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Hogg and colleagues (21) in 1968 first used the term small airways disease to describe airway disease in patients with variably severe chronic airflow obstruction characterized by loss of bronchioles, mucus plugs, and variable amounts of inflammation and fibrosis that involve "the smallest bronchi as well as the bronchioles, so that neither bronchitis nor bronchiolitis is an appropriate term.
The question is whether small VisoV changes in young people can be actually connected to increases in non-laminar or turbulent flow in damaged airways, and whether it can be used as an indication of the beginning of small airways disease in young smokers or in populations with chemical or air pollution exposure.
Miller agrees that a lung biopsy is not the standard of care in this setting, but says they opted to use it "after seeing too many soldiers with the exact same story" To date, he's biopsied 66 soldiers, with 62 showing small airways disease, 3 sarcoid, and 1 normal.
A variant of spirometry which was commonly used thirty years ago to help diagnose beginning small airways disease is the helium iso-flow test which involves performing flow volume loop after the patient has taken three deep breaths of heliox which is 80% helium and 20% nitrogen.
Key words: air pollution, chronic obstructive pulmonary disease, COPD, small airways disease.

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