Effects of thoracoscopic upper dorsal sympathicolysis for essential hyperhidrosis on bronchial responsiveness to histamine: Implications on the autonomic imbalance theory of asthma

Abstract

Autonomic nervous system abnormalities in airway control may contribute to the symptoms of asthma, and even to the pathogenesis of bronchial hyperresponsiveness (BHR). Partial pulmonary sympathetic denervation by means of bilateral upper dorsal thoracoscopic D2-D3 sympathicolysis (TS) is an accepted treatment in severe essential hyperhidrosis (EH). The effects of this intervention on BHR are unknown. The objective of this study was to evaluate whether partial pulmonary sympathetic denervation by means of TS has an effect on BHR. Bronchial challenge tests with histamine, enabling the calculation of the provocative dose causing a 20% reduction in FEV1 (PD20 His) were performed 1 day before, and 6 weeks and 6 months after TS in 35 patients with severe EH. In nine patients (including three patients with a previous history of asthma) with pre-operative BHR (defined as PD20 His < 2 mg), mean PD20 His did not change significantly at 6 weeks, nor at 6 months after TS (0.62 +/- 0.33, 0.71 +/- 0.42 and 0.93 +/- 0.65 mg, respectively) although there was a non-significant trend towards an increase in PD20 His at 6 months. Three of the 26 patients (12%) without pre-operative BHR became hyperresponsive after TS, whereas 1 of the 9 patients with pre-operative BHR lost hyperresponsiveness. No patient developed asthma symptoms after TS. Upper dorsal thoracoscopic D2-D3 sympathicolysis performed for the treatment of EH has no significant effects on mean PD20 His and individual loss (11%) or development (12%) of BHR occurs only in a minority of patients.

Effect of Thoracic Sympathectomy on Arm and Leg Exercise Capacity and on Lung Function

“…These findings suggest that in contrast to the common belief, neurosympathetic output may play a role in regulating the airway tone, at least in some subjects [3, 4, 6]. In a previous study in which only 3 of the subjects had a past history of asthma [13], TS caused on average no effect on bronchial reactivity. Therefore, the impact of TS on airway tone and reactivity in patients with coexisting asthma and hyperhidrosis should be carefully studied.…”

The Effect of Thoracosopic Thoracic Sympathetomy on Pulmonary Function and Bronchial Hyperresponsiveness

“…These findings have been observed in other studies (5,7,8). Noppen and Vincken found only minimal and temporary decrease in lung volume in pulmonary function and reported that the decrease was due to the thoracoscopic procedure itself (18).…”

“…It is reported that ESD reduces the lung volume or diffusion capacity early after ESD, but patients rarely have any functional impairment of the lung (4,5,7). A few clinical studies have shown that ESD affects bronchial hyperresponsiveness (BHR), but without clinical significance (5,7,8).…”

“…A few clinical studies have shown that ESD affects bronchial hyperresponsiveness (BHR), but without clinical significance (5,7,8). The purpose of this study was to examine the effect of Supported …”

“…The main target of ESD is the upper thoracic sympathetic ganglia, which control the thoracic organs such as the heart and airway (3,4). Surgical thoracic sympathectomy such as ESD or heart transplantation can result in an imbalance between the sympathetic and parasympathetic activities and result in functional changes in the intrathoracic organs (1,(4)(5)(6).…”