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Mechanical response to methacholine and deep inspiration in supine men

Maurizio Meinero,^1, Giuseppe Coletta,¹ Luca Dutto,¹ Manlio Milanese,² Giorgio Nova,¹ Andrea Sciolla,¹ Riccardo Pellegrino,³ and Vito Brusasco⁴

¹Anestesia, Rianimazione e Medicina d'Urgenza, Azienda Ospedaliera S. Croce e Carle; ²Unità Operativa Pneumologia S. Corona, Pietra Ligure; ³Centro di Fisiopatologia Respiratoria e di Studio della Dispnea, Azienda Ospedaliera S. Croce e Carle, Cuneo; and ⁴Fisiopatologia Respiratoria, Dipartimento di Medicina Interna, Università di Genova, Genova, Italy

Submitted 3 April 2006 ; accepted in final form 18 August 2006

The effects of supine posture on airway responses to inhaled methacholine and deep inspiration (DI) were studied in seven male volunteers. On a control day, subjects were in a seated position during both methacholine inhalation and lung function measurements. On a second occasion, the whole procedure was repeated with the subjects lying supine for the entire duration of the study. On a third occasion, methacholine was inhaled from the seated position and measurements were taken in a supine position. Finally, on a fourth occasion, methacholine was inhaled from the supine position and measurements were taken in the seated position. Going from sitting to supine position, the functional residual capacity decreased by 1 liter in all subjects. When lung function measurements (pulmonary resistance, dynamic elastance, residual volume, and maximal flows) were taken in supine position, the response to methacholine was greater than at control, and this was associated with a greater dyspnea and a faster recovery of dynamic elastance after DI. By contrast, when methacholine was inhaled in supine position but measurements were taken in sitting position, the response to methacholine was similar to control day. These findings document the potential of the decrease in the operational lung volumes in eliciting or sustaining airflow obstruction in nocturnal asthma. It is speculated that the exaggerated response to methacholine in the supine posture may variably contribute to airway smooth muscle adaptation to short length, airway wall edema, and faster airway renarrowing after a large inflation.

mechanics of breathing; lung volumes; airway caliber; dyspnea

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