Assessing the effect of deep inhalation on airway calibre: a novel approach to lung function in bronchial asthma and COPD

Pellegrino, Riccardo; Sterk, Peter J.; Sont, Jacob K.; Brusasco, Vito

doi:10.1183/0903.1936.98.12051219

Cited by 96 publications

(115 citation statements)

References 86 publications

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“…Although it is speculated that the target of modulation by lung volume change is the smooth muscle embedded in the airways [21][22][23][24][25][26][27][28][29][30], a direct relationship between lung volume change and alteration in ASM contractility is yet to be established. Investigations into the differences in the effects of deep inspiration on Raw in normal and asthmatic subjects have provided important insights into the disease mechanism of asthma and have implicated the involvement of ASM [31,32]. However, even if ASM is involved in the pathophysiology of asthma, it does not necessarily mean that the muscle itself is abnormal.…”

Section: Evidence Of Asm Involvement In Asthmamentioning

confidence: 99%

See 1 more Smart Citation

Airway smooth muscle dynamics: a common pathway of airway obstruction in asthma

An¹,

Bai²,

Bates³

et al. 2007

European Respiratory Journal

342

298

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Excessive airway obstruction is the cause of symptoms and abnormal lung function in asthma.As airway smooth muscle (ASM) is the effecter controlling airway calibre, it is suspected that dysfunction of ASM contributes to the pathophysiology of asthma. However, the precise role of ASM in the series of events leading to asthmatic symptoms is not clear. It is not certain whether, in asthma, there is a change in the intrinsic properties of ASM, a change in the structure and mechanical properties of the noncontractile components of the airway wall, or a change in the interdependence of the airway wall with the surrounding lung parenchyma. All these potential changes could result from acute or chronic airway inflammation and associated tissue repair and remodelling.Anti-inflammatory therapy, however, does not ''cure'' asthma, and airway hyperresponsiveness can persist in asthmatics, even in the absence of airway inflammation. This is perhaps because the therapy does not directly address a fundamental abnormality of asthma, that of exaggerated airway narrowing due to excessive shortening of ASM.In the present study, a central role for airway smooth muscle in the pathogenesis of airway hyperresponsiveness in asthma is explored.

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Section: Evidence Of Asm Involvement In Asthmamentioning

confidence: 99%

“…Tepper 32 , T. Tran 16 and L. Wang ABSTRACT: Excessive airway obstruction is the cause of symptoms and abnormal lung function in asthma.…”

mentioning

confidence: 99%

Airway smooth muscle dynamics: a common pathway of airway obstruction in asthma

An¹,

Bai²,

Bates³

et al. 2007

European Respiratory Journal

342

298

View full text Add to dashboard Cite

show abstract

“…A mechanistic interpretation of the above studies is, however, limited by the use of forced expiratory volume in 1 s (FEV 1 ) and forced vital capacity (FVC), measurements that are highly and variably affected by the full lung inflation preceding the forced expiratory maneuver. During induced bronchoconstriction, a full inflation transiently increases airway caliber, and the magnitude of this increase depends on the relative magnitude of the distending force of lung parenchyma and the constrictor force of airway smooth muscle (17). Therefore, any parameter derived from a full forced expiratory maneuver, including FEV 1 and FVC, will depend on both airway smooth muscle shortening capacity and airway wall response to a deep breath.…”

mentioning

confidence: 99%

Deep breaths, methacholine, and airway narrowing in healthy and mild asthmatic subjects

Crimi

Pellegrino

Milanese

et al. 2002

Journal of Applied Physiology

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Crimi, Emanuele, Riccardo Pellegrino, Manlio Milanese, and Vito Brusasco. Deep breaths, methacholine, and airway narrowing in healthy and mild asthmatic subjects. J Appl Physiol 93: 1384-1390, 2002. First published June 21, 2002 10.1152/japplphysiol.00209.2002Deep breaths taken before inhalation of methacholine attenuate the decrease in forced expiratory volume in 1 s and forced vital capacity in healthy but not in asthmatic subjects. We investigated whether this difference also exists by using measurements not preceded by full inflation, i.e., airway conductance, functional residual capacity, as well as flow and residual volume from partial forced expiration. We found that five deep breaths preceding a single dose of methacholine 1) transiently attenuated the decrements in forced expiratory volume in 1 s and forced vital capacity in healthy (n ϭ 8) but not in mild asthmatic (n ϭ 10) subjects and 2) increased the areas under the curve of changes in parameters not preceded by a full inflation over 40 min, during which further deep breaths were prohibited, without significant difference between healthy (n ϭ 6) and mild asthmatic (n ϭ 16) subjects. In conclusion, a series of deep breaths preceding methacholine inhalation significantly enhances bronchoconstrictor response similarly in mild asthmatic and healthy subjects but facilitates bronchodilatation on further full inflation in the latter.forced expiratory volume in 1 s; specific airway conductance; partial flow-volume curve; functional residual capacity; residual volume RECENT STUDIES HAVE SHOWN that deep breaths taken immediately before inhalation of methacholine (MCh) greatly modulate the bronchoconstrictor response in normal (10, 12, 21) but not in asthmatic (10) subjects. This would suggest that the shortening capacity of airway smooth muscle is reduced by previous lung stretching in healthy subjects, and the lack of such a bronchoprotective mechanism may be responsible for airway hyperresponsiveness in asthma. A mechanistic interpretation of the above studies is, however, limited by the use of forced expiratory volume in 1 s (FEV 1 ) and forced vital capacity (FVC), measurements that are highly and variably affected by the full lung inflation preceding the forced expiratory maneuver. During induced bronchoconstriction, a full inflation transiently increases airway caliber, and the magnitude of this increase depends on the relative magnitude of the distending force of lung parenchyma and the constrictor force of airway smooth muscle (17). Therefore, any parameter derived from a full forced expiratory maneuver, including FEV 1 and FVC, will depend on both airway smooth muscle shortening capacity and airway wall response to a deep breath.It is reasonable to postulate that, if the lack of a bronchoprotective effect by multiple deep breaths taken before inhaling a constrictor agent in asthma is due to the inability to reduce the shortening capacity of airway smooth muscle, then the different effects of the deep breaths on airway response to MCh between asthmati...

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“…The effect of this type of deep inspiration is well documented. 42 In normal patients, deep inspiration causes mild bronchodilation, and this may also be seen in patients with mild asthma. In some patients who have marked airway hyper-responsiveness, deep inspiration may have little or no effect, instead of having a bronchoprotective effect.…”

Section: Safety During Bronchoprovocationmentioning

confidence: 99%

Aerosol Use in the Pulmonary Function Lab

Ruppel

2015

Respir Care

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Aerosols in the Pulmonary Aerosols in the Pulmonary Function Testing LabAerosolized agents are an essential component of pulmonary function testing (PFT). 1 Inhaled bronchodilators are widely used to assess reversibility of airway obstruction, particularly in patients suspected of having asthma. 2 Measurement of the FEV 1 /FVC ratio after administration of a ␤ agonist is the de facto test to establish the diagnosis of COPD. 3 Similarly, measurement of FEV 1 following bronchodilator administration is used to categorize the severity of airway obstruction. Improvement in air flow is the primary end point in the evaluation of new inhaled bronchodilators, and PFT provides the necessary tools for assessment. The other primary use of aerosols in the PFT lab involves inhaled bronchial challenge agents. As is the case for bronchodilators, bronchial provocation using an aerosolized agent is a key tool for making or excluding the diagnosis of asthma. 4 Inhalation of challenge aerosols also provides a means to quantify the degree of hyper-responsiveness. How Aerosols Are Administered in the PFT Lab BronchodilatorsBronchodilators can be administered by various methods for diagnostic purposes. Typically, a ␤ agonist or anMr Ruppel is affiliated with the Division

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Assessing the effect of deep inhalation on airway calibre: a novel approach to lung function in bronchial asthma and COPD

Cited by 96 publications

References 86 publications

Airway smooth muscle dynamics: a common pathway of airway obstruction in asthma

Airway smooth muscle dynamics: a common pathway of airway obstruction in asthma

Deep breaths, methacholine, and airway narrowing in healthy and mild asthmatic subjects

Aerosol Use in the Pulmonary Function Lab

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