Chronic bronchitis in coal miners: ante-mortem/post-mortem comparisons

Abstract

From the Joint Coal Board, Sydney, A ustralia From bronchial measurements in 136 deceased coal miners a comparison with well-documented ante-mortem findings shows that with increasing clinical severity of chronic bronchitis there is increasing narrowing of intrapulmonary airways due to wall thickening at the expense of the lumen. With the aid of the Reid index (gland/wall ratio) and a new proposed index which more directly measures airway obstruction-the wall internal to cartilage/lumen radius ratio-both of which tend to be independent of bronchus size but change with increasing abnormality-it is possible to quantitate chronic bronchitis pathologically and to obtain satisfactory correlations with ante-mortem data. Chronic bronchitis may thereby be evaluated independently from pneumoconiosis and emphysema, thus facilitating the study of their separate relationships with cigarette smoking and with other possible aetiological factors.As part of a long-term study of respiratory diseases in post-mortem lung specimens from coal miners we recently began measuring bronchi and calculating ratios including the Reid index (1960).The purpose of this paper is to present some of our findings, covering so far some 136 individual miners. Our objectives have been, first, to try to devise a system of severity grading of chronic bronchitis post mortem which could be satisfactorily related to the ante-mortem status; secondly, using such a system, to study the relationships of the post-mortem pathology to such ante-mortem factors as cigarette smoking and occupation, and possibly other constitutional or environmental influences. This paper covers only the first objective. Several methods have been described for quantitating chronic bronchitis, mostly in relation to the degree of hypersecretion or mucous gland or goblet cell hyperplasia noted. The pathological signs of infection are not readily quantitated. Our own interest is mainly concerned with the obstructive phase of this disease, and with those measurable aspects of the pathology which appear to be relevant to this phase.After examining a number of Gough sections from the lungs of miners affected by severe chronic bronchitis our interest in wall/lumen measurements was aroused by the gross wall thickening and lumen narrowing seen macroscopically, extending through most of the visible intrapulmonary tree. An attempt to quantitate this change was undertaken.

Physiological and histological alterations in the bronchial mucociliary clearance system of rabbits following intermittent oral or nasal inhalation of sulfuric acid mist

“…In human chronic bronchitis, an initial change in secretory cell number or size is followed by intrabronchial narrowing, especially in small bronchi and bronchioles (Matsuba and Thurlbeck, 1973), due in part to a thickening of the airway wall (McKenzie et al, 1969). Similar temporal changes occur in experimental animals (Lamb and Reid, 1969;Suhs et al, 1969).…”

Pneumoconiosis and Respiratory Disorders of Coal Mine Workers of New South Wales, Australia

“…Postmortem emphysema has been studied similarly relating to antemortem symptoms and signs, radiological signs, FEV, and/or Peak Expiratory Flow rate. 22 The postmortem emphysema assessments have been found to correlate well with recognized radiographic/fluoroscopic signs of emphysema, such as rarefied lung markings; small central heart shadow; depressed, flattened, poorly moving diaphragm; and sternal bowing with enlarged retrosternal window. A particularly good inverse correlation (unpublished) was found between the amount of emphysema assessed pathologically and the recorded diaphragmatic excursus as measured fluoroscopically within five years of death.…”

Development and application of a virtual imaging trial framework for airway quantifications via CT

“…The wall thickness of the airways for each phantom was modeled based on pathological data described in figure 2 of McKenzie's work in 1989 [14], which reflects the correlation between the overall bronchus size (Br) and the total airway wall thickness (TW). The patient data collected from the post-mortem with multiple bronchial airway obstruction severities were categorized into "severe", "intermediate", and "nil + simple" types.…”

“…The patient data collected from the post-mortem with multiple bronchial airway obstruction severities were categorized into "severe", "intermediate", and "nil + simple" types. The "nil + simple" patients were diagnosed with no chronic bronchitis or chronic expectorators without clinical airway obstruction [14]. Twelve XCAT airway anatomies were modeled with six in "simple" (GOLD 0-1) and six in "severe" (GOLD 3-4) bronchitis severities.…”