Verleden SE, Tanabe N, McDonough JE, et al. - Researchers undertook this retrospective cohort study to re-assess the hypothesis that airways are spared in idiopathic pulmonary fibrosis (IPF) by employing a multiresolution imaging protocol that integrates multidetector CT, with micro-CT and histology. They compared explanted lungs from patients suffering from severe IPF managed by lung transplantation vs a cohort including unused donor (control) lungs. The donor control lungs had no known lung disease, comorbidities, or structural lung injury. A 57% loss of the terminal bronchioles, the appearance of fibroblastic foci, and infiltration of the tissue by inflammatory immune cells capable of forming lymphoid follicles, all were noted in relation to minimal fibrosis in IPF tissue vs healthy (control) lung anatomy, in the micro-CT analysis. Overall, small airways disease was identified as a characteristic of IPF, with significant loss of terminal bronchioles happening within areas of minimal fibrosis. Experts hypothesized, based on these data, that the small airways could be a potential treatment target in IPF.