The immune response to resistive breathing

Abstract

Resistive breathing is an "immune challenge" for the body, initiating an inflammatory response consisting of an elevation of plasma cytokines, and the recruitment and activation of lymphocyte subpopulations. These cytokines do not originate from monocytes, but are, instead, produced within the diaphragm, secondary to the increased muscle activation.Oxidative stress is a major stimulus for the cytokine induction, secondary to resistive breathing. The production of cytokines within the diaphragm may be mediating the diaphragm muscle fibre injury that occurs with strenuous contractions, or contributing towards the expected repair process. These cytokines may also compromise diaphragmatic contractility or contribute towards the development of muscle cachexia. They may also have systemic effects, mobilising glucose from the liver and free fatty acid from the adipose tissue to the strenuously working respiratory muscles. At the same time, they stimulate the hypothalamic-pituitary-adrenal axis, leading to production of adrenocorticotropin and b-endorphins.The adrenocorticotropin response may represent an attempt of the organism to reduce the injury occurring in the respiratory muscles via the production of glucocorticoids and the induction of the acute phase-response proteins. The b-endorphin response would decrease the activation of the respiratory muscles and change the pattern of breathing, which becomes more rapid and shallow, possibly in an attempt to reduce and/or prevent further injury to the respiratory muscles.

The immune response to resistive breathing

“…Recently, a new anatomoclinical entity has been reported by BEASLEY et al [2] as ''acute fibrinous and organizing pneumonia (AFOP)''. The clinical spectrum of this entity may be similar to cryptogenic organising pneumonia and, taking into account the morphological features on surgical lung biopsy specimens, in our opinion, the case reported by CHEE et al [1] is more consistent with this diagnostic hypothesis.…”

“…Secondly, the diagnostic approach described in the paper by CHEE et al [1] is dissimilar to that usually followed in our centre (GB Morgagni Hospital, Azienda USL di Forlì, Forlì, Italy). In patients with alveolar opacification shadows, bronchoscopy with bronchoalveolar lavage and transbronchial lung biopsy may contribute to a definitive diagnosis in .60% of cases [3,4], with fine-needle aspiration being less sensitive and specific [5].…”

“…The excellent review by VASSILAKOPOULOS et al [1] discusses in detail the immune response to resistive breathing. The authors report the systemic effects of resistive breathing (cytokines in plasma), as well as the effects of resistive loads on the respiratory muscles (diaphragm).…”

What Does Airway Resistance Tell Us About Lung Function?

“…Interestingly, this theory mirrors the concept suggested by Ingenito and colleagues, mentioned above, that describes the relationship between outcomes from LVRS and inspiratory resistance. 21 High inspiratory resistance may not only reflect differences in underlying physiology, but may relate to the pathogenesis of airway inflammation 64 and acute lung injury. 65 The methodology and analysis of FOT data are complex.…”

The Neutrophil Lymphocyte Ratio as a Successful Extubation Predictor of Prolonged Intubation in Pediatric Heart Surgery

“…It has been indicated in recent experimental and human studies that strenuous resistive breathing, as a form of respiratory muscle exercise, induces proinflammatory cytokines and stimulates the hypothalamic-pituitaryadrenal axis in healthy human (22).…”