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Clinical Investigations: CARDIOLOGY |

Parasympathetic Airway Response and Heart Rate Variability Before and at the End of Methacholine Challenge*

Aurélien Pichon, PhD; Claire de Bisschop, PhD; Véronique Diaz, MD, PhD; André Denjean, MD, PhD
Author and Funding Information

*From the Laboratoire des Adaptations Physiologiques aux Activités Physiques (Drs. Pichon and de Bisschop), Faculté des Sciences du Sport, UPRES EA 3813; and Service d’Explorations Fonctionnelles (Drs. Diaz and Denjean), Physiologie Respiratoire et de l’Exercice, Pôle Cœur-Poumons, CHU de Poitiers, Poitiers, France.

Correspondence to: Aurélien Pichon, PhD, Laboratoire ‘Réponses cellulaires et fonctionnelles à l’hypoxie,’ UFR Santé Médecine Biologie Humaine, 74 rue Marcel Cachin, 93017 Bobigny, France; e-mail: aurelien.pichon@orange.fr



Chest. 2005;127(1):23-29. doi:10.1378/chest.127.1.23
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Background: The autonomic nervous system plays a primary role in regulating airway caliber, and its dysfunction is likely to contribute to the pathogenesis of airways diseases. Moreover, some findings support the hypothesis that autonomic dysfunction and/or dysregulation contributes to the pathogenesis of airway hyperresponsiveness (AHR). Heart rate variability (HRV) spectral analysis allows identifying noninvasively perturbations of the autonomic system.

Purpose: We tested the relationship between AHR and cardiac parasympathetic tone assessed by HRV spectral analysis in patients submitted to a diagnostic methacholine bronchial challenge (MBC).

Methods: Fifteen women and 38 men (age range, 18 to 56 years) participated in the study. The principal indications for MBC were suspected asthma, chronic cough, unexplained exercise-induced dyspnea, or cough. The R-R intervals were continuously recorded during the MBC. Autoregressive method was performed on two series of 256 R-R intervals extracted before and after the MBC to obtain low-frequency (LF) and high-frequency (HF) components.

Results: The MBC distinguished 29 subjects without airway responsiveness (R−) and 24 responder or hyperresponsive subjects (R+): mean provocative dose of methacholine causing a 20% reduction in mean (± SD) FEV1 of 467 ± 351 μg (range, 70 to 1,426 μg). The HF component expressed in normalized units (n.u.) [the index of parasympathetic modulation] was significantly higher in R+ than in R− at baseline, before MBC (21 ± 21 n.u. vs 11 ± 9 n.u., p < 0.05). Interestingly, R+ showed a significant increase of HF component after MBC (243 ± 30 to 567 ± 620 ms2 and 21 ± 21 to 34 ± 30 n.u., p < 0.01). For all subjects, HF (n.u.) calculated at baseline and after MBC were significantly influenced by the bronchial responsiveness (r2 = − 0.28 and – 0.51, respectively; p < 0.001).

Conclusion: In summary, we found that R+ had a significantly higher parasympathetic tone than R− at baseline, and that R+ showed a significant increase in cardiac reactivity after bronchial challenge. These findings demonstrate that the autonomic nervous system, which contributes to the pathogenesis of AHR, is closely linked to cardiac modulation.

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