ArticleThorax2021
Small airway determinants of airflow limitation in chronic obstructive pulmonary disease.
Article in Thorax, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 38 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
38 citing papers in PubMed, 53 citations in OpenAlex.
- Direct visualisation and measurement of lung microstructure reveal insights into extracellular matrix dysregulation in COPD.Respiratory research · 2026Article
- Deep learning approach for probabilistic pulmonary function estimation from chest X-ray and peak expiratory flow rate.Communications medicine · 2026Article
- Clinical characteristics, symptom burden, and pulmonary function trajectories of spirometry- and MMEF-defined bronchodilator responsiveness in COPD: a single-center prospective study.Journal of thoracic disease · 2026Article
- Increased alveolar tissue destruction in a sub-group of COPD patients with increased alveolar septal eosinophil counts.ERJ open research · 2026Article
- Treatment of chronic obstructive pulmonary disease: current pipeline and new opportunities.Nature reviews. Drug discovery · 2026Review
- Small Airway Disease in Pre-COPD and Early COPD: Insights Into the Pulmonary "Silent Zone".International journal of chronic obstructive pulmonary disease · 2026Review
- Efficacy and Safety of Dupilumab in Chronic Obstructive Pulmonary Disease with Type 2 Inflammation: A Single-Center Real-World Study.International journal of chronic obstructive pulmonary disease · 2026Article
- Distinct Morphological Types of Small Airway Obstructions in Smokers with Emphysema and End-Stage Chronic Obstructive Pulmonary Disease.American journal of respiratory and critical care medicine · 2025Article
- Mendelian causes of early-onset emphysema: a review of the current literature.European respiratory review : an official journal of the European Respiratory Society · 2025Review
- Bridging the Gap: Small Airways, Mechanical Stress, and the Evolution of Emphysema.American journal of respiratory and critical care medicine · 2025Article
- X-ray velocimetry provides temporally and spatially-resolved biomarkers of lung ventilation in small airways disease.Respiratory research · 2025Article
- GOLD grade-specific characterization of COPD in the COSYCONET multi-center trial: comparison of semiquantitative MRI and quantitative CT.European radiology · 2025Article
- Diffusing capacity and alveolar attachments to small airways in smokers with and without COPD.ERJ open research · 2025Article
- Computational fluid dynamics of small airway disease in chronic obstructive pulmonary disease.EBioMedicine · 2025Article
- Role of impulse oscillometry in chronic obstructive pulmonary disease and asthma-chronic obstructive pulmonary disease overlap.Clinical and translational allergy · 2025Article
- MicroRNAs as promising drug delivery target to ameliorate chronic obstructive pulmonary disease using nano-carriers: a comprehensive review.Molecular and cellular biochemistry · 2025Review
- Development and validation of a novel AI-derived index for predicting COPD medical costs in clinical practice.Computational and structural biotechnology journal · 2025Article
- Managing Small Airways Dysfunction in COPD Patients in Real Life Under Fixed Triple Combination of Beclomethasone/Formoterol/Glycopyrronium: The MASCOT Real World Evidence Study.International journal of chronic obstructive pulmonary disease · 2025Observational
- Differentiating Emphysema From Emphysema-Dominated COPD Patients with CT Imaging Feature and Machine Learning.International journal of chronic obstructive pulmonary disease · 2025Article
- Exploring the Causal Relationship Between Saliva Microbiota Abundance and Chronic Obstructive Pulmonary Disease/Idiopathic Pulmonary Fibrosis: A Two-Sample Mendelian Randomization Study.International journal of chronic obstructive pulmonary disease · 2025Article
Corrections and comments
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Authors and funding
10 authors at 3 institutions in 1 country.
Funding
Abstract
backgroundAlthough a variety of pathological changes have been described in small airways of patients with COPD, the critical anatomic features determining airflow limitation remain incompletely characterised.
methodsWe examined lung tissue specimens from 18 non-smokers without chronic lung disease and 55 former smokers with COPD for pathological features of small airways that could contribute to airflow limitation. Morphometric evaluation was performed for epithelial and subepithelial tissue thickness, collagen and elastin content, luminal mucus and radial alveolar attachments. Immune/inflammatory cells were enumerated in airway walls. Quantitative emphysema scoring was performed on chest CT scans.
resultsSmall airways from patients with COPD showed thickening of epithelial and subepithelial tissue, mucus plugging and reduced collagen density in the airway wall (in severe COPD). In patients with COPD, we also observed a striking loss of alveolar attachments, which are connective tissue septa that insert radially into the small airway adventitia. While each of these parameters correlated with reduced airflow (FEV
conclusionIn COPD, loss of radial alveolar attachments in small airways is the pathological feature most closely related to airflow limitation. Destruction of alveolar attachments may be mediated by neutrophilic inflammation.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.