Meessen N E, van der Grinten C P, Luijendijk S C, Folgering H T
Dept of Pulmonary Diseases, University Hospital Nijmegen, Dekkerswald, Groesbeek, The Netherlands.
Eur Respir J. 1997 May;10(5):1059-63. doi: 10.1183/09031936.97.10051059.
Increases in minute ventilation (V'E) have been observed during exacerbations of asthma and in response to administration of histamine. However, it is not yet clear how the breathing pattern is affected, and whether the increase in V'E is found in general. In the present study, the effects of inhalation of histamine on respiratory frequency (fR), tidal volume (VT), V'E, and on functional residual capacity (FRC) were evaluated in 63 humans. Forty four subjects were hyperresponsive (BHR+). In each of these subjects, the doses of histamine applied for the present study (mean 3.5 mg x mL(-1)) caused a decrease in forced expiratory volume in one second (FEV1) that was greater than 20% of the control value. The dose of histamine applied in the 19 nonhyperresponsive subjects (BHR-) was substantially larger (8.0 mg x mL(-1)) whilst for this dose the decrease in FEV1 was less than 20% of control value. After histamine, fR was significantly increased in both subgroups of subjects, BHR+ and BHR-. The increase in V'E was significant in BHR- but not significant in BHR+. In general, the changes in V'E,fR and VT were not uniform; comparable numbers of subjects responded with increases (n=33) and decreases (n=30) in V'E. For fR 40 subjects responded with an increase and 23 with a decrease, and for VT these numbers were 26 and 37, respectively. The increase in FRC after histamine was significantly larger in BHR+ subjects than in BHR-. These findings may be interpreted to indicate that different mechanisms with opposite effects may be operating simultaneously, e.g. excitation of central inspiratory activity by stimulation of rapidly-adapting pulmonary stretch receptors, which will promote increases in respiratory frequency, tidal volume and minute ventilation, and bronchoconstriction with increased airway resistance, which will promote decreases in these parameters. As a consequence, depending on the net result of these opposite contributions to, e.g. minute ventilation, administration of histamine will cause an increase in minute ventilation in one subject and a decrease in another.
在哮喘发作期间以及在给予组胺后,观察到分钟通气量(V'E)增加。然而,呼吸模式如何受到影响以及V'E的增加是否普遍存在尚不清楚。在本研究中,评估了63名受试者吸入组胺对呼吸频率(fR)、潮气量(VT)、V'E和功能残气量(FRC)的影响。44名受试者为高反应性(BHR+)。在这些受试者中的每一个中,本研究应用的组胺剂量(平均3.5mg×mL(-1))导致一秒用力呼气量(FEV1)下降超过对照值的20%。在19名非高反应性受试者(BHR-)中应用的组胺剂量要大得多(8.0mg×mL(-1)),而对于该剂量,FEV1的下降小于对照值的20%。给予组胺后,BHR+和BHR-这两个受试者亚组的fR均显著增加。BHR-组中V'E的增加显著,而BHR+组中不显著。总体而言,V'E、fR和VT的变化并不一致;V'E增加(n=33)和减少(n=30)的受试者数量相当。对于fR,40名受试者反应增加,23名反应减少,对于VT,这些数字分别为26和37。组胺后BHR+受试者的FRC增加显著大于BHR-受试者。这些发现可以解释为表明可能同时存在具有相反作用的不同机制,例如通过刺激快速适应的肺牵张感受器激发中枢吸气活动,这将促进呼吸频率、潮气量和分钟通气量增加,以及支气管收缩伴气道阻力增加,这将促进这些参数下降。因此,取决于这些对例如分钟通气量的相反作用的净结果,给予组胺将导致一名受试者的分钟通气量增加而另一名受试者减少。