IN RECENT years, great progress has been made in our understanding of the chronic obstructive pulmonary syndromes. It now appears that these diseases begin in the periphery of the lung and interfere with the function of the small airways located there long before they produce diagnostically interpretable symptoms or compromise results of the standard tests of lung function, such as one-second forced expiratory volume (FEV1) or even more sophisticated measurements, such as airway resistance. Thus, diseases of the peripheral airways may be the earliest lesion in the pathogenetic course of chronic obstructive lung disease, and more important, at this stage the abnormalities may be reversible.1-3 Consequently, the concept of small-airway disease has become quite important and has proved useful in helping to explain uncommon, perplexing clinical syndromes such as disproportionately severe hypoxemia in obstructive disease associated with only a modest overall increase in flow resistance. Yet, this area of
McFadden ER, Ingram RH. Peripheral Airway Obstruction. JAMA. 1976;235(3):259–260. doi:10.1001/jama.1976.03260290017017
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