Chest
Bronchial Hyperresponsiveness to Inhaled Methacholine in Subjects with Chronic Left Heart Failure at a Time of Exacerbation and After Increasing Diuretic Therapy
Section snippets
Subjects
Twelve adult subjects with chronic (two to six years' duration except in two patients for whom it had been <six months) LV failure were assessed by a cardiologist for exacerbation of dyspnea either in the emergency room (n = 5) or during visits to the outpatient heart failure clinic (n = 7). Eleven were classified as having grade 4 (“inability to carry on any physical activity without discomfort”); one was classified as grade 3 (“comfortable at rest; less than ordinary physical activities cause
RESULTS
Baseline anthropometric and clinical results at the beginning of the study are shown in Table 1. Every subject was either a smoker or an ex-smoker. Two subjects had symptoms of chronic bronchitis. Mean ± SD pack-years reported by the subjects was 43.2 ± 20.3. Two subjects had a history of atopy, but none had a previous history of asthma. As well as reporting dyspnea, all except subject 6 had symptoms frequently encountered in asthma, ie, cough, wheezing, respiratory symptoms after exercise
DISCUSSION
Three stages of pulmonary edema have been described. The initial step is characterized by an increase in pulmonary blood volume without a change in extravascular pulmonary water. Peripheral but not total airway resistance is then increased.4 The second stage of pulmonary edema is characterized by interstitial edema which accumulates around vessels and bronchi.3 An increase in total airway resistance is then found at the level of either the small4,5,8 or large airways,22,23 although some authors6
ACKNOWLEDGMENTS
Christophe Pison was sponsored as a fellow by the Echanges France-Québec through the Fonds de la Recherche en Santé du Québec. This study was partially funded by the Canadian Lung Association. We thank Katherine Tallman for reviewing the manuscript.
REFERENCES (34)
- et al.
The chest roentgenogram in pulmonary edema
Clin Chest Med
(1985) - et al.
Effects of edema and height on bronchial diameter and shape in excised dog lung
Respir Physiol
(1984) - et al.
Nouvelles recherches sur l'asthme cardiaque
Bull Med
(1943) - et al.
Le rôle des bronches dans certaines affections broncho-pulmonaires associées à des cardiopathies
Bull et Med Soc Med Hôp Paris
(1946) - et al.
Pulmonary edema in dogs, especially the sequence of fluid accumulation in lungs
J Appl Physiol
(1967) - et al.
Distribution of airway resistance with developing pulmonary edema in dogs
J Appl Physiol
(1972) - et al.
Effects of pulmonary congestion and edema on the small airways
Bull Eur Physiopathol Respir
(1971) - et al.
Does interstitial lung edema compress airways and arteries? A morphometric study
J Appl Physiol
(1987) - et al.
Effects of hemodynamic edema formation on peripheral vs central airway mechanics
J Appl Physiol
(1985) - et al.
Changes in airway caliber following pulmonary venous congestion
Br J Anaesth
(1978)
Effects of pulmonary congestion on airway reactivity to histamine aerosol in dogs
J Appl Physiol
Effects of interstitial pulmonary edema on airway responsiveness to inhaled methacholine in dogs [Abstract]
Fed Proc
Bronchial reactivity in heart valve disease
Chest
Bronchial hyperresponsiveness to methacholine in patients with impaired left-ventricular function [Abstract]
Am Rev Respir Dis
Principles of body plethysmography
Standardization of spirometry: 1987 update
Am Rev Respir Dis
Cited by (65)
Surgical Repair of Mitral Valve Disease in Children: Perioperative Changes in Respiratory Function
2016, Journal of Cardiothoracic and Vascular AnesthesiaEffects of chronic administration of β-blockers on airway responsiveness in a murine model of heart failure
2014, Pulmonary Pharmacology and TherapeuticsCitation Excerpt :These changes have been observed in other tissues [4,5]. An imbalance in the adenylate-cyclase (AC) signal transduction system of airway smooth muscles, paralleling the changes occurring in the failing myocardium, has been demonstrated to induce a reduction in the bronchial relaxation mediated by β-ARs and, as a consequence, a sensitization to constrictive stimuli as well as attenuation of cAMP-mediated relaxation [5–7]. Moreover, a rapid desensitization and uncoupling of β-ARs in lungs from rats treated with catecholamines was described [8].
Cardiac asthma
2013, Revue Francaise d'AllergologieAssessment of dyspnea in acute decompensated heart failure: Insights from ASCEND-HF (Acute Study of Clinical Effectiveness of Nesiritide in Decompensated Heart Failure) on the contributions of peak expiratory flow
2012, Journal of the American College of CardiologyCitation Excerpt :First, PEFR was used rather than FEV1. FEV1 has been shown to be an independent predictor of mortality (30) and have a modest improvement in response to diuresis (31). PEFR was selected because we sought to test a simple, portable, reproducible, and inexpensive measurement that could be applied in the acute setting across multiple sites with minimal additional training.
Mechanisms of airway hyper-responsiveness after coronary ischemia
2008, Respiratory Physiology and Neurobiology
Manuscript received October 13; accepted December 12.