Chronic Bronchitis

Some patients with severe airflow obstruction do not have emphysema, but rather have severe narrowing of small airways without any destruction of alveolar walls. Of course, any combination of emphysema and airway narrowing may also occur. The clinical story is similar in both types of patients.

Chronic Bronchitis

This very black lung is not from a coal miner. It is from a smoker who developed severe airflow obstruction similar to the man whose case was summarized. There is no emphysema. However, small airways showed severe damage (see below) and mucous plugs were prominent in the larger airways.

The inactivation of the cilia and a narrowing of small airways by cigarette smoke decreased removal of dust inhaled from city air. However, this lung breathed air in Chicago before the early 60's when coal burning accounted for heavy dust burdens in the air. Nevertheless, in comparison, non-smokers from the same era had very little black pigment in their lungs.

Airway Disease in Chronic Bronchitis

This is a small airway from a patient with chronic bronchitis. Compared to the normal airway, it shows thickening of the wall, some loss of epithelial lining cells, and filling of the lumen by mucus and cells.

Find and outline the thickened airway wall.

Find the plug of mucus and cells in the lumen.

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smoking now

Early Lesion of Smokers

In a study of the lungs of young smokers who died as a result of accidents, it was found that alveolar walls near airways were slightly thickened (scarred) and that there was an accumulation in air spaces of macrophages with brown pigment, as shown here. Macrophages are cells derived from the blood that protect gas exchange by taking up and removing dust and germs. The brown pigment is derived from the cigarette smoke.

Find examples of brown-pigmented, smokers' macrophages.

Find an alveolus (air space) with a thickened wall.

Find a small airway.

macs1macs2alvairwayairway

Comment: These changes in young smokers are not associated with symptoms but do indicate that damage, which may cause disease later on, is occurring in the lungs .

 

 

Breathing in Chronic Obstructive Pulmonary Disease

These animated lungs illustrate the difference between breathing in the normal lung (red) and breathing in the lung with chronic obstructive pulmonary disease (black). Note that the black lung breathes slower than the normal one. The person with the black lung would be very limited in ability to exercise or even to perform ordinary tasks.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Plug of mucus and cells in airway lumen. These plugs obstruct airflow.

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Thickened airway wall. The thickening narrows the airway and obstructs airflow. The thickening (scarring) was caused by cigarette smoke.

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Alveolar macrophages with brown pigment

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Alveolus with thickened wall

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Small airway. Only part of this airway has respiratory epithelium (lower right). The airway also has some alveoli in its wall.

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