Successive effects of a vagolitic and a betadrenergic in the differential diagnosis of nonimmunologic and allergic asthma.

In order to determine whether the vagal mechanism is predominant in the physiopathology of asthma, we investigated in the first part of this work. If the new vagolithic, ipratropium can improved the respiratory parameters of asthmatic patients. If the effect is complete or admits yet the supplementary effect of a betadrenergic, Fenoterol. 46 asthmatic patients were registered in some spirographic parameters, e.g. FEV1 (Forced Expiratory Volume in 1 sec.), MMFR25-75 (Maximum Mid-expiratory Flow Rate between the 25 per cent and the 75 per cent of the forced vital capacity) and FEF 200-1200 (Forced Expiratory Flow between 200 ml. and 1200 ml. of the forced vital capacity). The same registers were made 30 minutes after aerolization with 0.05 mg of Ipratropium (two shots) and 10 minutes after 60 micrograms of Fenoterol (three shots). It was found that 78.5 per cent of the patients improved one of the parameters with Ipratropium more than 20 per cent. But 58 per cent of the patients showed an additional improvement with the betadrenergic in one or more of the parameters. This shows that in many cases the physiopathology of asthma is mixed, vagal and betareceptor dependent, in which the medication with Ipratropium plus Fenoterol will obtain better results. Only in some patients the bronchial spasm is vagolithic dependent exclusively, while few others responded to betadrenergic and only 9 per cent of patients did not respond to either one. In the second part of this work we tried to verify if by anamnestic inquiry and additional use of Ipratropium and Fenoterol it is possible to recognize one group of patients with asthma produced by nonimmunologic irritant factors acting on the large airways from another group with asthma due to inhalants allergens and spasm of the small bronchi. The same 46 patients were divided in two groups: Patients who recognize that asthmatic accesses begin after exercise, laughter cold weather, cigarette smoker exposure sprays, synthetics and insecticides. This is the predominantly irritative nonimmunologic group. Patients who recognize that coughing or wheezing begins after contact either with pollen, dust or danders. This is the predominantly allergic group. We proved that patients A improve more with Ipratropium and the opposite is true with patients B. The results with the two drugs are roughly parallel to the anamnestic records.(ABSTRACT TRUNCATED AT 400 WORDS)