Histamine-induced asthma in children: effects on the ventilation-perfusion relationship
G. Hedlin
Departments of Pediatrics and Clinical Physiology, Huddinge Hospital, Karolinska Institute, S–141 86 Huddinge, Sweden
Search for more papers by this authorU. Freyschuss
Departments of Pediatrics and Clinical Physiology, Huddinge Hospital, Karolinska Institute, S–141 86 Huddinge, Sweden
Search for more papers by this authorCorresponding Author
G. Hedenstierna
Departments of Pediatrics and Clinical Physiology, Huddinge Hospital, Karolinska Institute, S–141 86 Huddinge, Sweden
Department of Pediatrics, Huddinge Hospital, Karolinska Institute, S–141 86 Huddinge, Sweden.Search for more papers by this authorG. Hedlin
Departments of Pediatrics and Clinical Physiology, Huddinge Hospital, Karolinska Institute, S–141 86 Huddinge, Sweden
Search for more papers by this authorU. Freyschuss
Departments of Pediatrics and Clinical Physiology, Huddinge Hospital, Karolinska Institute, S–141 86 Huddinge, Sweden
Search for more papers by this authorCorresponding Author
G. Hedenstierna
Departments of Pediatrics and Clinical Physiology, Huddinge Hospital, Karolinska Institute, S–141 86 Huddinge, Sweden
Department of Pediatrics, Huddinge Hospital, Karolinska Institute, S–141 86 Huddinge, Sweden.Search for more papers by this authorAbstract
Summary. . Asthma was provoked by histamine inhalation in five children in order to study the hypoxaemia that might ensue and the underlying ventilation-perfusion (V̇A/Q̇) mismatching. The distribution of the V̇A/Q̇ ratios was measured by a multiple inert gas technique before the provocation, during the asthmatic attack and after salbutamol inhalation. All children displayed a unimodal distribution of ventilation and perfusion under baseline conditions. During asthma they all developed a bimodal distribution, one mode lying within normal V̇A/Q̇regions but with increased perfusion to regions with V̇A/Q̇ ratios of OT-1, which correlated with the observed hypoxaemia; the other mode was centred on a V̇A/Q̇ ratio of approximately 10 and the magnitude of this mode correlated with FEV1 in per cent of the predicted value. Salbutamol improved the V̇A/Q̇ distribution and restored the blood gases to normal. We hypothesize that histamine-induced asthma causes a state of hyperinflation which compromises regional ventilation and blood flow, resulting in a V̇A/Q̇ mismatching with one normal and one high V̇A/Q̇ mode, and hypoxaemia.
References
- Anderson S. D., Silverman M. & Walker S. R. (1972) Metabolic and ventilatory changes in asthmatic patients during and after exercise. Thorax 27, 718–725.
- Anderton R. C., Cuff M. T., Frith P. A., Cockcroft D. W., Morse J. L. C., Jones N. L. & Hargreave F. E. (1979) Bronchial responsiveness to inhaled histamine and exercise. J Allerg Clin Immunol 63, 315–320.
- Beaudry P. H., Wise B. M. & Seely J. E. (1967) Respiratory gas exchange at rest and during exercise in normal and asthmatic children. Am Rev Resp Dis 95, 248–254.
- Bevegard S., Eriksson B. O., Graff-Lonnevig V., Kraepelien S. & Saltin S. (1976) Respiratory function cardiovascular dimensions and work capacity in boys with bronchial asthma. Acta Paediatr Scand 65, 289–296.
- Bindslev L., Hedenstierna G., Santesson J., Gottlieb I. & Carvallhas A. (1981) Ventilation-perfusion distribution during inhalational anaesthesia. Acta Anaesth Scand 25, 360–371.
- Bleecher E. R., Rosenthal R. R., Menkes H. A., Norman P. S. & Permutt S. (1979) Physiologic effects of inhaled histamine in asthma. Reversible changes in pulmonary mechanics and total lung capacity. J Allerg Clin Immunol 64, 597–602.
- Cockcroft D. W., Killian D. N., Mellon J. J. A. & Hargreave F. E. (1977) Bronchial reactivity to inhaled histamine: A method and clinical survey. Clin Allergy 7, 235–243.
- DuBois A. B., Bothelo S. Y. & Bedell G. N. (1956) A rapid plethysmographic method for measuring thoracic gas volume. J Clin Invest 35, 322–326.
- Dueck R., Wagner P. D. & West J. B. (1977) Effects of positive end-expiratory pressure on gas exchange in dogs with normal and edematous lungs. Anesthesiology 47, 359–366.
- ENGSTRÖM I., Karlberg P. & Swarts C. L. (1962) Respiratory studies in children. IX. Relationships between mechanical properties of the lungs, lung volumes and ventilatory capacity in healthy children 7–15 years of age. Acta Paediatr Scand 51, 68–80.
- ENGSTRÖM I. (1964) Respiratory studies in children. XI. Acta Paediatr Scand Suppl. 155.
- Eriksson B. O. & Koch G. (1973) Effect of physical training on hemodynamic response during submaximal and maximal exercise in 11–13 year old boys. Acta Physiol Scand 87, 27–39.
- Eriksson B. O., Grimby G. & Saltin B. (1971) Cardiac output and arterial blood gases during exercise in pubertal boys. J Appl Physiol 31, 348–352.
- Evans J. W. & Wagner P. D. (1977) Limits on V̇A/Q̇ distributions from analysis of experimental inert gas elimination. J Appl Physiol 42, 889–898.
- Freyschuss U., Hedlin G. & Hedenstierna G. (1984) Ventilation-perfusion relationships during exercise-induced asthma. Am Rev Resp Dis. 130, 888–894.
- Hedenstierna G., Freyschuss U., Hedlin G., Thoren C. & Wallgren G. (1982) Ventilation-perfusion relationships in children. Clin Physiol 2, 181–188.
- Hedenstierna G., White F. C., Mazzone R. & Wagner P. D. (1979) Redistribution of pulmonary blood flow in the dog with PEEP ventilation. J Appl Physiol 46, 278–287.
- Hlastala M. P. & Robertson H. T. (1978) Inert gas elimination characteristics of the normal and abnormal lung. J Appl Physiol 44, 258–266.
- Kiviloog J. (1973) Bronchial reactivity to exercise and metacholine in bronchial asthma. Scand J Resp Dis 54, 347–358.
- Kraepelien S., Engström I. & Karlberg P. (1958) Respiratory studies in children. II. Lung volumes in symptom-free asthmatic children 6–14 years of age. Acta Paediatr Scand 47, 399–411.
- McFadden E. R. Jr. & Lyons H. A. (1968) Arterial-blood gas tension in asthma. New Engl J Med 278, 1027–1032.
- Mellis C. M., Kattan M., Keens T. G. & Levisen H. (1978) Comparative study of histamine and exercise challenges in asthmatic children. Am Rev Resp Dis 117, 911–915.
- Murray A. B., Ferguson A. C., & Morrison B. (1981) Airway responsiveness to histamine as a test for overall severity of asthma in children. J Allerg Clin Immunol 68, 119–124.
- Novey H. S., Wilson A. F., Surprenant E. L. & Bennett L. R. (1979) Early ventilation-perfusion changes in asthma. J Allerg 46, 221–230.
- Oberger E. & Engström I. (1978) Blood gases and acid-base balance in children with bronchial asthma. Lung 155, 111–122.
- Poppius H. & Stenius B. (1977) Changes in arterial oxygen saturation in patients with hyperreactive airways during a histamine inhalation test. Scand J Resp Dis 58, 1–4.
- Riley D. J., Fisher A. B., Hansell J. R. & Brody J. S. (1976) Regional bronchoconstriction in asthma. Chest 70, 715–718.
- Rosenzweig D. Y., Hughes J. M. B. & Glazier J. B. (1970) Effects of transpulmonary and vascular pressures on pulmonary blood volume in isolated lung. J Appl Physiol 28, 553–560.
- Rubinfeld A. R. Wagner P. D., West J. B. & Mattews R. C. (1978) Gas exchange during acute experimental canine asthma. Am Rev Resp Dis 118, 525–536.
- Snedecor G. W. & Cochran W. G. (1967) In: Statistical Methods. Iowa State University Press, Iowa .
- Solymar L., Aronsson P. H., Bake B. & Bjure J. (1980) Nitrogen single breath test, flow-volume curves and spirometry in healthy children 7–18 years of age. Eur J Resp Dis 61, 275–286.
- Souhrada J. F. & Buckley J. M. (1976) Pulmonary function testing in asthmatic children. Ped Clin North America 23, 249–278.
- Stanescu D. C., Rodenstein D., Canberghs M. & van de Woestinjne K. P. (1982) Failure of body plethysmography in bronchial asthma. J Appl Physiol 52, 939–948.
- Wagner P. D., Saltzman H. A. & West J. B. (1974a) Measurement of continuous distributions of ventilation-perfusion ratios: theory. J Appl Physiol 36, 588–599.
- Wagner P. D., Naumann P. F. & Laravuso R. B. (1974b) Simultaneous measurement of eight foreign gases in blood by gas chromatography. J Appl Physiol 36, 600–605.
- Wagner P. D., Dantzker D. R., Iacovini V. E., Tomlin W. C. & West J. B. (1978) Ventiiation-perfusion inequality in asymptomatic asthma. Am Rev Resp Dis 118, 511–524.
- Wagner P. D., Dantzker D. R., Dueck R., Clausen J. L. & West J. B. (1977) Ventiiation-perfusion inequality in chronic obstructive pulmonary disease. J Clin Invest 59, 203–216.
- Wagner, P. D., Allen D. H., Mathison D. A., Metcalf J. F. & Rubinfeld A. R. (1977) Gas exchange following bronchial challenge in patients with extrinsic asthma. Am Rev Resp Dis 115, 387.
- Weng T. R., Langer H. M., Featherby E. A. & Levison H. (1970) Arterial blood gas tensions and acid base balance in symptomatic and asymptomatic asthma in childhood. Am Rev Resp Dis 101, 274–282.
- Young I. H., Corte P. & Schoeffel R. E. (1982) Pattern and time course of ventiiation-perfusion inequality in exercise induced asthma. Am Rev Resp Dis 125, 304–311.
