Am. J. Respir. Crit. Care Med., Volume 163, Number 7, June 2001, 1551-1556

Distal Lung Dysfunction at Night in Nocturnal Asthma

MONICA KRAFT, JUNO PAK, RICHARD J. MARTIN, DAVID KAMINSKY, and CHARLES G. IRVIN

Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Health Sciences Center, National Jewish Medical and Research Center, Denver, Colorado; and Division of Pulmonary Disease and Critical Care Medicine, University of Vermont College of Medicine, Burlington, Vermont

We have previously shown that patients with nocturnal worsening of asthma (nocturnal asthma) exhibit increased parenchymal inflammation at night. To evaluate the functional significance of this parenchymal inflammation, 10 subjects with nocturnal asthma (NA), four subjects with non-nocturnal asthma (NNA), and four normal control subjects underwent bronchoscopy with measurement of peripheral airways resistance (Rp) at 4:00 P.M. and at 4:00 A.M. Employing a wedged bronchoscope technique, Rp was measured. Flow was stopped, and the pressure reached after 10 s of decay was termed the plateau pressure. The time constant of this decay () was measured, and the peripheral compliance (Cp) was calculated as /Rp. The NA group exhibited the highest Rp values at 4:00 P.M. and at 4:00 A.M. as compared with the NNA and control groups, but all groups were significantly different from each other at 4:00 P.M.: NA, 0.113 ± 0.02 cm H₂O/ml/min; NNA, 0.033 ± 0.005 cm H₂O/ml/min; Control subjects, 0.010 ± 0.001 cm H₂O/ ml/min; p = 0.0001; and at 4:00 A.M.: NA, 0.129 ± 0.023 cm H₂O/ ml/min; NNA, 0.035 ± 0.007 cm H₂O/ml/min; Control subjects, 0.009 ± 0.002 cm H₂O/ml/min; p = 0.0003. None of the groups exhibited statistically significant differences in Rp between 4:00 P.M. and 4:00 A.M.. The plateau pressure increased significantly from 4:00 P.M. to 4:00 A.M., but only in the NA group (7.7 ± 0.9 cm H₂O at 4:00 P.M. versus 16.9 ± 4.6 cm H₂O at 4:00 A.M.; p = 0.0004). Cp was decreased in the NA group as compared with the NNA and control groups at both 4:00 P.M. (p = 0.0003) and 4:00 A.M. (p = 0.003). The Rp positively correlated with the residual volume at both 4:00 P.M. (r = 0.71, p = 0.004) and 4:00 A.M. (r = 0.59, p = 0.03). We conclude that the distal lung units, specifically the collateral channels, and may be functionally altered at night in NA.

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