Respiration; international review of thoracic diseases
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Asthma and chronic obstructive pulmonary disease (COPD) are complex conditions with imprecise definitions which make definitive morphological comparisons difficult. Broadly, the airways in asthma are occluded by tenacious plugs of exudate and mucus, there is fragility of airway surface epithelium, thickening of the reticular layer beneath the epithelial basal lamina and bronchial vessel congestion and oedema. There is increased inflammatory infiltrate comprising 'activated' lymphocytes and eosinophils with release of granular content in the latter, and there is enlargement of bronchial smooth muscle particularly in medium sized bronchi. ⋯ In small (peripheral) airways disease, there is inflammation of bronchioli, mucous metaplasia and hyperplasia, with increased intralumenal mucus, increased wall muscle, fibrosis and airway stenoses. Respiratory bronchiolitis is a critically important early lesion which may predispose to the development of centrilobular emphysema. The severity of destruction of alveolar wall in emphysema appears to be the most important determinant of chronic deterioration of airflow.
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Thirty years have passed since the International Conference on Sarcoidosis, held in Washington, D. C., in 1960. ⋯ On the other hand, no information on the causative agents has been obtained, and no advances have been made in the treatment of sarcoidosis. We expect steady advances in both in the 1990s and hope that the 12th World Congress on Sarcoidosis in September 1991 in Kyoto will mark the first step toward these objectives.