Integration of single cell mRNA sequencing data from millions of cells revealed a high diversity of cell
types in the healthy and diseased human lung. In a large and complex organ, which is also constantly
exposed to external agents, it is crucial to understand the inuence of lung tissue topography or external
factors on gene expression variability within each cell type. Here, we applied three spatial
transcriptomics approaches, to: (i) localize the majority of lung cell types, including rare epithelial cells
within the tissue topography, (ii) describe consistent anatomical and regional variability in gene
expression within and across cell types, and (iii) reveal distinct cellular neighborhoods for specic
anatomical regions and examine gene expression variations in them. We thus provide a spatially
resolving tissue reference atlas including cell type composition and gene expression variations in three
representative regions of the healthy human lung. We further demonstrate its utility by dening
previously unknown imbalances of epithelial cell type compositions in diseased tissue from patients
with stage II COPD. Our topographic atlas enables a precise description of characteristic regional cellular
responses upon experimental perturbations or during disease progression.