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1 Anaesthesia, ASO S. Croce e Carle, Cuneo, Italy
2 Anaesthesia, Azienda Ospedaliera S. Croce e Carle, Cuneo, Italy
3 Emergency Department, Azienda Ospedaliera S. Croce e Carle, Cuneo, Italy
4 U.O. Pneumologia, Ospedale S. Corona, Pietra Ligure, Italy
5 Cuneo, Italy; Emergency Department, Azienda Ospedaliera S. Croce e Carle, Cuneo, Italy
6 Azienda Ospedaliera S. Croce e Carle, Centro di Fisiopatologia Respiratoria e dello Studio della Dispnea, CUNEO, Italy
7 Medicina Interna, Università di Genova, Genova, Italy
* To whom correspondence should be addressed. E-mail: vito.brusasco{at}unige.it.
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 laying supine for the entire duration of the study. On a third occasion, methacholine was inhaled from the seated position while 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 about 1 L 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 to the exaggerated response to MCh in the supine posture may variably contribute airway smooth muscle adaptation to short length, airway wall edema, and faster airway re-narrowing after a large inflation.
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