A. E. Anderson

Emphysema in Lung Macrosections Correlated with Smoking Habits

The relationship between smoking and pulmonary emphysema was explored in 71 autopsies, by correlating Gough-Wentworth lung macrosections with smoking histories. An increasing percentage of smokers was found with each increment of emphysema. Particularly close relationship was observed between centrilobular emphysema and smoking. No definite association was found between smoking and panlobular emphysema.

Centrilobular emphysema and panlobular emphysema: two different diseases

Anderson, A. E., and Foraker, A. G. (1973).Thorax, 28, 547-550. Centrilobular emphysema and panlobular emphysema: two different diseases. Twenty-one cases of centrilobular emphysema and 19 cases of panlobular emphysema, previously so designated according to recommended criteria, were reassessed for differences in zonal distribution within lungs through systematic sampling and statistical comparisons. Characteristic distribution profiles were defined for the two forms of disease. Centrilobular emphysema appeared to be mainly a disease of the upper lobe and the apices within the upper and lower lobes. In contrast, panlobular emphysema was a more or less diffuse process within lobes and lungs with mild preferential involvement of the lower lobe. These regional trends coupled with the typical appearance of individual lesions within lobules are considered to provide strong support for the contention that centrilobular emphysema and panlobular emphysema are morphologically distinct entities. Probable reasons for difficulties in differentiating some examples of centrilobular and panlobular emphysema are given. The need for further clarification of associated and background factors is stressed.

The morphological spectrum of aging and emphysematous lungs.

Excerpt It is generally conceded that there is extreme difficulty in distinguishing between the transformations associated with normal aging and old age complicated by morbid processes. Indeed, as ...

Further observations on luminal deformity and stenosis of nonrespiratory bronchioles in pulmonary emphysema.

In an endeavour to elucidate the anatomical basis for the increased resistance to airflow which characterises the most peripheral conducting air passages in pulmonary emphysema, lumina of nonrespiratory bronchioles of lungs with mainly centrilobular disease were assessed for two- and three-dimensional features by: (1) determination of percentage conformity of the lumina of individual bronchioles in histological sections to hypothetical planes through cylinders (ie, ellipses with the same areas and circumferences), and (2) comparison of luminal areas at regular intervals along bronchiolar longitudinal axes. The lumina of most nonrespiratory bronchioles from normal lungs conformed closely to their respective ellipses, thus corroborating previous observations that they are normally cylindroid. In contrast, there was a substantial excess of plane section deformities in the lumina of nonrespiratory bronchioles from the emphysematous specimens. The incidence of stenotic bronchioles (by both diameter and area determinations) was also greatly increased in emphysema. Since there was a strong positive association between such stenotic lesions and bronchiolar deformity, the latter was concluded to be a major factor in bronchiolar restriction. Furthermore, these characteristics seemed to have three-dimensional expression, for the lumina of stenotic bronchioles in emphysema were irregular in a longitudinal fashion.

THE BRONCHIAL GLANDS IN AGING

The basic histologic change in chronic bronchitis often is assumed to be hyperplasia and hypertrophy of the bronchial glands ( 1 4 ) . “Bronchitis,” in this sense, has been the subject of extensive study in recent years. I t s relations to emphysema (5, 6) , smoking (3, 7, 8) and atmospheric pollution (9, 10) have been of special interest. I n addition, we have been impressed with a possible association between bronchial gland overgrowth and aging, irrespective of the presence of emphysema and known exposure to inhaled irritants. Documentation of these presumed effects seemed pertinent t o a broader perspective of other conditions associated with, but not necessarily a direct function of, aging. The effects of aging on the bronchial glands, however, have not been systematically investigated to our knowledge. The purpose of this presentation is to describe the outcome of such an analysis of the glands, as well as certain other bronchial components. The bronchi of a group of aged subjects were compared in several ways with the bronchi of a group of younger subjects. Although there was a goodly spread between their ages, the subjects were matched with respect to emphysema and smoke exposure. All were nonsmokers. Such an approach revealed substantial evidence of bronchial gland overgrowth in association with aging.

Topology of nonrespiratory bronchioles of normal and emphysematous lungs

Abstract A series of bronchiolar lumina were reconstructed from serial histologic sections of nine nonrespiratory bronchioles from lungs of six normal male subjects and compared with 18 similar preparations from eight male subjects with severe centrilobular emphysema. The lumina of the normal nonrespiratory bronchioles had smooth surfaces and were generally cylindrical in shape between branchings. Irregular dichotomy was the rule. In contrast, the lumina of the nonrespiratory bronchioles from patients with emphysema showed a marked tendency to have rough surfaces, multiple levels of stenosis, occasional dilatation, and tortuosity along a longitudinal axis. These defects in the peripheral conducting air passages of the lungs are thought to provide logical bases for much of the fixed increased flow resistance that has been shown to prevail at this level in emphysema.

Comparative incidence of bronchogenic carcinoma in subjects with centrilobular and panlobular emphysema

Twenty‐one cases of centrilobular emphysema and nineteen cases of panlobular emphysema, all previously reported for morphological characteristics, were analyzed for the comparative incidence of bronchogenic carcinoma. Seven of the patients with centrilobular disease also had lung cancer, whereas, none of the patients with panlobular emphysema was so affected. These differences were statistically significant, suggesting a much closer tie between bronchogenic carcinoma and centrilobular emphysema than with panlobular disease. It was proposed that the frequent co‐existence of the two conditions reflected separate effects of a common agent, i.e. tobacco smoke.

Intraluminal exudates of nonrespiratory bronchioles in pulmonary emphysema

Abstract The plugging of nonrespiratory bronchioles by mucus and cellular debris was found to be approximately twice as common in emphysematous as in normal lungs. This plugging is presumed to be a significant source of reversible obstruction in emphysema.

Selective Venting of Cigarette Smoke in Dichotomous Ducts and Preserved Human Bronchi

Mechanically generated cigarette smoke and ambient air were injected into dichotomous ducts and geometrically preserved human bronchi in a fashion simulating typical smoking technique. When the air passages were at ambient temperature, the smoke settled into the lower branches. Smoke which was injected into passages warmed to body temperature rose to the upper branches. The latter selective distribution of the smoke resembled the distribution of centrilobular emphysema in the lungs.

Bronchial morphometry in emphysema and senescence.

Abstract Bronchi were assessed morphometrically for various components of the bronchial wall believed to play in maintaining normal air flow. Areas of the entire bronchial wall, the bronchial glands, and the bronchial cartilages were determined planimetrically in three groups of subjects: (1) elderly emphysematous individuals; (2) age-matched normal controls; and (3) young normal subjects. There were no significant differences in the areas of bronchial cartilage in the three groups studied. The bronchial glands of patients with emphysema were only slightly larger than the glands of elderly normal individuals when expressed as a percentage of the entire bronchial wall. Aged subjects with normal lungs showed a degree of bronchial gland hypertrophy which was significantly greater than young normal individuals. From our current results, it seems unlikely that emphysema is a result of chronic bronchitis as conventionally described in terms of bronchial gland hypertrophy. More likely, these two conditions coexist because of common background factors, the most commonly implicated of which is cigarette smoking.