Effects of increasing tidal volume and end-expiratory lung volume on induced bronchoconstriction in healthy humans.

BACKGROUND

Increasing functional residual capacity (FRC) or tidal volume (V) reduces airway resistance and attenuates the response to bronchoconstrictor stimuli in animals and humans. What is unknown is which one of the above mechanisms is more effective in modulating airway caliber and whether their combination yields additive or synergistic effects. To address this question, we investigated the effects of increased FRC and increased V in attenuating the bronchoconstriction induced by inhaled methacholine (MCh) in healthy humans.

METHODS

Nineteen healthy volunteers were challenged with a single-dose of MCh and forced oscillation was used to measure inspiratory resistance at 5 and 19 Hz (R and R), their difference (R), and reactance at 5 Hz (X) during spontaneous breathing and during imposed breathing patterns with increased FRC, or V, or both. Importantly, in our experimental design we held the product of V and breathing frequency (BF), i.e, minute ventilation (V) fixed so as to better isolate the effects of changes in V alone.

RESULTS

Tripling V from baseline FRC significantly attenuated the effects of MCh on R, R, R and X. Doubling V while halving BF had insignificant effects. Increasing FRC by either one or two V significantly attenuated the effects of MCh on R R, R and X. Increasing both V and FRC had additive effects on R, R, R and X, but the effect of increasing FRC was more consistent than increasing V thus suggesting larger bronchodilation. When compared at iso-volume, there were no differences among breathing patterns with the exception of when V was three times larger than during spontaneous breathing.

CONCLUSIONS

These data show that increasing FRC and V can attenuate induced bronchoconstriction in healthy humans by additive effects that are mainly related to an increase of mean operational lung volume. We suggest that static stretching as with increasing FRC is more effective than tidal stretching at constant V, possibly through a combination of effects on airway geometry and airway smooth muscle dynamics.