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Chronic obstructive pulmonary disease (COPD) is a chronic lung disease leading to irreversible destruction of the terminal bronchioles. Although the precise patho-physiological mechanisms remain to be elucidated, the bronchial epithelium seems to play a pivotal role in the disease. Recent studies have highlighted a great heterogeneity among COPD patients, with various disease courses including, in about half the cases, an origin in childhood. Modelling of COPD is a major goal but currently available models are imperfect. Our work aims to create a new in vitro cellular model to study the pathology of the disease. The differentiation of human induced pluripotential stem cells (hiPSCs) in bronchial epithelium is a step towards a better understanding of the developmental origin and the identification of new therapeutic targets., (Copyright © 2020 SPLF. Published by Elsevier Masson SAS. All rights reserved.)

Asthma is a chronic inflammatory disorder of the airways associated with bronchial hyperresponsiveness and permanent structural changes. Asthma can cause progressive lung impairment with a progressive decline of lung function leading to partially reversible or irreversible airway obstruction. These structural changes are called airway remodelling including loss of epithelial integrity, thickening of basement membrane, subepithelial fibrosis, goblet cell and submucosal gland enlargement, increase smooth muscle mass, decreased cartilage integrity and increased airway vascularity. These remodelling changes contribute to thickening of airway walls and consequently lead to airway narrowing, bronchial hyperresponsiveness, airway oedema and mucous hypersecretion. Airway remodelling is associated with a poorer clinical outcome among patients with asthma. Early diagnosis and prevention has the potential to decrease disease severity, to improve control and to prevent disease expression., (© 2011 médecine/sciences – Inserm / SRMS.)

Introduction: The bronchogenic cyst is a rare congenital malformation of the tracheobronchial tree. Ectopic bronchogenic cysts are extremely rare; they usually develop at the cervical level. This cyst is characterized by the presence of respiratory epithelium., Observation: A 5-year-old child was referred to maxillofacial surgery consultation because a right bronchial cyst was suspected. The radiological assessment suggested a thyroglossal tract cyst. The anatomopathological examination confirmed the cyst and lead to the final diagnosis of a dysembryoplastic bronchogenic cyst., Discussion: A bronchogenic cyst is rarely found at the cervical level. When this is the case, its embryological origin and management may be discussed. The preoperative diagnosis may be complex with no clinical or non-specific symptomatology. A complete excision of the lesion must be performed to reduce the risk of recurrence and malignant transformation., (Copyright © 2011 Elsevier Masson SAS. All rights reserved.)

Asthma and COPD (chronic obstructive pulmonary disease) are two pulmonary obstructive diseases. It is well recognized that inflammation plays a key role in the pathogenesis of these two diseases. However, inflammation per se does not entirely account for the progressive loss in pulmonary function. It is admitted that the functional changes partly relate to airway structural alteration called remodeling. In this review we summarize the most frequent tissue abnormalities found in patients with asthma and COPD and report on the relationship between structural alterations and clinical features of the disease.

Air-filled paratracheal bronchogenic cysts are extremely rare. They are lined by respiratory epithelium. We have operated on 2 patients whose cysts were diagnosed by CT scan: one presenting with bloody sputum and the other with dysphagia. Both patients had a history of neck surgery. Because such cases are rare in the literature, their exact origin, whether tracheocele, diverticulum or other form of air-filled cyst, remains a matter of debate. However, their frequency is probably underestimated because most cause few symptoms and are well tolerated. In a recent radiologic study their prevalence was found to be 2% in patients undergoing CT scan.

BACTERIAL FLORA IN THE SUBGLOTTAL AIRWAYS: In healthy non-smoking subjects, the subglottal airways are sterile. Inversely, bacteria are often isolated from the sublottal airways in patients with obstructive or non-obstructive chronic bronchitis, both during and between acute exacerbations. The significance of this bacterial colonization/infection, its natural history, and its impact on the course of chronic lung disease is poorly understood. BETWEEN EXACERBATIONS: 30 to 40% of all patients with chronic obstructive pulmonary disease in a stable situation without recent antibiotic therapy harbor potential pathogens in their intra-thoracic airways. The prevalence of Gram-negative bacilli increases in the more severe forms. This estimation is possibly biased due to the involuntary inclusion of patients with bronchial dilatation, since bronchectasia involves a high prevalence of bronchial colonization/infection. DURING EXACERBATIONS: The prevalence of bronchial colonization/infection by potential pathogens is to the order of 30-50%, irrespective of the bacteria isolated from endobronchial samples made during or between exacerbations. About half of the exacerbations would not be related to bacterial infection, but to viral infection. The other identified causes of exacerbations are: occupational or accidental exposure, co-morbidity (chronic sinus infection, chronic pharyngeal discharge, left ventricular failure, non-specific bronchial hyperreactivity). INFLAMMATION: Inflammation of the bronchial mucosa is a constant feature of chronic obstructive pulmonary disease. The biological and histocytological features are distinctive from those observed in asthma. Polynuclear activation appears to play an important role in polynuclear infiltration of the mucosa, amplified during bacterial colonization.

Acute bronchial mucosal sloughing related to Toxic Epidermal Necrolysis (Lyell syndrome) is widely reported in literature. On the contrary severe respiratory involvement is rare in post-infectious or toxic Epitheliolysis (Stevens-Johnson syndrome). There is no well-known predictive sign of bronchial epithelium involvement. An 18-year-old patient was admitted for Stevens-Johnson syndrome related to sulfasalazine (salazosulfapyridine). There were no respiratory signs. An acute respiratory failure occurred 36 hours after from admission due to an obstructive and desquamative necrosis of the tracheobronchial epithelium. We purpose that a fiberoptic laryngoscopy should be performed even in non-dyspneic patients suffering from Stevens-Johnson syndrome if hypersecretion is present. Fiberoptic bronchoscopy can be helpful in these cases.