Aspiration can lead to serious pulmonary disease and occasionally death. Substances aspirated commonly include bacteria or gastric contents or both, but may be as unusual as diesel oil or a variety of foreign bodies. Pulmonary symptoms range from a subtle cough, wheezing, or hoarseness to severe dyspnea or asphyxiation. We discuss the mechanism of pulmonary disease caused by aspiration as well as the appropriate treatment.

Airflow-induced bronchoconstriction (AIB) may be initiated in asthmatic patients by inhaling dry air during eucapnic hyperventilation or exercise. Hypertonic aerosol-induced bronchoconstriction (HIB) also occurs in these patients, but it differs from AIB by exhibiting a faster time course. Although AIB and HIB probably increase airway fluid osmolality, only AIB is associated with airway cooling. In light of the similarities between our canine model and human AIB, we examined peripheral airway responses to dry air and hypertonic aerosol challenge. Specifically, we studied the magnitude and time course of these responses in an in situ, isolated, perfused lobe in which airway temperature was independently controlled. At body temperature, HIB peaked immediately after challenge, whereas transient airway cooling during aerosol challenge delayed HIB. In contrast, airway cooling attenuated AIB but did not alter its time course. Hypocapnia- and histamine-induced responses were not affected by airway cooling, suggesting that smooth muscle function was not impaired. To the extent that the mechanisms producing AIB in dogs and in humans are similar, our results suggest that (1) changes in airway fluid osmolality initiate AIB, (2) AIB = HIB + Cooling, and (3) exercise-induced asthma results from an imbalance between an excitatory pathway stimulated by airway drying and an inhibitory pathway initiated by airway cooling.

No abstract

Our goal was to partition whole lung resistance (RL) and cholinergic reactivity in rabbits into central airway, peripheral airway, and alveolar tissue (Rt) resistances by using forced oscillation (2 Hz), a retrograde catheter, and an alveolar capsule. Central and peripheral airway resistances accounted for approximately 80% of the baseline RL. However, immediately after acetylcholine challenge, Rt was negative. Bilateral vagal stimulation made Rt negative when the capsule was located on the left lung and not on the right lung. Stimulating either vagus produced a negative Rt in the lung ipsilateral to the stimulated nerve. Partial occlusion of the right main-stem bronchus with a balloon also made Rt negative. These results suggest that heterogeneous airflow exists at the level of the alveolar capsule during bronchoconstriction. Phase relationships between tracheal flow and retrograde catheter pressure suggest that flow at the level of the catheter was homogeneous. Thus, using only tracheal and retrograde catheter pressures, we repartitioned RL into its central airway and peripheral lung components. We conclude that cholinergic reactivity resides predominantly in the peripheral lung and that its peripheral location may be due largely to the development of heterogeneous airflow in peripheral airways.

No abstract