Bronchial remodeling is currently known to affect not only patients with asthma, but also COPD patients. Some studies have demonstrated that basement membrane thickening and destruction of the bronchial epithelium are also found in COPD. The aim of the study was to compare the basement membrane thickness (BMT) and epithelial damage in biopsy specimens from patients with asthma and COPD.
METHODS:
The study was performed in 20 subjects with asthma and 12 subjects with COPD, who had not been treated with corticosteroids for at least 3 months before study enrollment. Subjects' characteristics were based on the results of clinical assessment, allergic skin-prick tests, lung function testing, and methacholine bronchial challenge. All subjects underwent bronchoscopy with forceps biopsies of bronchial mucosa. Light-microscope and semi-automatic software were used to measure BMT in hematoxylin-eosin stained sections. Total (denudation) and partial epithelial damage were assessed independently by 2 pathologists.
RESULTS:
The mean BMT in subjects with asthma was 12.54 ± 2.8 μm, and only 7.81 ± 2.0 μm in COPD patients (P < .001). Overall percentage of the basement membrane length lined with damaged epithelium was 45 ± 20% in the asthma group and 47 ± 22% in the COPD group (difference not significant). Complete and partial epithelial damage did not differ between the groups.
CONCLUSIONS:
BMT might be a histopathological parameter helpful in distinguishing asthma and COPD patients, whereas the extent and pattern of epithelial damage is not.
HuberHL, KoesslerKK. The pathology of bronchial asthma. Arch Intern Med, 1922; 30(6):689–760.
2.
DunnillMS. The pathology of asthma, with special reference to changes in the bronchial mucosa. J Clin Pathol, 1960; 13(1):27–33.
3.
RocheWR, BeasleyR, WilliamsJH, HolgateST. Subepithelial fibrosis in the bronchi of asthmatics. Lancet, 1989; 1(8637):520–523.
4.
OlivieriD, ChettaA, Del DonnoM, BertorelliG, CasaliniA, PesciA, et al. Effect of short-term treatment with low-dose inhaled fluticasone propionate on airway inflammation and remodeling in mild asthma: a placebo-controlled study. Am J Respir Crit Care Med, 1997; 155(6):1864–1871.
5.
KasaharaK, ShibaK, OkazawaT, OkudaK, AdachiM. Correlation between the bronchial subepithelial layer and whole airway wall thickness in patients with asthma. Thorax, 2002; 57(3):242–246.
6.
JefferyPK. Remodeling in asthma and chronic obstructive pulmonary disease. Am J Respir Crit Care Med, 2001; 164(10):S28–S38.
7.
VignolaAM, KipsJ, BousquetJ. Tissue remodeling as a feature of persistent asthma. J Allergy Clin Immunol, 2000; 105(6):1041–1053.
8.
ChanezP, VignolaAM, O'ShaughnessyT, EnanderI, LiD, JefferyPK, BousquetJ. Corticosteroid reversibility in COPD is related to features of asthma. Am J Respir Crit Care Med, 1997; 155(5):1529–1534.
9.
BourdinA, SerreI, FlammeH, VicP, NeveuD, AubasP, et al. Can endobronchial biopsy discriminate between asthma and COPD in routine practice?. Thorax, 2004; 59(6):488–493.
10.
Global Initiative for Asthma (GINA): Global strategy for asthma management and prevention. NHLBI/WHO Workshop Report. National Heart, Lung and Blood Institute, National Institutes of Health, Public Health Service, U.S. Department of Health and Human Services, Washington, 2002 update, www.ginasthma.org..
11.
Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy for the diagnosis, management and prevention of chronic obstructve pulmonary disease. NHLBI/WHO workshop report. Bethesda, National Heart, Lung and Blood Institute, April 2001. 2003 update. GOLD website www.goldcopd.org..
12.
Standardized lung function testing. Official statement of the European Respiratory Society. Eur Respir J, 1993;(6 Suppl 16):1–100.
13.
CrapoRO, CasaburiR, CoatesAL, EnrightPL, HankinsonJL, IrvinCG, et al. Guidelines for methacholine and exercise challenge testing-1999. This official statement of the ATS was adopted by the ATS Board of Directors July 1999. Am J Respir Crit Care Med, 2000; 161(1):309–329.
14.
SullivanP, StephensD, AnsariT, CostelloJ, JefferyPK. Variation in the measurements of basement membrane thickness and inflammatory cell number in bronchial biopsies. Eur Respir J, 1998; 12(4):811–815.
15.
OllerenshawSL, WoolcockAJ. Characteristics of inflammation in biopsies from large airways of subjects with asthma and subjects with chronic airflow limitation. Am Rev Respir Dis, 1992; 145(4):922–927.
16.
JefferyPK, GodfreyRW, AdelrothE, NelsonF, RogersA, JohanssonSA. Effects of treatment on airway inflammation and thickening of basement membrane reticular collagen in asthma. A quantitative light and electron microscopic study. Am Rev Respir Dis, 1992; 145(4):890–899.
17.
TriggCJ, ManolitsasND, WangJ, CalderonMA, McAulayA, JordanSE, et al. Placebo-controlled immunopathologic study of four months of inhaled corticosteroids in asthma. Am J Respir Crit Care Med, 1994; 150(1):17–22.
18.
SoltaniA, ReidDW, SoholSS, Wood-BakerR, WestonS, MullerHK, WaltersEH. Basement membrane and vascular remodeling in smokers and chronic obstructive pulmonary disease: a cross-sectional study. Respir Res, 2010; 11:105. doi:10.1186/1465-9921-11-105.
19.
MilaneseM, CrimiE, ScordamagliaA, RiccioA, PellegrinoR, CanonicaGW, BrusascoV. On the functional consequences of bronchial membrane thickening. J Appl Physiol, 2001; 91(3):1035–1040.
20.
PayneD, RogersAV, AdelrothE, BandiV, GuntupalliKK, BushA, JefferyPK. Early thickening of the reticular basement membrane in children with difficult asthma. Am J Respir Crit Care Med, 2003; 167(1):78–82.
21.
KöksalD, KarnakD, KayacanO, BederS, ErekulS. Bronchitis index and mucosal biopsy findings in patients with chronic bronchitis. Turk Respir J, 2005; 6(1):4–9.
PohunekP, WarnerJ, TurzikovaJ, KudrmannJ, RocheWR. Markers of eosinophilic inflammation and tissue remodeling in children before clinically diagnosed bronchial asthma. Pediatr Allergy Immunol, 2005; 16(1):43–51.
24.
AminK, LudviksdottirD, JansonC, NettelbladtO, BjörnssonE, RoomansGM, et al. Inflammation and structural changes in the airways of patients with atopic and nonatopic asthma. Am J Respir Crit Care Med, 2000; 162(6):2295–2301.
25.
VignolaAM, ChanezP, CampbellAM, SouquezF, LebelB, EnanderI, BousquetJ. Airway inflammation in mild intermittent and in persistent asthma. Am J Respir Crit Care Med, 1998; 157(2):403–409.
26.
ShibaK, KasaharaK, NakajimaH, AdachiM. Structural changes of the airway wall impair respiratory function, even in mild asthma. Chest, 2002; 122(5):1622–1626.
HolgateST, DaviesDE, LackiePM, WilsonSJ, PuddicombeSM, LordanJL. Epithelial–mesenchymal interactions in pathogenesis of asthma. J Allergy Clin Immunol, 2000; 105(2):193–204.
29.
WangH, LiuX, UminoT, SköldCM, ZhuY, KohyamaT, et al. Cigarette smoke inhibits human bronchial epithelial cell repair processes. Am J Respir Cell Mol Biol, 2001; 25(6):772–779.
30.
BeasleyR, RocheWR, RobertsJA, HolgateST. Cellular events in the bronchi in mild asthma and after bronchial provocation. Am Rev Respir Dis, 1989; 139(3):806–817.
31.
JefferyPK, WardlawAJ, NelsonFC, CollinsJV, KayAB. Bronchial biopsies in asthma: an ultrastructural, quantitative study and correlation with hyperreactivity. Am Rev Respir Dis, 1989; 140(6):1745–1753.
32.
CohenL, XuepingE, TarsiJM, RamkumarT, HoriuchiTK, CochranR, et al. and the NHLBI Severe Asthma Research Program (SARP). Epithelial cell proliferation contributes to airway remodeling in severe asthma. Am J Respir Crit Care Med, 2007; 176(2):138–145.
33.
OrdoñezC, FerrandoR, HydeMD, WongHH, FahyJV. Epithelial desquamation in asthma: artifact or pathology?. Am J Respir Crit Care Med, 2000; 162(6):2324–2329.
34.
TurcotteH, LavioletteM, BoutetM, BouletLP. Variability of inflammatory cell counts on bronchial biopsies of normal subjects. Lung, 2003; 181(1):9–21.
35.
TrifilieffA, El-HashimA, BertrandC. Time course of inflammatory and remodeling events in a murine model of asthma; effect of steroid treatment. Am J Physiol Cell Mol Physiol, 2000; 279(6):L1120–L1128.
AlevaR, KraanJ, SmithM, ten HackenNHT, PostmaDS, TimensW. Quantity and morphology of bronchial biopsy specimens by forceps of three different sizes. Chest, 1998; 113(1):182–185.
38.
LaitinenLA, LaitinenA, HaahtelaT. Comparative study of the effects of an inhaled corticosteroid, budesonide, and a beta 2-agonist, terbutaline, on airway inflammation in newly diagnosed asthma: a randomized, double-blind, parallel-group controlled trial. J Allergy Clin Immunol, 1992; 90(1):32–42.
