Maneuver induces airway obstruction or bronchodilatation
A deep breath may lead to bronchodilation as well as bronchoconstriction (ref. 1). This is in part explained by differences in the hysteresis of lung parenchyma and airways. It can often be demonstrated by comparing flow-volume curves started after a normal tidal breath (partial expiratory flow-volume curve: PEFV) with curves started from the level of TLC (maximum expiratory flow-volume curve: MEFV). In ‘healthy’ subjects the curves are practically superimposable; in patients with lung disease flow during the FVC maneuver is either larger (bronchodilatation) or smaller (bronchoconstriction) than in the partial curve.
When airway obstruction arises from an
inflammatory process in small airways, hysteresis of the parenchyma
is larger than that of the airways; in that case a deep inspiration
is associated with bronchoconstriction, the extent of which is a
measure of the activity of the inflammatory process (ref. 2).
After induced airway obstruction (allergen, cold air, histamine
or methacholine challenge) airway hysteresis predominates over that
of lung parenchyma, leading to airway dilatation: contracted smooth
muscles, after being stretched, only slowly return to previous muscle
tone. More information about basal factors affecting bronchial hyperresponsiveness
is available elsewhere on this site.
Ref. 1 - Deep breath and airway patency
- Nadel JA, Tierney DF. Effect of previous deep inspiration on airway resistance in man. J Appl Physiol 1961; 16: 717-719.
- Gimeno F, Berg WC, Sluiter HJ, Tammeling GJ. Spirometry-induced bronchial obstruction. Am Rev Respir Dis 1972; 105: 68-74.
- Fish JE, Peterman VI, Cugell DW. Effect of deep inspiration on airway conduction in subjects with allergic rhinitis and allergic asthma. J Allergy Clin Immunol 1977; 60: 41-46.
- Gayrard P, Orehek J, Grimaud C, Charpin
J. Mechanism of the bronchoconstrictor effects of deep inspiration
in asthmatic patients. Thorax 1979; 34: 234-240.
Orehek J, Charpin J, Velardocchio JM, Grimaud C. Bronchomotor effect of bronchoconstriction-induced deep inspirations in asthmatics. Am Rev Respir Dis 1980; 121: 297-305.
- Fish JE, Ankin MG, Kelly JF, Peterman VL. Regulation of bronchomotor tone by lung inflation in asthmatic and non-asthmatic subjects. J Appl Physiol 1981; 50: 1079-1086.
- Orehek J, Nicoli MM, Delpierre S, Beaupré A. Influence of the previous deep inspiration on the spirometric measurement of provoked bronchoconstriction in asthma. Am Rev Respir Dis 1981; 123: 269-272.
- Beaupré A, Orehek J. Factors influencing the bronchodilator effect of a deep inspiration in asthmatic patients with provoked bronchoconstriction. Thorax 1982; 37: 124-128.
- Zamel N, Hughes D, Levison H, Fairshter RD, Gelb AF. Partial and complete maximum expiratory flow-volume curves in asthmatic patients with spontaneous bronchospasm. Chest 1983; 83: 35-39.
- Hida W, Arai M, Shindoh C, Liu Y-N, Sasaki H, Takishima T. Effect of inspiratory flow rate on bronchomotor tone in normal and asthmatic subjects. Thorax 1984; 39: 86-92.
- Sterk PJ, Daniel EE, Zamel N, Hargreave FE. Limited bronchoconstriction to methacholine using partial flow-volume curves in non-asthmatic subjects. Am Rev Respir Dis 1985; 132: 272-277.
- Zamel N. Partial flow-volume curves. Bull Europ Physiopathol Respir 1984; 20: 471-475.
- Berry RB, Fairshter RD. Partial and maximal expiratory flow-volume curves in normal and asthmatic subjects before and after inhalation of metaproterenol. Chest 1985; 88: 697-702.
- Burns CB, Taylor WR, Ingram RH. Effects of deep inhalation in asthma: relative airway and parenchymal hysteresis. J Appl Physiol 1985; 59: 1590-1596.
- Fairshter RD. Airway hysteresis in normal subjects and individuals with chronic airflow obstruction. J Appl Physiol 1985; 58: 1505-1510.
- Fairshter RD. Effect of deep inspiration on expiratory flow in normals and patients with chronic obstructive lung disease. Bull Europ Physiopathol Respir 1986; 22: 119-125.
- Pichurko BM, Ingram RH. Effects of airway tone and volume history on maximal expiratory flow in asthma. J Appl Physiol 1987; 62: 1133-1140.
- Lim TK, Pride NB, Ingram RH. Effects of volume history during spontaneous and acutely induced airway obstruction in asthma. Am Rev Respir Dis 1987; 135: 591-596.
- Mialon P, Barthélémy L, Sébert P. Effects of maximal breath holding on maximal expiratory flows. Eur Respir J 1989; 2: 340-343.
- Wheatley JR, Paré PD, Engel LA. Reversibility of induced bronchoconstriction by deep inspiration in asthmatic and normal subjects. Eur Respir J 1989; 2: 331-339.
- Malo J, L’Archevèque J, Cartier A. Comparative effects of volume history on bronchoconstriction induced by hyperventilation and methacholine in asthmatic subjects. Eur Respir J 1990; 3: 639-643.
- Ingram RH. Physiological assessment of inflammation in the peripheral lung of asthmatic patients. Lung 1990; 168: 237-247.
- Duggan CJ, Chan J, Whelan AJ, Berend N. Bronchodilation induced by deep breaths in relation to transpulmonary pressure and lung volume. Thorax 1990; 45: 93-934.
- Pellegrino R, Wilson O, Jenouri G, Rodarte JR. Lung mechanics during induced bronchoconstriction. J Appl Physiol 1996; 81: 964-975.
Ref. 2 - Airway and
Ingram RH. Physiological assessment of inflammation in the peripheral lung of asthmatic patients. Lung 1990; 168: 237-247.