A 56-year-old man is evaluated for dyspnea, wheezing, and cough productive of yellow sputum. The patient reports that he has been treated with antibiotics when the dyspnea is severe. He has smoked 2 packs of cigarettes daily for the past 25 years. The schematic diagram below is a representation of a bronchial wall. Which of the following ratios is the best pathological index to determine the severity of this patient's disease?

Question

A 56-year-old man is evaluated for dyspnea, wheezing, and cough productive of yellow sputum.  The patient reports that he has been treated with antibiotics when the dyspnea is severe.  He has smoked 2 packs of cigarettes daily for the past 25 years.  The schematic diagram below is a representation of a bronchial wall.  Which of the following ratios is the best pathological index to determine the severity of this patient's disease?

Quizplus · Accepted Answer

11ec160b_3a0a_a497_9249_97fe479ce068_MD0001_00 This patient's dyspnea, wheezing, and productive cough in the setting of heavy smoking are consistent with chronic obstructive pulmonary disease (COPD). Patients with COPD often have components of both chronic bronchitis and emphysema. Chronic bronchitis is characterized by increased mucus secretion and bronchial wall thickening with consequent narrowing of the bronchial lumen. Bronchial gland hyperplasia in the submucosa is the major contributor to bronchial wall thickening. The severity of this change can be measured by the Reid index. The Reid index is a pathologic tool that measures the ratio of the thickness of the submucosal glands to the thickness of the bronchial wall between the epithelial basement membrane and the bronchial cartilage. A normal Reid index is 0.4. Higher values correlate with increased duration and severity of chronic bronchitis. Educational objective: Hyperplasia of the submucosal bronchial glands is the major contributor to bronchial wall thickening in chronic bronchitis. The Reid index is the ratio of the thickness of the submucosal bronchial glands to the thickness of the bronchial wall between the epithelial basement membrane and the bronchial cartilage. Higher values correlate with increased duration and severity of chronic bronchitis. __________ References: Quantitative study of bronchial mucous gland enlargement. (http://www.ncbi.nlm.nih.gov/pubmed/7385091)

A 56-Year-Old Man Is Evaluated for Dyspnea, Wheezing, and Cough