ABSTRACT
OBJECTIVES: Immunohistochemical evaluation of the effectiveness of bronchodilator treatment in patients with chronic obstructive pulmonary disease (COPD). MATERIALS AND METHODS: There have been examined bronchial mucosa biopsies taken endoscopically from 18 patients with obstructive pulmonary disease. The biopsies were fixed in 4% buffered formalin for 24-48 hours and paraffin inclusion was made using the standard technique. For each biopsy, there were performed 10 serial sections with a thickness of 5 µm. The sections were stained using morphological, histochemical and immunohistochemical methods. At three of the cases, the paraffin blocks were reconverted for the electron microscopy study, in order to assess subcellular details, with special reference to "target" cells involved in local immune response. Morphohistochemical and immunohistochemical analysis was effectuated on biopsies removed before and after the treatment with bronchodilators. RESULTS: The analysis of the biopsies removed before treatment revealed the following aspects: degenerative alterations of the surface epithelium, loss of ciliary differentiation, absence of caliciform cells, hyperexfoliation, formation of pseudopapillary structures, degenerative lesions of the glands, mucoid and oncocytary metaplasia, stasis in the dilated blood vessels, partly hyalinized wall, multiforme chronic inflammatory infiltrate, myofibroblasts in the depth of lamina propria; argyrophilic basement membrane, fragmentation and lysis of elastic fibers, degranulated mast cells associated with inflammatory infiltrate, with electron-dense typical granules, inflammatory infiltrate with CD20 positive B-lymphocytes, arranged perivasculary and in the vicinity of the basement membrane; rare positive CD4 T-lymphocytes; reduced number of plasma cells. After treatment we found the following aspects: partial or complete regeneration of the covering epithelium, with the presence of cilia cells and occasionally of caliciform cells; remaining myofibroblastic reaction in the lamina propria; increased number of mast cells with minimal or no degranulation; immature, lamelled mast cells. CONCLUSIONS: The application of management principles in group therapy study was done by the study which aims to demonstrate the beneficial role in COPD therapy of combining a ß2-agonist with an anticholinergic, obtaining in this way an additional bronchodilator effect, compared with the one obtained by administrating bronchodilators of type ß2 agonists. Deepening the molecular and cellular mechanisms of COPD can lead to more effective methods for early detection of disease, pharmacotherapy targeted and effective conduct exacerbations.
