Potent bronchoprotective effect of deep inspiration and its absence in asthma.
In the absence of deep inspirations, healthy individuals develop bronchoconstriction with methacholine inhalation. One hypothesis is that deep inspiration results in bronchodilation. In this study, we tested an alternative hypothesis, that deep inspiration acts as a bronchoprotector. Single-dose methacholine bronchoprovocations were performed after 20 min of deep breath inhibition, in nine healthy subjects and in eight asthmatics, to establish the dose that reduces forced expiratory volume in 1 s by >15%. The provocation was repeated with two and five deep inspirations preceding methacholine. Additional studies were carried out to assess optimization and reproducibility of the protocol and to rule out the possibility that bronchoprotection may result from changes in airway geometry or from differential spasmogen deposition. In healthy subjects, five deep inspirations conferred 85% bronchoprotection. The bronchoprotective effect was reproducible and was not attributable to increased airway caliber or to differential deposition of methacholine. Deep inspirations did not protect the bronchi of asthmatics. We demonstrated that bronchoprotection is a potent physiologic function of lung inflation and established its absence, even in mild asthma. This observation deepens our understanding of airway dysfunction in asthma.
Division of Clinical Immunology, Department of Medicine, Johns Hopkins University, School of Medicine, Baltimore, Maryland 21224, USA.
T
T
Kapsali
S
S
Permutt
B
B
Laube
N
N
Scichilone
A
A
Togias
D000328:Adult; D000336:Aerosols; D000485:Allergens / Q000633:toxicity; D001249:Asthma / Q000503:physiopathology*; D001980:Bronchi / Q000502:physiology* / Q000503:physiopathology*; D016085:Bronchoconstrictor Agents / Q000494:pharmacology; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D008297:Male; D016210:Methacholine Chloride / Q000494:pharmacology; D008875:Middle Aged; D012016:Reference Values; D015203:Reproducibility of Results; D012129:Respiratory Function Tests; D015656:Respiratory Mechanics / Q000502:physiology*; D014797:Vital Capacity / Q000502:physiology
D000336:Aerosols; D000485:Allergens; D016085:Bronchoconstrictor Agents; D016210:Methacholine Chloride