A prospective clinical-pathologic study of the lungs and heart in chronic obstructive lung disease.

Abstract

A prospective clinical-pathologic study was made of 60 patients with chronic obstructive lung dis­ ease. The clinical criteria used did not allow differentiation of chronic bronchitis from pulmonary emphysema in the individual patient. Patients with a low emphysema score had increased goblet cells, evidence of bronchial inflammation, hyperemia, and basement membrane abnormalities compared with patients who had a high emphysema score, but the Reid index was unrelated to the emphysema score. There was a good correlation between the clinical and laboratory evi­ dences of cor pulmonale and enlargement of the right ventricle at autopsy. Patients with chronic obstructive lung disease had a larger right ventricular endocardial surface area and a thinner myocardium than patients in a consecutive series of routine autopsies. An increase in serum bi­ carbonate was more closely associated with cor pulmonale than was an increase in hematocrit. Cor pulmonale was not significantly related to the degree of emphysema found postmortem or to the degree of airway obstruction as determined spirometrically.