Chest
Volume 94, Issue 3, September 1988, Pages 457-461
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Clinical Investigations
Airway Responsiveness to Inhaled Histamine in Chronic Obstructive Airways Disease: Chronic Bronchitis vs Emphysema

https://doi.org/10.1378/chest.94.3.457Get rights and content

Airway responsiveness to inhaled histamine was examined in two groups of carefully selected patients with nonasthmatic chronic obstructive airways disease (COAD). Twelve patients with chronic bronchitis and airflow obstruction but little emphysema and 13 with predominantly emphysema and airflow obstruction but little bronchitis were selected based on history, chest roentgenogram, and diffusing capacity for carbon monoxide (Dsb). Emphysema patients had less cough, less sputum, less chronic bronchitis, lower Dsb, and more radiographic evidence of vascular deficiency. There was no difference in anthropometric features, smoking history, atopic skin sensitivity, hemoglobin, blood eosinophilia, PaO2, PaCO2, ECG, lung volumes, or expiratory flow rates. The two groups had similar airway responsiveness to inhaled histamine; the geometric mean provocation concentration producing a 20 percent FEV1 fall (PC20) was 0.56 mg/ml for the bronchitis patients and 0.28 mg/ml for the emphysema patients (p>0.20). Regression of log histamine PC20 vs percent predicted FEV1 showed a high correlation in both groups (r = 0.73, p<0.01 in bronchitis and r = 0.79, p<0.001 in emphysema). The regression lines were almost identical. These data suggest that in COAD bronchial responsiveness to inhaled histamine is mainly due to the altered airway geometry, and that there is no difference in histamine responsiveness between patients with emphysematous COAD and nonemphysematous COAD with chronic bronchitis. (Chest 1988; 94:457-61)

Section snippets

Subjects

Patients were selected by chart review of outpatients attending the Respiratory Diseases Clinic at the University Hospital in Saskatoon. Twelve patients with COAD and chronic bronchitis were selected. All had long-standing smoking history, irreversible airflow obstruction, normal diffusing capacity, minimal, if any, evidence of vascular deficiency on chest roentgenogram, and chronic cough and sputum. Thirteen patients with COAD and emphysema were selected who had irreversible airflow

RESULTS

Anthropometric and historic data of the 25 patients studied is presented in Table 1. The two groups of patients were comparable with regard to their age, sex, height, weight, and pack-years of smoking. Bronchitis patients had greater cough, sputum, and chronic bronchitis than the emphysema patients. All patients (except one α1-antitrypsin deficient emphysema patient) had a history of heavy smoking. Mean pack-years of smoking for the bronchitis and emphysema patients were 46.9 and 28.3,

DISCUSSION

These data confirm previous work showing the presence of airway hyperresponsiveness in patients with chronic obstructive airways disease and its dependence on the degree of airflow obstruction. Previous work is extended by demonstrating no difference between subject with nonemphysematous COAD with chronic bronchitis and those with emphysematous, nonbronchitis COAD.

Chronic obstructive airways disease (also called chronic obstructive pulmonary disease, chronic obstructive lung disease, chronic

ACKNOWLEDGMENTS

The authors wish to thank Brenda Gore and Jacquie Bramley for their assistance in preparing this manuscript.

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    Supported by John Moorhead Fellowship Foundation.

    Manuscript received January 11; revision accepted March 14.

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