Am. J. Respir. Crit. Care Med., Volume 164, Number 2, July 2001, 207-215

Airway Constriction Pattern Is a Central Component of Asthma Severity
The Role of Deep Inspirations

KENNETH R. LUTCHEN, ANDREW JENSEN, HAYTHAM ATILEH, DAVID W. KACZKA, ELLIOT ISRAEL, BELA SUKI, and EDWARD P. INGENITO

Respiratory and Physiological Systems Identification Laboratory, Biomedical Engineering, Boston University, and Pulmonary Division, Brigham and Women's Hospital, Boston, Massachusetts

Measurements of lung resistance and elastance (RL and EL) from 0.1 to 8 Hz reflect both the mean level and pattern of lung constriction. The goal of this study was to establish a relation between a deep inspiration (DI) and the heterogeneity of constriction in healthy versus asthmatic subjects. Constriction pattern was assessed from measurements of the RL and EL from 0.1 to 8 Hz in seven healthy subjects and in 12 asthmatics. These data were acquired before and after a DI and before and after a standard methacholine challenge versus a modified challenge in which a DI is prohibited. Generally, avoidance of a DI increased responsiveness. In healthy subjects and in those with mild-to-moderate baseline asthma a bronchial challenge, especially during self-inhibited DI, produced a heterogenous pattern of constriction inclusive of randomly distributed airway closures or near closures. Nevertheless, such subjects were able to reopen their airways via a DI. In contrast, in subjects with severe baseline asthma, there is a more extreme heterogeneous constriction pattern with random airway closures even at baseline. Further, there is no residual bronchodilatory effect of a DI either before or after bronchial challenge. We conjecture that inflammation and wall-remodeling facilitate a dangerous degree of heterogeneous constriction inclusive of airway closures or near closures, and contribute to the prevention of a DI from having a residual bronchodilatory effect.

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