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The degree of airway obstruction has not been well investigated within the pathogenesis of LAM.<\/jats:p><jats:p>Using a combination of<jats:italic>ex vivo<\/jats:italic>computed tomography (CT), microCT and histology, the site and nature of airway obstruction in LAM explant lungs was compared with matched control lungs (n=5 each). The total number of airways per generation, total airway counts, terminal bronchioles number and surface density were compared in LAM<jats:italic>versus<\/jats:italic>control.<\/jats:p><jats:p><jats:italic>Ex vivo<\/jats:italic>CT analysis demonstrated a reduced number of airways from generation 7 on (p&lt;0.0001) in LAM compared with control, whereas whole-lung microCT analysis confirmed the three- to four-fold reduction in the number of airways. Specimen microCT analysis further demonstrated a four-fold decrease in the number of terminal bronchioles (p=0.0079) and a decreased surface density (p=0.0079). Serial microCT and histology images directly showed the loss of functional airways by collapse of airways on the cysts and filling of the airway by exudate.<\/jats:p><jats:p>LAM lungs show a three- to four-fold decrease in the number of (small) airways, caused by cystic destruction which is the likely culprit for the progressive loss of pulmonary function.<\/jats:p>","DOI":"10.1183\/13993003.01965-2019","type":"journal-article","created":{"date-parts":[[2020,2,27]],"date-time":"2020-02-27T13:27:06Z","timestamp":1582810026000},"page":"1901965","update-policy":"https:\/\/doi.org\/10.1183\/ers-crossmark-policy","source":"Crossref","is-referenced-by-count":14,"title":["Quantitative analysis of airway obstruction in lymphangioleiomyomatosis"],"prefix":"10.1183","volume":"56","author":[{"given":"Stijn 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