Pulmonary function testing and chest tomography in patients with acromegaly

Background: Despite the gradual improvement in treatment procedures and cure rates of acromegaly, a steady increase in the mortality rate due to respiratory disease has been documented in recent decades. In this study, our objectives were to describe the abnormalities in lung structure and function that occur in acromegalic patients and to correlate these changes with hormonal levels. Methods: This cross-sectional study included 20 acromegalic patients and 20 age-and height-matched control subjects, all non-smokers. All subjects underwent spirometry, whole body plethysmography, carbon monoxide diffusing capacity, and respiratory muscle strength. Acromegalic patients also performed high-resolution computed tomography (HRCT). Results: Most patients were female (65%), with a mean age of 52.5 ± 13 years. Acromegalic patients showed lower values of maximum expiratory pressure (55.9 ± 17.1 vs. 103.7 ± 19.2%; p < 0.001) and maximum inspiratory pressure (71.4 ± 27.8 vs. 85.3 ± 24.1%; p = 0.005) compared to control subjects. The values of forced vital capacity (107.1 ± 15.9 vs. 98.9 ± 21.4%; p = 0.028), total lung capacity – TLC (107.3 ± 12.9 vs. 93.7 ± 7.60%; p = 0.002), residual volume (114.1 ± 22.7 vs. 90.0 ± 14.6%; p < 0.001), and airways’ resistance (3.82 vs. 2.31 cmH2O/L/s; p = 0.039) were greater in acromegalic patients than in control subjects. The difference between the TLC measured by plethysmography and the VA (alveolar volume) measured during the DLCO maneuver was higher in acromegalic patients than in control subjects (0.69 ± 0.46 vs. 0.19 ± 0.61 L; p = 0.021). The main findings in HRCT in acromegalic patients were air trapping, airway calcification and bronchiectasis, which were observed in 60%, 40% and 35% of cases, respectively. There was no significant correlation between the levels of growth hormone and insulin-like growth factor I, the lung function and the air trapping. Conclusions: Acromegalic patients show changes consistent with the involvement of the small airways and ventilation inhomogeneity, both in terms of lung function and structure. However, air trapping cannot be explained either by hormone levels or changes in lung function.

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Body mass index status and peripheral airway obstruction in school-age children: a population-based cohort study

Thorax ◽

10.1136/thoraxjnl-2017-210716 ◽

2018 ◽

Vol 73 (6) ◽

pp. 538-545 ◽

Cited By ~ 12

Author(s):

Sandra Ekström ◽

Jenny Hallberg ◽

Inger Kull ◽

Jennifer L P Protudjer ◽

Per Thunqvist ◽

...

Keyword(s):

Body Mass Index ◽

Lung Function ◽

Airway Obstruction ◽

Body Mass ◽

Overweight And Obesity ◽

School Age Children ◽

Childhood And Adolescence ◽

Small Airways ◽

Cross Sectional ◽

The Impact

BackgroundFew large prospective studies have investigated the impact of body mass index (BMI) on lung function during childhood.MethodsUsing data collected between 2002 and 2013, we analysed associations between BMI status and lung function (assessed by spirometry) from 8 to 16 years, as well as cross-sectional associations with small airway function (impulse oscillometry) at 16 years in the BAMSE cohort (n=2889). At 16 years, cross-sectional associations with local and systemic inflammation were investigated by analysing FENO, blood eosinophils and neutrophils.ResultsOverweight and obesity at 8 years were associated with higher FVC, but lower FEV1/FVC ratio at 8 and 16 years. In boys, but not girls, obesity at 8 years was associated with a further reduction in FEV1/FVC between 8 and 16 years. In cross-sectional analyses, overweight and obesity were associated with higher frequency dependence of resistance (R5–20) and larger area under the reactance curve (AX0.5) at 16 years. Increased blood neutrophil counts were seen in overweight and obese girls, but not in boys. No association was found between BMI status and FENO. Persistent, but not transient, overweight/obesity between 8 and 16 years was associated with higher R5–20 and AX0.5 and lower FEV1/FVC (−2.8% (95% CI −4.1 to −1.2) in girls and −2.7% (95% CI −4.4 to −1.1) in boys) at 16 years, compared with persistent normal weight.ConclusionIn childhood and adolescence, overweight and obesity, particularly persistent overweight, were associated with evidence of airway obstruction, including the small airways.

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P051 The bigger you are the harder you fall? Short term effects of LUM/IVA (Orkambi) on lung function in children with cystic fibrosis

Archives of Disease in Childhood ◽

10.1136/archdischild-2019-nppc.60 ◽

2019 ◽

Vol 104 (7) ◽

pp. e2.57-e2

Author(s):

Emma O’ Grady ◽

Rebecca Finnegan ◽

Anna Smyth ◽

Stephanie Ryan ◽

Michael Williamson

Keyword(s):

Cystic Fibrosis ◽

Lung Function ◽

Pulmonary Function Tests ◽

Real Life ◽

Young Patients ◽

Forced Expiratory Volume ◽

List Type ◽

High Resolution Computed Tomography ◽

Air Trapping ◽

Female Ratio

AimCystic Fibrosis conductance Transmembrane Regulator (CFTR) protein modulators represent a major breakthrough in the pharmacological management of Cystic Fibrosis (CF). Previous studies report acute changes in lung function after first administration of lumacaftor/ivacaftor (LUM/IVA) without a clear underlying mechanism.1 2 Our aim was to explore links between changes in percent predicted forced expiratory volume in one second (ppFEV1) and a number of potentially influencing factors.MethodsWe conducted a retrospective review of all children with CF who were started on LUM/IVA treatment between September 2016 and August 2017 in our institution. Data was collected from patient charts, electronic laboratory and radiology records. CT Thorax images were reviewed for evidence of air trapping using the Brody score.3 Descriptive and statistical analyses were performed using SPSS. ResultsData was collected from 15 children with CF who were started on LUM/IVA treatment. The mean (±SD) age of starting treatment was 14 years (±1.7 years), with a mean weight of 47.3 kg (±8.9 kg) and male-to-female ratio of 9:6. Ninety-three percent of patients experienced an acute decline in ppFEV1 post initiation of LUM/IVA, with an absolute mean decline of -10.8% (0–20%). There is a statistically significant inverse relationship between absolute change in ppFEV1 (FEV1) and baseline ppFEV1. There is no correlation between FEV1 and weight, gender or air trapping score.ConclusionOur results suggest that a LUM/IVA related decline in lung function is more significant in CF children with higher baseline ppFEV1. This offers reassurance when initiating LUM/IVA as the patients who experience significant declines have a greater respiratory reserve with which to support this reduction. ReferencesRatjen F, Hug C, Marigowda G, et al. Efficacy and safety of lumacaftor and ivacaftor in patients aged 6–11 years with cystic fibrosis homozygous for F508del-CFTR: a randomised, placebo-controlled phase 3 trial. Lancet Respir Med 2017;5:557–567.Labaste A, Ohlmann C, Mainguy C, et al. Real-life acute lung function changes after lumacaftor/ivacaftor first administration in paediatric patients with cystic fibrosis. J Cyst Fibros 2017;16:709–712.Brody A, Klein J, Molina P, et al. High- resolution computed tomography in young patients with cystic fibrosis: distribution of abnormalities and correlation with pulmonary function tests. Journal of Pediatrics 2004;145:32–38.

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Air trapping is associated with heterozygosity for Alpha-1 Antitrypsin mutations in patients with asthma

10.21203/rs.3.rs-23377/v1 ◽

2020 ◽

Author(s):

Marina Aiello ◽

Ghirardini Marianna ◽

Pisi Roberta ◽

Ferrarotti Ilaria ◽

Bertorelli Giuseppina ◽

...

Keyword(s):

Lung Function ◽

Serum Concentration ◽

Genetic Disorder ◽

University Hospital ◽

Small Airways ◽

Air Trapping ◽

Asthmatic Patients ◽

Alpha 1 Antitrypsin Deficiency ◽

Alpha 1 Antitrypsin ◽

Few Data

Abstract Background: Alpha-1 Antitrypsin Deficiency (AATD) is a hereditary genetic disorder involving lungs in adults, characterized by low serum concentration of the protein alpha-1 antitrypsin (AAT). Several reports indicate that asthma is common in AATD patients, but there are only few data on respiratory function in asthmatic patients with AATD. The aim of the study is to evaluate lung function in asthmatic outpatients with AATD vs. asthmatic subjects without AATD. Methods: We performed the quantitative analysis of the serum concentration of AAT in 600 outpatients affected by mild to moderate asthma from the University Hospital of Parma, Italy. Fifty-seven of them underwent the genetic analysis subsequently, they were subdivided into AATD and non-AATD subjects. All the AATD patients had a heterozygous genotype, except one (PI*SS). We assessed the lung function through a flow-sensing spirometer and the small airways parameters through an impulse oscillometry system.Results: The values of FVC (% predicted) and of the RV/TLC (%) ratio were respectively lower and higher in patients with AATD vs. patients without AATD, showing a significantly greater air trapping (p = 0.014 and p = 0.017 respectively). Moreover, patients with AATD in comparison to patients without AATD showed lower FEV3 (% predicted) and FEV6 (L) spirometric values, reflecting a smaller airways contribution.Conclusions: AATD in asthmatic heterozygote patients with PI*MZ and PI*MS genotypes was associated with small airways dysfunction and with lung air trapping.

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Small airways dysfunction is associated to Alpha-1 Antitrypsin Deficiency in patients with asthma

10.21203/rs.2.17783/v1 ◽

2019 ◽

Author(s):

Marina Aiello ◽

Marianna Ghirardini ◽

Roberta Pisi ◽

Ilaria Ferrarotti ◽

Giuseppina Bertorelli ◽

...

Keyword(s):

Lung Function ◽

Genetic Disorder ◽

University Hospital ◽

Small Airways ◽

Air Trapping ◽

Asthmatic Patients ◽

Antitrypsin Deficiency ◽

Alpha 1 Antitrypsin Deficiency ◽

Alpha 1 Antitrypsin ◽

Few Data

Abstract Background Alpha-1 Antitrypsin Deficiency (AATD) is a hereditary genetic disorder involving lungs in adults, characterized by low serum concentration of the protein alpha-1 antitrypsin (AAT). Several reports indicate that asthma is common in AATD patients, but there are only few data on respiratory function in asthmatic patients with intermediate AATD. The aim of the study is to evaluate lung function in asthmatic outpatients with AATD vs. asthmatic subjects without AATD.Methods We enrolled 57 outpatients affected by mild to moderate asthma from the University Hospital of Parma, Italy. We submitted to genetic analysis the asthmatic outpatients with a serum AAT concentration <113 mg/dL and those with relatives affected by AATD. Subsequently, the study population was split into AATD and not AATD subjects. We assessed lung function through a flow-sensing spirometer and the small airways parameters through an impulse oscillometry system.Results The values of FVC (% predicted) and of the RV/TLC (%) ratio were respectively lower and higher in patients with AATD vs. patients without AATD, showing a significantly greater air trapping (p = 0.014 and p = 0.017 respectively). Moreover, patients with AATD in comparison to patients without AATD showed lower FEV3 (% predicted) and FEV6 (L) values. A significant and positive correlation (p=0.041; r=0.894) occurred between the RV/TLC ratio and the years of smoking in the group of asthmatic patients with AATD.Conclusions AATD predisposes asthmatic heterozygote patients with PI*MZ, PI*MS and intermediate levels of AAT to small airways dysfunction and to increased values of pulmonary air trapping.

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Aspergillus and progression of lung disease in children with cystic fibrosis

Thorax ◽

10.1136/thoraxjnl-2018-211550 ◽

2018 ◽

Vol 74 (2) ◽

pp. 125-131 ◽

Cited By ~ 15

Author(s):

Sabariah Noor Harun ◽

Claire E Wainwright ◽

Keith Grimwood ◽

Stefanie Hennig

Keyword(s):

Cystic Fibrosis ◽

Lung Function ◽

Bronchoalveolar Lavage ◽

Lung Disease ◽

Lung Function Decline ◽

Air Trapping ◽

Cross Sectional ◽

Progression Model ◽

Non Linear ◽

The Impact

BackgroundThe impact of Aspergillus on lung disease in young children with cystic fibrosis is uncertain.AimsTo determine if positive respiratory cultures of Aspergillus species are associated with: (1) increased structural lung injury at age 5 years; (2) accelerated lung function decline between ages 5 years and 14 years and (3) to identify explanatory variables.MethodsA cross-sectional analysis of association between Aspergillus positive bronchoalveolar lavage (BAL) cultures and chest high-resolution CT (HRCT) scan findings at age 5 years in subjects from the Australasian Cystic Fibrosis Bronchoalveolar Lavage (ACFBAL) study was performed. A non-linear mixed-effects disease progression model was developed using FEV1% predicted measurements at age 5 years from the ACFBAL study and at ages 6–14 years for these subjects from the Australian Cystic Fibrosis Data Registry.ResultsPositive Aspergillus BAL cultures at age 5 years were significantly associated with increased HRCT scores for air trapping (OR 5.53, 95% CI 2.35 to 10.82). However, positive Aspergillus cultures were not associated with either FEV1% predicted at age 5 years or FEV1% predicted by age following adjustment for body mass index z-score and hospitalisation secondary to pulmonary exacerbations. Lung function demonstrated a non-linear decline in this population.ConclusionIn children with cystic fibrosis, positive Aspergillus BAL cultures at age 5 years were associated contemporaneously with air trapping but not bronchiectasis. However, no association was observed between positive Aspergillus BAL cultures on FEV1% predicted at age 5 years or with lung function decline between ages 5 years and 14 years.

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Assessment of methacholine-induced airway constriction by ultrafast high-resolution computed tomography

Journal of Applied Physiology ◽

10.1152/jappl.1993.75.5.2239 ◽

1993 ◽

Vol 75 (5) ◽

pp. 2239-2250 ◽

Cited By ~ 110

Author(s):

I. Amirav ◽

S. S. Kramer ◽

M. M. Grunstein ◽

E. A. Hoffman

Keyword(s):

Computed Tomography ◽

High Resolution ◽

Small Airways ◽

Opening Pressure ◽

High Resolution Computed Tomography ◽

Cross Sectional ◽

Airway Caliber ◽

Airway Opening ◽

Residual Capacity ◽

Pressure Changes

Assessment of changes in airway dimensions during bronchoconstriction is conventionally based on measurements of respiratory mechanics. We evaluated the efficacy of ultrafast high-resolution computed tomography (UHRCT) to directly determine the dynamic changes in cross-sectional area (CSA) of airways in response to methacholine (MCh). UHRCT scans were obtained at functional residual capacity before (baseline) and after intravenous bolus injections of MCh (10(-8.5)-10(-7.0) mol/kg) to seven mechanically ventilated pigs. Changes in CSA of bronchi of varying baseline size (1–10 mm diam) were determined by using a customized image processing software package (VIDA) based on a user-directed computer-adjusted edge-finding algorithm. MCh induced dose-dependent decreases in CSA, which were paralleled by increases in airway opening pressure at higher doses of MCh; at lower doses of MCh, decreases in CSA of smaller airways were detected without concomitant changes in airway opening pressure. Changes in CSA were heterogeneous and variable, especially in the smaller airway ranges. The results of the present study support the concept that UHRCT can be used in conjunction with bolus challenges to effectively determine dose-response changes in airway caliber in both large and small airways. This technique provides data that may not be reflected by conventional lung function measurements and, hence, is a useful tool to study airway reactivity.

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Desaturation-Distance Ratio During Submaximal and Maximal Exercise Tests and Its Association With Lung Function Parameters in Patients With Lymphangioleiomyomatosis

Frontiers in Medicine ◽

10.3389/fmed.2021.659416 ◽

2021 ◽

Vol 8 ◽

Author(s):

Douglas Silva Queiroz ◽

Cibele Cristine Berto Marques da Silva ◽

Alexandre Franco Amaral ◽

Martina Rodrigues Oliveira ◽

Henrique Takachi Moriya ◽

...

Keyword(s):

Lung Function ◽

Airway Obstruction ◽

Field Tests ◽

Interstitial Lung Diseases ◽

Functional Evaluation ◽

Air Trapping ◽

Exercise Tests ◽

Distance Ratio ◽

Cross Sectional ◽

Walking Test

Background: The desaturation–distance ratio (DDR), the ratio of the desaturation area to the distance walked, is a promising, reliable, and simple physiologic tool for functional evaluation in subjects with interstitial lung diseases. Lymphangioleiomyomatosis (LAM) is a rare neoplastic condition frequently associated with exercise impairment. However, DDR has rarely been evaluated in patients with LAM.Objectives: To assess DDR during maximal and submaximal exercises and evaluate whether DDR can be predicted using lung function parameters.Methods: A cross-sectional study was conducted in a cohort of women with LAM. The 6-min walking test (6MWT) and the incremental shuttle walking test (ISWT) were performed, and DDR was obtained from both tests. The functional parameters were assessed at rest using spirometry and body plethysmography. The pulmonary function variables predictive of DDR were also assessed.Results: Forty patients were included in this study. The mean age was 46 ± 10 years. Airway obstruction, reduced DLCO, and air trapping were found in 60, 57, and 15% of patients, respectively. The distance walked and the DDR for the 6MWT and ISWT were, respectively, 517 ± 65 and 443 ± 127 m; and 6.6 (3.8–10.9) and 8.3 (6.2–12.7). FEV1 (airway obstruction) and reduced DLCO and RV/TLC (air trapping) were independent variables predictive of DDR during exercises field tests [DDR6MWT = 18.66–(0.06 × FEV1%pred)–(0.10 × DLCO%pred) + (1.54 × air trapping), Radjust2 = 0.43] and maximal [DDRISWT = 18.84–(0.09 × FEV1%pred)–(0.05 × DLCO%pred) + (3.10 × air trapping), Radjust2 = 0.33].Conclusion: Our results demonstrated that DDR is a useful tool for functional evaluation during maximal and submaximal exercises in patients with LAM, and it can be predicted using airway obstruction, reduced DLCO, and air trapping.

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Respiratory Symptoms and Lung Function in Poultry Confinement Workers in Western Canada

Canadian Respiratory Journal ◽

10.1155/2003/109679 ◽

2003 ◽

Vol 10 (7) ◽

pp. 375-380 ◽

Cited By ~ 33

Author(s):

Shelley P Kirychuk ◽

Ambikaipakan Senthilselvan ◽

James A Dosman ◽

Victor Juorio ◽

John JR Feddes ◽

...

Keyword(s):

Lung Function ◽

Respiratory Symptoms ◽

Respiratory Health ◽

Forced Expiratory Volume ◽

Poultry Production ◽

Housing Type ◽

Cross Sectional ◽

Control Subjects ◽

Poultry Workers ◽

Grain Farmers

OBJECTIVE: To determine whether poultry production methods impact respiratory health, and whether poultry farmers have more respiratory symptoms and lower lung function than comparison control groups.DESIGN: Cross-sectional study.SETTING: Provinces of Saskatchewan, Alberta and Manitoba during the winters of 1997 to 1999. POPULATION: Three hundred three poultry workers, 241 grain farmers and 206 nonfarming control subjects were studied. Poultry workers were further classified according to the poultry housing type in which they worked, ie, workers who worked with poultry raised on the floor (floor-based operations), which included broiler/roaster, broiler/breeder and turkey operations (n=181), and workers who worked with poultry raised in a caged setting (cage-based operations), which included egg operations (n=122).INTERVENTIONS: Subjects completed a respiratory health questionnaire, which included questions on the poultry operation and work habits, and participated in lung function testing.MAIN RESULTS: Overall, this study indicated that poultry workers report greater prevalences of current and chronic respiratory symptoms than control populations, and that the type of production method (cage-based versus floor-based) appears to influence the prevalence of respiratory symptoms and lung function values. Workers from cage-based operations report greater prevalences of current cough and wheeze, as well as lower mean values for forced expiratory volume in the first second (FEV1), forced expiratory flow at 25% to 75% of vital capacity (FEF25-75) and FEV1/FVC than workers from floor-based facilities. Workers from cage-based facilities also reported greater prevalences of current and chronic cough and phlegm, as well as significantly lower FEF25-75 and FEV1/FVC values than nonfarming control subjects. Furthermore, grain farmers had lower FVC and FEV1 values than nonfarmers.CONCLUSIONS: The results suggest that the type of poultry production system (ie, floor- versus cage-based) appears to have an effect on the respiratory response of workers from these facilities. Further studies are required to understand the physiological mechanisms of respiratory dysfunction and the relationships concerning workplace exposure among poultry workers.

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Pulmonary Function and Circulating Adhesion Molecules in Patients with Diabetes Mellitus

Canadian Respiratory Journal ◽

10.1155/2003/295238 ◽

2003 ◽

Vol 10 (5) ◽

pp. 259-264 ◽

Cited By ~ 7

Author(s):

Mary S Boulbou ◽

Konstantinos I Gourgoulianis ◽

Efthymia A Petinaki ◽

Vasilios K Klisiaris ◽

Antonios N Maniatis ◽

...

Keyword(s):

Diabetes Mellitus ◽

Lung Function ◽

Adhesion Molecules ◽

Supine Position ◽

Glycosylated Hemoglobin ◽

Diabetic Patients ◽

Type 2 Diabetic Patients ◽

Alveolar Volume ◽

Control Subjects ◽

Circulating Levels

BACKGROUND: Lung function in diabetes has been reported in several studies with contradictory results. Diabetes mellitus increases expression of adhesion molecules through hyperglycemia. These molecules play an important role in the pathophysiological dysfunction of the vasculature.OBJECTIVE: To explore the possible relationship between lung function and circulating levels of adhesion molecules in diabetes.METHODS: Sixteen type 1 diabetic patients, 33 type 2 diabetic patients and 22 healthy subjects matched for age and sex were studied. Spirometry measurements were performed and pulmonary diffusion capacity for carbon monoxide (DLco) was measured in sitting and supine positions by the single-breath method corrected by alveolar volume (VA). Glycosylated hemoglobin, retinopathy and nephropathy were included as parameters of metabolic control and diabetic complications. Circulating levels of soluble E-selectin and vascular cell adhesion molecule-1 (VCAM-1) were determined in all subjects.RESULTS: Diabetic subjects showed lower variation in DLco and DLco/VA by changing posture from sitting to supine position (P=0.043 and P<0.001, respectively), and showed reduced total lung capacity (P<0.001) and forced expiratory volume in 1 s/forced vital capacity (P=0.009) compared with healthy control subjects. Serum concentrations of E-selectin were elevated in diabetic patients (P<0.001). There was no difference in serum VCAM-1 concentrations between diabetic and control subjects. On stepwise regression analysis, E-selectin concentrations were the most important contributing factor to the variation in DLco/VA.CONCLUSIONS: Diabetic patients show lower pulmonary volumes and variation in DLco by changing posture from sitting to supine position, and they also show increased levels of E-selectin. A possible explanation is impaired pulmonary microvasculature, because adhesion molecules seem to be sensitive markers of endothelial activation and damage seen in diabetes.

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Dysregulation of endocytic machinery and ACE2 in small airways of smokers and COPD patients can augment their susceptibility to SARS-CoV-2 (COVID-19) infections

AJP Lung Cellular and Molecular Physiology ◽

10.1152/ajplung.00437.2020 ◽

2020 ◽

Author(s):

Mathew Suji Eapen ◽

Wenying Lu ◽

Tillie-Louise Hackett ◽

Gurpreet K Singhera ◽

Isobel E. Thompson ◽

...

Keyword(s):

Lung Function ◽

Cathepsin L ◽

Smoking History ◽

Receptor Protein ◽

Normal Lung ◽

Small Airways ◽

Cross Sectional ◽

Viral Attachment ◽

Copd Patients ◽

Patient Groups

Lungs of smokers and COPD are severely compromised and are susceptible to SARS-CoV-2 attack. The lethal combination of enhanced SARS-CoV-2 attachment receptor protein ACE2 along with an increase in endocytic vacuoles will enable viral attachment, entry, and replication. The objective of the study was to identify the presence of SARS-CoV-2 host attachment receptor angiotensin-converting enzyme-2 (ACE2) along with endocytic vacuoles, early endosome antigen-1 (EEA1), late endosome marker RAB7, cathepsin-L and lysosome-associated membrane protein-1 (LAMP-1) as lysosome markers, in the airways of smokers and COPD patients. The study design was cross-sectional and involved lung resections from 39 patients in total, which included 19 patients with GOLD stage I or stage II COPD, of which 9 were current smokers with COPD (COPD-CS), and 10 ex-smokers with COPD (COPD-ES), 10 normal lung function smokers (NLFS) and 10 were never smoking normal controls (NC). Immunostaining for ACE2, EEA1, RAB7, and cathepsin-L was done. A comparative description for ACE2, EEA1, RAB7, and cathepsin-L expression pattern is provided for the patient groups. Further, staining intensity for LAMP-1 lysosomes was measured as the ratio of the LAMP-1 stained areas per total area of epithelium or sub-epithelium, using Image ProPlus software. LAMP-1 expression showed a positive correlation to patient smoking history while in COPD LAMP-1 negatively correlated to lung function. The active presence of ACE2 protein along with endocytic vacuoles such as early/late endosomes and lysosomes in the small airways of smokers and COPD patients provides evidence that these patient groups could be more susceptible to COVID-19.

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