Airway responsiveness to methacholine: effects of deep inhalations and airway inflammation

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Abstract
We determined the dose-response curves to inhaled methacholine (MCh) in 16 asthmatic and 8 healthy subjects with prohibition of deep inhalations (DIs) and with 5 DIs taken after each MCh dose. Flow was measured on partial expiratory flow-volume curves at an absolute lung volume (plethysmographically determined) equal to 25% of control forced vital capacity (FVC). Airway inflammation was assessed in asthmatic subjects by analysis of induced sputum. Even when DIs were prohibited, the dose of MCh causing a 50% decrease in forced partial flow at 25% of control FVC (PD50MCh) was lower in asthmatic than in healthy subjects (P < 0.0001). In healthy but not in asthmatic subjects, repeated DIs significantly decreased the maximum response to MCh [from 90 ± 4 to 62 ± 8 (SD) % of control, P < 0.001], increased PD50MCh (P < 0.005), without affecting the dose causing 50% of maximal response. In asthmatic subjects, neither PD50MCh when DIs were prohibited nor changes in PD50MCh induced by DIs were significantly correlated with inflammatory cell numbers or percentages in sputum. We conclude that1) even when DIs are prohibited, the responsiveness to MCh is greater in asthmatic than in healthy subjects;2) repeated DIs reduce airway responsiveness in healthy but not in asthmatic subjects; and3) neither airway hyperresponsiveness nor the inability of DIs to relax constricted airways in asthmatic subjects is related to the presence of inflammatory cells in the airways.

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