0
Clinical Investigations: NEUROMUSCULAR DISEASE |

Airway Hyperreactivity in Subjects With Tetraplegia Is Associated With Reduced Baseline Airway Caliber*

David R. Grimm, EdD; Dipak Chandy, MD; Peter L. Almenoff, MD, FCCP; Gregory Schilero, MD, FCCP; Marvin Lesser, MD
Author and Funding Information

*From the Pulmonary/Critical Care Medicine Section (Drs. Chandy, Almenoff, Schilero, and Lesser), Bronx Veterans Affairs Medical Center, Bronx, NY; and the Department of Medicine (Dr. Grimm), The Mount Sinai School of Medicine, New York, NY.

Correspondence to: Marvin Lesser, MD, Pulmonary Section, VA Medical Center, 130 West Kingsbridge Rd, Bronx, NY



Chest. 2000;118(5):1397-1404. doi:10.1378/chest.118.5.1397
Text Size: A A A
Published online

Objectives: We administered aerosolized histamine to 32 subjects with tetraplegia to determine whether there were differences in spirometric and/or lung volume parameters between responders and nonresponders.

Results: Baseline pulmonary function parameters revealed mild to moderate restrictive dysfunction. We found that 25 subjects (78%) were hyperreactive to histamine (mean provocative concentration of a substance causing a 20% fall in FEV1 [PC20], 1.77 mg/mL). Responders (PC20, < 8 mg/mL) had significantly lower values for forced expiratory flow between 25% and 75% of the outflow curve (FEF25–75), FEF25–75 percent predicted, and FEF25–75/FVC ratio. Among all 32 subjects, the natural logarithmic transformation performed on PC20 values (lnPC20) correlated with FEF25–75 percent predicted, FEV1 percent predicted, and FEF25–75/FVC ratio but not with FVC percent predicted. Responders with PC20 values < 2 mg/mL (n = 13) had significantly reduced values for FVC, FVC percent predicted, FEV1, and FEV1 percent predicted compared to those with PC20 values between 2 mg/mL and 8 mg/mL. In addition, among responders, there was a significant correlation between lnPC20 and FVC percent predicted. A significant relationship was found between maximal inspiratory pressure (Pimax) and both FEV1 percent predicted and FEF25–75 percent predicted, but not between lnPC20 and either Pimax or maximal expiratory pressure (Pemax).

Conclusions: These findings demonstrate that subjects with tetraplegia who exhibit airway hyperreactivity (AHR) have reduced baseline airway caliber and that lower values for lnPC20 are associated with parallel reductions in surrogate spirometric indexes of airway size (FEV1 percent predicted and FEF25–75 percent predicted) and airway size relative to lung size (FEF25–75/FVC ratio). The absence of an association between lnPC20 and FVC percent predicted for the entire group or between lnPC20 and either Pimax or Pemax indicates that reduced lung volumes secondary to respiratory muscle weakness cannot explain the mechanism(s) underlying AHR. Among responders, however, a possible role for reduction in lung volume, as it pertains to increasing AHR, cannot be excluded. Proposed mechanisms for reduced baseline airway caliber relative to lung size in subjects with tetraplegia include unopposed parasympathetic activity secondary to the loss of sympathetic innervation to the lungs and/or the inability to stretch airway smooth muscle with deep inhalation.

Figures in this Article

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543