RESPONSIVENESS AND VARIABILITY OF AIR-FLOW OBSTRUCTION IN CHRONIC OBSTRUCTIVE PULMONARY-DISEASE - CLINICOPATHOLOGICAL CORRELATIVE STUDIES

We have studied the relationships between pulmonary lesions and bronch odilator response and variability of FEV(1) in 41 patients enrolled in the National Institutes of Health Intermittent Positive Pressure Brea thing Trial who died, came to autopsy, and provided adequate tissue to quantitate lesions. The patients had moderate to severe chronic airfl ow obstruction and various degrees of response to 250 mu g isoproteren ol inhalation. Airway responsiveness was positively correlated with br onchial eosinophilia, bronchial inflammation, and bronchiolar fibrosis , and it was negatively correlated with bronchiolar goblet cell metapl asia and emphysema. Patients with an increase of 190 ml or more in FEV (1) after bronchodilator had less bronchial cartilage and less goblet metaplasia in bronchioles. Airway smooth muscle was not related to air way responsiveness and variability. Flow rates were adversely affected by bronchial eosinophilia for given emphysema scores. This study show s the importance of the eosinophil as part of chronic nonspecific lung disease. Lack of airway responsiveness was associated with lesions su ch as emphysema and goblet cell metaplasia, which by themselves cause severe chronic airflow obstruction. The better-preserved lung function in patients with increased airway responsiveness is attributed to neg ative correlations with emphysema and positive correlations with bronc hial eosinophilia.