Reid Index Research Articles

Quantified pathology of emphysema, pneumoconiosis, and chronic bronchitis in coal workers.

ABSTRACT From a continuous series of 886 postmortem examinations on coal mine workers in New South Wales, Australia, from 1949 to 1982 and their histories the following data were obtained: age at death (886 cases), percentage of emphysema in both lungs (Heard method) (870 cases), bronchial gland wall (G-W) ratio (Reid Index) (412 cases), chest radiograph within 10 years of death (792 cases), history of work at the coal face (844 cases), history of amount of tobacco smoked (606 cases), and FEV₁ five years before death (278 cases). Linear regression analysis showed the following: (1) The severity of emphysema had a significant positive regression on years of face work independently of age at death. (2) The severity of emphysema had a significant positive regression on the severity of ϰ-ray pneumoconiosis, which was best defined in the non-smoking group and the non-bronchitic group. (3) There was a significant multiple linear regression relationship between severity of emphysema (dependent variable) and pneumoconiosis and G-W (independent variables). The ratio of standardised regression coefficients was pneumoconiosis: G-W = 3:1. (4) The severity of ϰ-ray pneumoconiosis had a significant positive regression on years of face work and a negative regression on smoking amount. (5) G-W ratio had significant positive regression on age of death and severity of emphysema but not years of face work or severity of pneumoconiosis. (6) Smoking was not correlated with severity of emphysema or G-W ratio. (7) FEV₁ (% predicted) was significantly negatively correlated with bronchitis, emphysema, and pneumoconiosis. (8) Severity of pneumoconiosis and emphysema have declined slightly but significantly over the 33 year period, but there has been no significant change in G-W ratio during 1960-82.

The morphologic features of the bronchi, bronchioles, and alveoli in chronic airway obstruction: a clinicopathologic study.

A 6-year semiquantitative clinicopathologic study revealed that among 196 men and 46 women 40 or more years of age at death, the severity of destructive emphysema was overwhelmingly the most important morphologic correlate of the clinical state of chronic airway obstruction. The pathogenic mechanisms whereby emphysema may lead to airway obstruction are probably multifactorial, but our data are consistent with a growing consensus that loss of small airway support by surrounding lung tissue in emphysema may cause kinking, tortuosity, and collapse of the airways, with subsequent increased airflow resistance and clinical obstruction. Pathologic changes (inflammation, fibrosis, increased goblet cells, and mucous gland enlargement) in large or small airways in the absence of much emphysema were very seldom associated with significant chronic airway obstruction, and correlated rather poorly with chronic airway obstruction, regardless of severity of emphysema. A subjective method of evaluating mucous gland enlargement in the large airways was consistently better than the Reid Index in correlations with clinical and anatomic abnormalities, presumably because it took all glands into consideration. The clinical features of subjects with severe centrilobular versus severe panlobular emphysema were essentially the same. "Blue bloater" and "pink puffer" clinical types of chronic airway obstruction continued to reveal differences in airway pathologic features, but no longer revealed a major difference in the severity of emphysema at the time of death. Presumably this was due, at least partially, to improved treatment, longer survival, and fusion into a similar end-stage. The total exposure to cigarette smoke was quantitatively related to clinical chronic airway obstruction and to both alveolar and airway pathologic features.

Bronchial gland measurements: A continuing search for a “Yardstick”

Bronchial morphometry has been the object of great interest in the past few years. A recent investigation whowed poor correlation between the Reid Index and gland area determinations by a variety of methods. In the present study, gland/wall ratio (Reid Index) was compared with estimation of total, inner, and outer gland areas by the card-weighing method. Correlation was in general poor but unexpectedly presented a lower Coefficient Index for glands located internal than for those located external to the cartilage. A new proposed index of gland/lumen ratio has the advantage of including information not only about the glands in their entirety, but also the cross-sectional luminal area of bronchi.

An autopsy study of bronchial mucous gland hypertrophy in Glasgow.

Hypertrophy of the bronchial mucous glands was measured by the Reid index method in 359 specimens of right main bronchus obtained from consecutive autopsies performed in a general hospital in Glasgow. in 119 of these cases, the mucous glands were also measured by the point-counting technique. There was a close correlation between these 2 methods of estimating bronchial mucous gland size, and the Reid index retains a useful place both as a quick method of measurement for routine hospital use and in epidemiologic studies. the total incidence of mucous gland hypertrophy in the range observed in bronchitis, which was defined as a Reid index of greater than 0.50 or a point count of greater than 16.7 per cent, was 31 per cent by the Reid Index and 33 per cent by point counting. This incidence was approximately 2.5 times greater than that obtained in a large clinical survey. Mucous gland hypertrophy in the bronchitis range was more common in men than women but did not increase in incidence with increasing age in...

The Use of Expiratory Forced Flows for Determining Response to Bronchodilator Therapy

Two hundred seventeen patients were studied before and after administration of isoproterenol by IPPB. In 35 patients, lung specimens were examined within 12 months after the study. Patients with elevated bronchial gland-bronchial wall ratio (Reid index showed significantly more improvement in forced expiratory flows after bronchodilator therapy, as compared to patients with normal Reid index. There was no difference in response to therapy in patients with emphysema of less than 20 percent, as compared to patients with emphysema of more than 20 percent. Patients with severe reduction in lung recoil pressure had lesser improvement after therapy in forced expiratory flows, as compared to patients with moderate reduction in recoil pressure or normal recoil pressure. In 39 patients inspiratory pulmonary resistance and forced expiratory flows were measured before and after therapy. In all these 39 patients, airway resistance showed comparable improvement regardless of the value for recoil pressure. The lack of response in expiratory flows is attributed to the increased collapsibility of the large airways and not to lack of response to therapy.

Muscle and mucous gland size in the major bronchi of patients with chronic bronchitis, asthma, and asthmatic bronchitis.

Mucous gland size and the amount of muscle in the bronchi were measured in 7 patients with typical chronic bronchitis, 4 patients with chronic bronchitis and attacks of wheezing (chronic asthmatic bronchitis), and 3 patients with classic spasmodic asthma. The patients with asthma had increased bronchial muscle, but the patients with chronic bronchitis did not. Three of the 4 patients with asthmatic bronchitis had increased muscle; such patients can therefore be recognized morphologically, and might account for a proportion of patients with bronchitis and unusual degrees of airways obstruction. Mucous gland size was increased in asthma when assessed by the Dunnill point count, but not by the Reid index.

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

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.

Distribution of bronchial gland measurements in a Jamaican population.

Measurements of the gland thickness and Reid index have been made on bronchi obtained at necropsy on 53 male and 52 female Jamaicans. The mean values for the Reid index and mucous gland thickness obtained were 0·314 and 0·192 mm. for males, and 0·302 and 0·170 mm. for females respectively. No significant increase in value was seen with age, although the data suggest this trend. The results have been compared with data published from Montreal and the same overall Gaussian distribution is seen. This supports the suggestion that the gland measurements in non-bronchitic and bronchitic subjects do not fall into two distinct groups but are part of a continuous distribution. The similarity of the two studies is also of interest as the populations are drawn from two distinct environments, one from a non-industrialized tropical island, the other from a large city in the northern hemisphere.

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

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.

Acomparison of changes in the mucous glands and goblet cells of nasal, sinus, and bronchial mucosa.

A comparison of mucous gland size in the bronchial and nasal mucosa was performed on material from 24 random necropsies. The Reid index and counts of mucous gland acini were used as measures of hypertrophy. In 14 of these cases the relationship between goblet cell hyperplasia in the sinus mucosa and the presence of chronic bronchitis was investigated by comparing the proportion of goblet cells with the corresponding Reid index. No significant correlation was found between nasal and bronchial mucous gland size, and no association was demonstrated between the proportion of goblet cells in the sinus mucosa and the presence of chronic bronchitis as assessed by the Reid index. These findings suggest that a direct association between chronic bronchitis and chronic sinusitis probably does not exist, and that the inclusion of chronic bronchitis in the `sino-bronchial syndrome9 is not valid. We feel that this term should be restricted to the association of chronic sinusitis with bronchiectasis or adult pulmonary mucoviscidosis. If either infection or air pollution were the predominant cause of mucous gland hypertrophy, changes similar to those found in the bronchi would be expected in the nose and sinuses. Since our results show they are not found there, then some other factor, such as cigarette smoking, must be responsible.

Mucous gland hypertrophy in babies and children aged 15 years or less

Summary Major bronchi from 84 babies and children dying before the age of 16 years were examined for mucous gland hypertrophy. A Reid index of greater than 0·40 was more prevalent in babies dying from pulmonary atelectasis than in any other group. Mucous gland hypertrophy was more frequent in babies less than one year old, even after the exclusion of babies dying with pulmonary atelectasis or other respiratory disease, but after the age of one year its frequency was similar to that in non-smoking adults. Mucous gland hypertrophy was also more prevalent in patients dying from acute respiratory infections. No association was found between either sex or place of residence and mucous gland hypertrophy.

The variation of Reid index measurements within the major bronchial tree.

The variation of Reid index measurements within the major bronchial tree.

Mucous gland hypertrophy in chronic bronchitis, and its occurrence in smokers

Summary 1. Reid's observations that there is hypertrophy of the bronchial mucous glands in chronic bronchitis has been confirmed in a study of 106 necropsy and 16 surgical cases. 2. An overlap was found in the gland/wall ratio (Reid index) between bronchitics and non-bronchitics. The technique, however, distinguishes between groups of bronchitics and non-bronchitics at a highly significant statistical level. 3. The ratio of gland/wall thickness was increased in smokers as opposed to non-smokers. This was due almost entirely to the increase in the ratio which occurred in heavy smokers.