Am. J. Respir. Crit. Care Med., Volume 163, Number 2, February 2001, 413-419

The Lack of the Bronchoprotective and Not the Bronchodilatory Ability of Deep Inspiration Is Associated with Airway Hyperresponsiveness

NICOLA SCICHILONE, SOLBERT PERMUTT, and ALKIS TOGIAS

Division of Clinical Immunology, Department of Medicine, and Division of Respiratory and Critical Care Medicine, Department of Medicine, Johns Hopkins University, School of Medicine, Baltimore, Maryland

In healthy subjects, deep inspiration (DI) acts both as a bronchodilator and a bronchoprotector. The latter is impaired in asthmatics. We have now evaluated whether the lack of bronchoprotection is related to bronchial hyperresponsiveness (BHR), and whether the bronchodilatory effect is also lost in asthmatics. Ten healthy subjects (PC₂₀ > 75 mg/ml), 12 asthmatics with moderate to severe BHR (PC₂₀ < 1 mg/ml), 14 asthmatics with mild to borderline BHR (1 < PC₂₀ < 25 mg/ml), and 10 rhinitics with mild to borderline BHR (1 < PC₂₀ < 25 mg/ml) underwent single-dose methacholine provocations inducing at least 20% reduction in FEV₁ after 20 min of DI inhibition. To measure the bronchodilatory effect, DIs were taken immediately after the postmethacholine spirometry, and lung function was again tested. To measure the bronchoprotective effect, DIs were taken before the administration of spasmogen. All four groups achieved the same reductions in FEV₁ and FVC, in the absence of deep breaths (analysis of variance [ANOVA], p = 0.49). Only healthy subjects showed bronchoprotection (percent bronchoprotection, mean ± SEM; healthy: 79 ± 4.0; asthmatics with moderate to severe BHR: 12 ± 14.5; asthmatics with mild to borderline BHR: 7 ± 19.7; rhinitics with mild to borderline BHR: 2 ± 14.0). In contrast, DIs were able to partially reverse bronchial obstruction in all four groups, albeit percent bronchodilation in healthy subjects was somewhat stronger. The dissociation between bronchoprotection and bronchodilation suggests that the two effects involve different mechanisms.

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