A comparison of the quantitative anatomy of the bronchi in normal subjects, in status asthmaticus, in chronic bronchitis, and in emphysema.

A comparison of the quantitative anatomy of the bronchi in normal subjects, in status asthmaticus, in chronic bronchitis, and in emphysema The quantitative anatomy of the bronchi has been studied in sudden deaths in normal subjects, in deaths from status asthmaticus and chronic bronchitis, and in patients with emphysema. In the normal bronchi the observed range of values for the percentage volume of mucous glands was between 7 6 and 16 7. In the status asthmaticus group the mucous gland volume was greatly increased and in no case was there an overlap with the normal subjects. In the 19 cases of chronic bronchitis, two cases had values of 15-2 and 154% respectively, but all the others had values higher than the normal range and, in two instances, values of over 40% were obtained. The values obtained for mucous gland volume in the bronchi in emphysema were variable, approximately half being within the normal range. The bronchial smooth muscle accounted for 4-6 +2-2% of the volume of the normal bronchial wall. The values obftained in chronic bronchitis and emphysema did not differ significantly from this but in those dying of status asthmaticus there was a very significant increase with a mean value of 11 9 + 3 36. In a previous paper (Dunnill, 1960) the pathological anatomy of the bronchi in asthma was described with special reference to the mucosal changes. The outstanding feature at necropsy was the presence of numerous plugs of mucus in the airways. Histologically, shedding of the ciliated bronchial mucosa cells was prominent, and this was attributed to a transudation of oedema fluid from the submucosa. The loss of the ciliated epi-thelium, together with interference with the action of the remaining ciliated cells by the oedema fluid, were considered to be the essential factors in the failure of clearance of the bronchial secretions in asthma. The finding of smooth muscle hyper-trophy emphasized by Huber and Koessler (1922) was also noted. The present paper is concerned with the quantitative differences in the bronchial wall between normal subjects and those with status asthmaticus, chronic bronchitis, and emphysema. The bronchi were divided into four groups, and were from (1) normal individuals who had died suddenly, usually a traumatic death, with no previous history of chronic bronchitis; (2) patients who had died in status asthmaticus; (3) patients who had died with a history of chronic airways obstruction with expec-toration and who, …