Density Dependence of Expiratory Flow and Bronchodilator Response in Asthma

Kumar, Ashutosh; Mead, Glenn; Dickey, Jack C.; Berman, Paul Schiff; Kuppinger, Mitchell

doi:10.1378/chest.77.1.68

Cited by 19 publications

(10 citation statements)

References 14 publications

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“…Several groups of inves tigators have recently observed high fre quencies of local and/or systemic side ef fects following inhalation of atropine (dos ages of 0.05-0.1 mg/kg) [1,5,6], In fact, in one study, side effects were considered severe in 8/26 asthmatics treated with atro pine [6], In our study, 1 mg of atropine was placed into a continuously (inspiration and expiration) nebulizing system. Although we cannot be certain how much atropine was inhaled, it is probable that a substantial amount of the atropine originally placed in the nebulizer was actually lost in the appa ratus or during expiration.…”

Section: Discussionmentioning

confidence: 77%

“…Some investigators have observed effects suggesting predominant large airways dilatation [6,[27][28][29] whereas others have suggested a more peripheral action [20, [30][31][32], It is clear that the large airways of most animal species are innervated by choli nergic fibers [33,34], The innervation of peripheral airways is less certain; however, some animal species do have documented cholinergic innervation of peripheral air ways [31,33,34], Unfortunately, knowl edge of the cholinergic innervation of hu man airways is incomplete [30,34]. Based upon available animal studies, there would appear to be at least the potential that atro pine could dilate both large and small air ways.…”

Section: Discussionmentioning

confidence: 99%

“…Although a number of studies have indicated that atropine is an effective bronchodilator [1][2][3][4][5][6], the drug is used infrequently in clinical practice [5,6]. Furthermore, although atropine is an anti muscarinic agent, the use of atropine or its cogeners in combination with other bronchodilators is controversial.…”

Section: Introductionmentioning

confidence: 99%

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Inhaled Atropine Sulfate in Acute Asthma

Fairshter

Habib²,

Wilson

1981

Respiration

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We administered inhaled atropine sulfate to acute asthmatics already receiving therapeutic doses of adrenergic agonists, theophylline, and corticosteroids. Following atropine, hyperinflation diminished whereas vital capacity and expiratory flow rates breathing air and helium-oxygen increased (p < 0.025 – p < 0.005). Initial density dependence correlated inversely with changes in density dependence after atropine (r = – 0.69, p < 0.001). We conclude that: (1) inhaled atropine sulfate was effective therapy for acutely ill asthmatics already being treated with multiple antiasthmatic agents; (2) atropine caused large and peripheral airways bronchodilatation, and (3) the predominant site of bronchodilatation after atropine was related to the site of flow limitation before atropine

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Section: Discussionmentioning

confidence: 77%

Section: Discussionmentioning

confidence: 99%

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Inhaled Atropine Sulfate in Acute Asthma

Fairshter

Habib²,

Wilson

1981

Respiration

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“…There is some preliminary evidence that asthmatics with obstruction primarily in the upper airways may be more likely to have attacks triggered by emotional stress, and also may benefit more from relaxation therapy (57). Measurement of the predominant site of airway obstruction can be done noninvasively by measuring flow rate changes that occur when breathing heliox (a mixture of 21% oxygen and 79% helium) (58)(59)(60). There is evidence that the upper airways are more responsive to parasympathetic stimulation than the lower airways, and that the lower airways are more responsive to sympathetic stimulation than the upper airways (56].…”

Section: Suggestion and Emotion In Asthmamentioning

confidence: 99%

The effects of suggestion and emotional arousal on pulmonary function in asthma: a review and a hypothesis regarding vagal mediation.

Isenberg

Lehrer

Hochron

1992

Psychosomatic Medicine

169

118

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This paper reviews the empirical literature on the relation between asthma, suggestion, and emotion, and proposes the hypothesis that these effects are mediated parasympathetically. The literature indicates that, among asthmatics, suggestion can produce both bronchoconstriction and bronchodilation, and that stress can produce bronchoconstriction. The proportion of asthmatic subjects showing bronchoconstriction to both suggestion and stress averages 35%-40% across studies, but, because of methodological considerations, might be conservatively estimated as closer to 20%. The effect is smaller for suggestion of bronchodilation, and is very short-lived among nonasthmatics. No clear connection has been found between these responses and such subject variables as age, gender, asthma severity, atopy, or method of pulmonary assessment, although some nonsignificant tendencies appear. Most studies in this literature used small n's and did not systematically examine various somatic, environmental, and demographic factors that could influence results. A hypothesis is presented regarding vagal mediation of psychological effects on the airways, as well as possible alternative mechanisms, and recommendations for future research to evaluate these hypotheses.

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“…Some authors suggest that the effect of IB is based mainly on its action on the large respiratory tract either in normal subjects [5,16] or in asthmatics [1,8].…”

Section: Discussionmentioning

confidence: 99%

Bronchodliator Effect of the Association Ipratropium Bromide plus Fenoterol (Low Doses) versus Terbutaline and Salbutamol in Bronchitic Patients

Marín¹,

Servera²,

Vergara³

et al. 1986

Respiration

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In 12 chronic bronchitic out-patients, during 3 successive days, the variations of FEV₁ and V_max25 were studied at 15, 30, 45,60, 120, and 180min after inhalation of: (1) [0.1 mg fenoterol (F) associated with 0.04 mg ipratropium bromide (IB)]; (2) [0.2 mg salbutamol (S)], and (3) [0.5 mg terbutaline (T)]. There were no secondary effects resulting from any treatment. Maximum effectiveness appeared on FEV₁ at 60 min with F + IB, and at 45 min with S and T. On V_max25, it was produced after 30 min with F + IB and no modifications in this parameter were observed either with S or with T. After 15 min, there were changes on FEV₁ with the three products: P < 0.001 for F+ IB and S; p < 0.01 for T. The variation persisted for up to 120 min with F + IB (p < 0.001) and with S (p < 0.05), and for up to 60 min with T(p < 0.01). With F+ IB, V_max25 increased since after 15 min (p < 0.001) and up to 60 min (p < 0.01). In conclusion, the association of a small dose of F to IB provides as positive results as S, and better than T, in a group of chronic bronchitic out-patients.

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Density Dependence of Expiratory Flow and Bronchodilator Response in Asthma

Cited by 19 publications

References 14 publications

Inhaled Atropine Sulfate in Acute Asthma

Inhaled Atropine Sulfate in Acute Asthma

The effects of suggestion and emotional arousal on pulmonary function in asthma: a review and a hypothesis regarding vagal mediation.

Bronchodliator Effect of the Association Ipratropium Bromide plus Fenoterol (Low Doses) versus Terbutaline and Salbutamol in Bronchitic Patients

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