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Pathology of Lung Disease pp 77–102Cite as

Airway Diseases

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Abstract

Tracheitis and bronchitis are one of the most common diseases in all ages. Acute tracheobronchitis is common in children as well as in old patients, less common in middle ages. The causes are in most instances infections. In children viral infections dominate the infectious spectrum. It usually starts at kindergarten age as a first peak. Later on children also get in contact with bacterial organisms, but most often develop immune protection. In most developed countries, due to vaccination programs, classical infections are decreasing. However, in some countries because of refusal of vaccination by parents, the situation can change.

 Bronchial Asthma is a chronic inflammatory disease of the conducting airways, in which the epithelium, and cells of the innate and adaptive immune system are involved. Asthma affects approximately 300 million people worldwide, and its incidence is increasing especially in developed countries. The leading symptom is hyperreactivity of the airway smooth muscle cells. Clinically it is characterized by shortness of breath, wheezing, and chest tightness. Traditionally asthma was separated into allergic (intrinsic) and non-allergic (extrinsic) asthma, but in recent years within non-allergic asthma several so-called endotypes have been identified. So asthma is no longer regarded as a single disease but a rather a syndrome. These endotypes differ with respect to genetic susceptibility, environmental risk factors, age of onset, clinical presentation, prognosis, and response to treatment.

 Bronchioles are small airways defined by an inner diameter ≤ 1 mm. Bronchioles have a thin muscular layer and are devoid of cartilage. Bronchioles start at the 16th generation of airways. The epithelial layer is composed of a mixture of Clara, ciliated and secretory columnar, and few goblet cells. At the basal lamina there is also a layer of triangular shaped basal cells and atop of them polygonal reserve cells. At the larger bronchioles the thickness of the epithelial layer is 3 cell layers, but towards the terminal bronchioles the epithelial layer is reduced to 2 layers, basal cells and Clara cells with a few interspersed columnar cells38. Regeneration starts from Clara cells and reserve cells, whereas basal cells are functioning to serve as attachments for the columnar cells. At the bronchioloalveolar junction zone (BJZ) terminal stem cell have been identified, which express Clara cell protein 10 (CC10), Surfactant Apoprotein C and stem cell markers.

 Bronchiolitis most often is associated with either bronchitis such as in asthma, or it is associated with pneumonia, an example is organizing pneumonia. However, there are two reasons to discuss bronchiolitis separately: Bronchiolitis is the underlying pathology in clinically called small airways disease, and it does occur sometimes as an isolated disease confined only to bronchioles.

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  1. Institute of Pathology, Medical University Graz, Graz, Austria

    Helmut Popper

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Popper, H. (2017). Airway Diseases. In: Pathology of Lung Disease. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-50491-8_6

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  • DOI: https://doi.org/10.1007/978-3-662-50491-8_6

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