Journal of Clinical PracticeJournal of Clinical Practice2220-30952618-8627Eco-Vector1071610.17816/clinpract9415-24Research ArticleIn vivo endomicroscopic features of distal airways in chronic bronchitis and chronic obstructive pulmonary diseaseDanilevskayaO. V.danless@mail.ruhttps://orcid.org/0000-0002-7573-3554AveryanovA. V.averyanovav@mail.ruhttps://orcid.org/0000-0003-1031-6933Research Institute of Pulmonology of the Federal Medical and Biological Agency of Russia151220189415241212201820122018Copyright © 2018, Danilevskaya O.V., Averyanov A.V.2018<p><strong>Relevance:</strong> Probe-based confocal laser endomicroscopy (CLE) of distal airways is a unique technology that allows real-time visualization of structures containing natural fluorophores, which are emitted by exposure to laser radiation with a wavelength of 488 nm, in vivo. To date, the endomicroscopic features of the distal respiratory tract have not been adequately studied in lung diseases, including chronic obstructive pulmonary disease and chronic bronchitis.</p>
<p><strong>The</strong> <strong>goal</strong> of the present study is to describe the endomicroscopic signs of the distal parts of the respiratory system in chronic inflammatory lung diseases such as chronic obstructive pulmonary disease and chronic bronchitis.</p>
<p><strong>Methods:</strong> A total of 21 patients with emphysematous and bronchitic phenotypes of chronic obstructive pulmonary disease and chronic bronchitis were examined. All the patients have undergone CLE of distal airways or alveoloscopy during bronchoscopy. The most pathognomonic changes were evaluated on the obtained endomicroscopic images.</p>
<p><strong>Results:</strong> For each studied nosological form of chronic inflammatory lung diseases, by careful morphometric analysis of a significant number of informative images, the most specific endomicroscopic changes were identified with the release of CLE patterns.</p>
<p><strong>Conclusions: </strong>CLE of distal airways in patients with chronic inflammatory lung diseases allows visualizing changes in the elastic framework of the acini, as well as identifying pathological intraluminal contents, which can be attributed to valuable additional tools in a row of diagnostic methods of respiratory medicine.</p>probe-based confocal laser endomicroscopyalveoloscopychronic inflammatory lung diseasesdistal airwayschronic obstructive pulmonary diseasechronic bronchitisконфокальная лазерная эндомикроскопияальвеолоскопияхронические воспалительные заболевания легкихдистальные отделы дыхательных путейхроническая обструктивная болезнь легкиххронический бронхит[Thiberville L, Salaun M, Lachkar S, et al. Human in vivo fluorescence microimaging of the alveolar ducts and sacs during bronchoscopy. Eur Respir J. 2009;33(5):974−985. doi: 10.1183/09031936.00083708.][Wellikoff AS, Holladay RC, Downie GH, et al. Comparison of in vivo probe-based confocal laser endomicroscopy with histopathology in lung cancer: A move toward optical biopsy. Respirology. 2015;20(6):967–974. doi: 10.1111/resp.12578.][Fuchs FS, Zirlik S, Hildner K, et al. Confocal laser endomicroscopy for diagnosing lung cancer in vivo. Eur Respir J. 2013;41(6):1401–1408. doi: 10.1183/09031936.00062512.][Yick CY, von der Thüsen JH, Bel EH, et al. In vivo imaging of the airway wall in asthma: fibered confocal fluorescence microscopy in relation to histology and lung function. Respir Res. 2011;12(1):85. doi: 10.1186/1465-9921-12-85.][Black PN, Ching PS, Beaumont B, et al. Changes in elastic fibres in the small airways and alveoli in COPD. Eur Respir J. 2008;31(5):998–1004. doi: 10.1183/09031936.00017207.][Danilevskaya O, Averyanov A, Lesnyak V, et al. Confocal laser endomicroscopy for diagnosis and monitoring of pulmonary alveolar proteinosis. J Bronchology Interv Pulmonol. 2015;22(1):33–40. doi: 10.1097/LBR.0000000000000126.][Shafiek H, Fiorentino F, Cosio BG, et al. Usefulness of bronchoscopic probe-based confocal laser endomicroscopy in the diagnosis of pneumocystis jirovecii pneumonia. Respiration. 2016;92(1):40–47. doi: 10.1159/000447431.][Yserbyt J, Alamé T, Dooms C, Ninane V. Pulmonary alveolar microlithiasis and probe-based confocal laser endomicroscopy. J Bronchology Interv Pulmonol. 2013;20(2):159–163. doi: 10.1097/LBR.0b013e31828abc03.][Newton RC, Kemp SV, Yang GZ, et al. Imaging parenchymal lung diseases with confocal endomicroscopy. Respir Med. 2012;106(1):127–137. doi: 10.1016/j.rmed.2011.09.009.][Meng P, Tan GL, Low SY, et al. Fibred confocal fluorescence microscopy in the diagnosis of interstitial lung diseases. J Thorac Dis. 2016;8(12):3505–3514. doi: 10.21037/jtd.2016.12.60.][Cosío BG, Shafiek H, Fiorentino F, et al. Structure-function relationship in COPD revisited: an in vivo microscopy view. Thorax. 2014;69(8):724–730. doi: 10.1136/thoraxjnl-2013-204479.][Vlahovic G, Russell ML, Mercer RR, Crapo JD. Cellular and connective tissue changes in alveolar septal walls in emphysema. Am J Respir Crit Care Med. 1999;160(6):2086–2092. doi: 10.1164/ajrccm.160.6.9706031.][Timmins SC, Diba C, Farrow CE, et al. The relationship between airflow obstruction, emphysema extent, and small airways function in COPD. Chest. 2012;142(2):312–319. doi: 10.1378/chest.11-2169.][Zanini A, Cherubino F, Zampogna E, et al. Bronchial hyperresponsiveness, airway inflammation, and reversibility in patients with chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis. 2015;10:1155–1161. doi: 10.2147/COPD.S80992.][Kim V, Criner GJ. Chronic bronchitis and chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2013;187(3):228–237. doi: 10.1164/rccm.201210-1843CI.][de Oca MM, Halbert RJ, Lopez MV, et al. The chronic bronchitis phenotype in subjects with and without COPD: the PLATINO study. Eur Respir J. 2012;40(1):28–36. doi: 10.1183/09031936.00141611.]