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We recognize that quantitative methods of evaluating airway remodeling must include the direction of the 2D cross-section relative to the longitudinal axis of the airway and realize that the airways position significantly influences the quantitative parameters analysed 104

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Furthermore, cigarette smoke can activate the autophagy-dependent mechanism mediated by the deacetylase HDAC6, while causes the cilia proteins to be delivered to the lysosome for degradation or recycling, shortening the airway cilia ( in vitro to cause e-cadherin-mediated barrier function destruction of airway epithelial cells, leading to increased infection risk by viruses and bacteria that exacerbate COPD (Oldenburger et al., 2014)