Tranfa C M, Vatrella A, Parrella R, Bariffi F
Cattedra di Malatti dell'Apparato Respiratorio, Università degli Studi Federico II, Napoli, Italy.
Eur Respir J. 1995 Apr;8(4):600-4.
The mechanisms underlying water-induced bronchoconstriction are still not fully understood. Cholinergic reflexes and mast cell mediator release are currently believed to play an important pathogenetic role. In order to evaluate the relative contribution of each of these mechanisms, we studied the effect of ipratropium bromide (80 micrograms), a muscarinic antagonist, and sodium cromoglycate (20 mg), an inhibitor of mast cell mediator release, administered alone and in combination, in the prevention of bronchospasm induced by ultrasonic mist of distilled water (UMDW). Fifteen patients with documented atopic asthma and hyperresponsiveness to distilled water were selected for this randomized, placebo-controlled, double-blind study. Airway responses to pharmachological agents and bronchial challenge were measured by change in specific airways conductance (sGaw). Sodium cromoglycate had no effect on bronchial calibre, whilst ipratropium bromide and the combination of the two drugs produced a significant bronchodilation 30, 60 and 90 min after treatments. The maximal increase in sGaw (mean % +/- SD) was observed at 90 min: 63 +/- 28% and 58 +/- 22% after ipratropium bromide and the combined drugs respectively. UMDW (2, 4, 8, 16 ml water) caused a -36 +/- 19%, -42 +/- 19%, -49 +/- 18%, -56 +/- 15% mean % +/- SD fall in sGaw after placebo. Pretreatment with sodium cromoglycate abolished the bronchoconstriction to 2 ml (fall sGaw -5 +/- 23% NS) and significantly reduced the effect of 4 (-15 +/- 22%), 8 (-21 +/- 20%) and 16 ml (-24 +/- 18%) water.(ABSTRACT TRUNCATED AT 250 WORDS)
水诱导支气管收缩的潜在机制仍未完全明确。目前认为胆碱能反射和肥大细胞介质释放起着重要的致病作用。为了评估这些机制各自的相对作用，我们研究了毒蕈碱拮抗剂异丙托溴铵（80微克）和肥大细胞介质释放抑制剂色甘酸钠（20毫克）单独及联合使用时，对蒸馏水超声雾化（UMDW）诱发的支气管痉挛的预防作用。15名有特应性哮喘且对蒸馏水高反应性记录的患者被选入这项随机、安慰剂对照、双盲研究。通过特定气道传导率（sGaw）的变化来测量气道对药物和支气管激发的反应。色甘酸钠对支气管口径无影响，而异丙托溴铵及两种药物联合使用在治疗后30、60和90分钟产生了显著的支气管扩张。sGaw的最大增加（平均%±标准差）在90分钟时观察到：异丙托溴铵和联合用药后分别为63±28%和58±22%。安慰剂后，UMDW（2、4、8、16毫升水）使sGaw平均下降（%±标准差）-36±19%、-42±19%、-49±18%、-56±15%。色甘酸钠预处理消除了对2毫升水的支气管收缩（sGaw下降-5±23%，无统计学意义），并显著降低了4（-15±22%）、8（-21±20%）和16毫升（-24±18%）水的作用。（摘要截短于250字）
