'narrowed', whereas 33{\%} (6 of 18) had airways that overall were 'not narrowed'. 59{\%} (10 of 17) had frequency-dependent dynamic compliance, 50{\%} (9 of 18) had abnormal maximum expiratory flow-volume curves, and 39{\%} (7 of 18) had abnormal maximum flow-static recoil curves. Comparisons between morphologic and physiologic data revealed a significant correlation between the results of dynamic compliance and the overall estimate of small airways diameter (P = 0.001), and the results of maximum flow-volume curves and the overall estimate of small airways diameter (P = 0.009); there was no significant correlation between the results of maximum flow-static recoil curves and the overall estimate of small airways diameter (P = 0.1). The results of this study suggest that: idiopathic pulmonary fibrosis is a disease of small airways as well as alveoli; dynamic compliance and the maximum expiratory flow-volume curve can predict the overall status of small airways diameter in idiopathic pulmonary fibrosis; and whereas the maximum flow-static recoil curve predicts the overall estimate of small airways diameter in most patients with this disease, it is the least sensitive of these 3 monitors of small airways.",
author = "Fulmer, {J. D.} and Roberts, {W. C.} and {Von Gal}, {E. R.} and Ronald Crystal",
year = "1977",
month = "12",
day = "1",
language = "English",
volume = "60",
pages = "595--610",
journal = "Journal of Clinical Investigation",
issn = "0021-9738",
publisher = "The American Society for Clinical Investigation",
number = "3",

}

TY - JOUR

T1 - Small airways in idiopathic pulmonary fibrosis. Comparison of morphologic and physiologic observations

AU - Fulmer, J. D.

AU - Roberts, W. C.

AU - Von Gal, E. R.

AU - Crystal, Ronald

PY - 1977/12/1

Y1 - 1977/12/1

N2 - 18 patients with idiopathic pulmonary fibrosis were studied to determine if they had morphologic evidence of small airways disease and if physiologic testing could predict morphologic findings. In the presence of normal airway function by standard physiologic studies (forced expiratory volume in 1 s/forced vital capacity and airway resistance by plethysmography), dynamic compliance, maximum expiratory flow-volume curves, and maximum flow-static recoil curves were measured to detect physiologic alterations consistent with small airways abnormalities. These physiologic data were then compared with estimates of small airways diameter made in lung biopsy specimens. 94% (17 of 18) of the patients had peribronchiolar fibrosis or peribronchiolar inflammation or bronchiolitis. 67% (12 of 18) had an overall estimate of small airways diameter of 'narrowed', whereas 33% (6 of 18) had airways that overall were 'not narrowed'. 59% (10 of 17) had frequency-dependent dynamic compliance, 50% (9 of 18) had abnormal maximum expiratory flow-volume curves, and 39% (7 of 18) had abnormal maximum flow-static recoil curves. Comparisons between morphologic and physiologic data revealed a significant correlation between the results of dynamic compliance and the overall estimate of small airways diameter (P = 0.001), and the results of maximum flow-volume curves and the overall estimate of small airways diameter (P = 0.009); there was no significant correlation between the results of maximum flow-static recoil curves and the overall estimate of small airways diameter (P = 0.1). The results of this study suggest that: idiopathic pulmonary fibrosis is a disease of small airways as well as alveoli; dynamic compliance and the maximum expiratory flow-volume curve can predict the overall status of small airways diameter in idiopathic pulmonary fibrosis; and whereas the maximum flow-static recoil curve predicts the overall estimate of small airways diameter in most patients with this disease, it is the least sensitive of these 3 monitors of small airways.

AB - 18 patients with idiopathic pulmonary fibrosis were studied to determine if they had morphologic evidence of small airways disease and if physiologic testing could predict morphologic findings. In the presence of normal airway function by standard physiologic studies (forced expiratory volume in 1 s/forced vital capacity and airway resistance by plethysmography), dynamic compliance, maximum expiratory flow-volume curves, and maximum flow-static recoil curves were measured to detect physiologic alterations consistent with small airways abnormalities. These physiologic data were then compared with estimates of small airways diameter made in lung biopsy specimens. 94% (17 of 18) of the patients had peribronchiolar fibrosis or peribronchiolar inflammation or bronchiolitis. 67% (12 of 18) had an overall estimate of small airways diameter of 'narrowed', whereas 33% (6 of 18) had airways that overall were 'not narrowed'. 59% (10 of 17) had frequency-dependent dynamic compliance, 50% (9 of 18) had abnormal maximum expiratory flow-volume curves, and 39% (7 of 18) had abnormal maximum flow-static recoil curves. Comparisons between morphologic and physiologic data revealed a significant correlation between the results of dynamic compliance and the overall estimate of small airways diameter (P = 0.001), and the results of maximum flow-volume curves and the overall estimate of small airways diameter (P = 0.009); there was no significant correlation between the results of maximum flow-static recoil curves and the overall estimate of small airways diameter (P = 0.1). The results of this study suggest that: idiopathic pulmonary fibrosis is a disease of small airways as well as alveoli; dynamic compliance and the maximum expiratory flow-volume curve can predict the overall status of small airways diameter in idiopathic pulmonary fibrosis; and whereas the maximum flow-static recoil curve predicts the overall estimate of small airways diameter in most patients with this disease, it is the least sensitive of these 3 monitors of small airways.

UR - http://www.scopus.com/inward/record.url?scp=0017671139&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0017671139&partnerID=8YFLogxK

M3 - Article

VL - 60

SP - 595

EP - 610

JO - Journal of Clinical Investigation

JF - Journal of Clinical Investigation

SN - 0021-9738

IS - 3

ER -