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1 Respiratory Division, Academic Hospital, Vrije Universiteit Brussel, 1090 Brussels; and 2 Biomedical Physics Laboratory, Université Libre de Bruxelles, 1070 Brussels, Belgium
A multiple-breath washout technique
was used to assess residual ventilation heterogeneity in the conductive
and acinar lung zones of asthmatic patients after maximal
2-agonist reversibility. Reversibility was assessed in
13 patients on two separate visits corresponding to a different
baseline condition in terms of forced expiratory volume in 1 s
[FEV1; average FEV1 over 2 visits: 92 ± 21% of predicted (SE)]. On the visit corresponding to each patient's best baseline, 400 µg salbutamol led to normal acinar ventilation heterogeneity, normal FEV1, and normal peak expiratory
flow; i.e., none was significantly different from that obtained in 13 matched controls. By contrast, conductive ventilation heterogeneity and forced expiratory flow after exhalation of 75% forced vital capacity remained significantly different from controls (P 
0.005 on both indexes). In addition, the degree of postdilation conductive
ventilation heterogeneity was similar to what was previously obtained
in asthmatic individuals with a 19% lower baseline FEV1
and twofold larger acinar ventilation heterogeneity (Verbanck S,
Schuermans D, Noppen M, Van Muylem A, Paiva M, and Vincken W. Am J Respir Crit Care Med 159: 1545-1550,
1999). We conclude that, even in the mildest forms of asthma,
the most consistent pattern of non-2-agonist-reversible ventilatory heterogeneity is in the conductive lung zone, most probably
in the small conductive airways.
bronchodilation; small airway
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