Polosukhin VV, Gutor SS, Du RH, et al. - Given that a variety of pathological alterations have been reported in small airways of COPD patients, researchers herein focused on the critical anatomic characteristics determining airflow limitation. From 18 non-smokers without chronic lung disease and 55 former smokers with COPD, they obtained and analyzed lung tissue specimens. They also conducted quantitative emphysema scoring on chest CT scans. Thickening of epithelial and subepithelial tissue, mucus plugging and decreased collagen density in the airway wall (in severe COPD), all were found in small airways from patients suffering from COPD. The pathological feature that was most closely associated with airflow limitation in COPD was loss of radial alveolar attachments in small airways. Neutrophilic inflammation may mediate alveolar attachments destruction.