Direct graphical recordings of the cumulative dose-response curves of the airway to methacholine in normal, bronchitic and asthmatic subjects.

We studied bronchial responsiveness to methacholine in 10 normal subjects, in 60 patients with bronchial asthma and in 30 patients with bronchitis using a new device, with which we were able to obtain the dose-response curve of respiratory resistance (Rrs) continuously and graphically by the 3 Hz oscillation method during inhalation of methacholine. All normal subjects were non-responders, while all of the bronchial asthma cases, 63% of the chronic bronchitis cases and 50% of the acute bronchitis cases were responders. Among responders we found a very poor correlation between the initial respiratory conductance (Grs.cont) and the bronchial sensitivity (defined as the reverse of the cumulative dose until Rrs starts to increase); yet we found a good correlation between Grs.cont and the bronchial reactivity (defined as the slope of the decreasing rate of Grs). Metaproterenol and atropine decreased the bronchial sensitivity and reactivity in 28 asthmatic patients. We concluded that for clinical purposes the new method was very useful for assessing bronchial responsiveness to inhalation challenge because of its simplicity of operation as well as the quantitative differentiation between bronchial sensitivity and reactivity. Our results suggest that the bronchial response system to methacholine is explainable by a model of multiple dose-response curves without any parallel shift.