Integrated response of the upper and lower respiratory tract of asthmatic subjects to frigid air

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  • Melissa L. McLane
    Division of Pulmonary and Critical Care Medicine, University Hospitals of Cleveland, and Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio 44106
  • Jo Ann Nelson
    Division of Pulmonary and Critical Care Medicine, University Hospitals of Cleveland, and Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio 44106
  • K. A. Lenner
    Division of Pulmonary and Critical Care Medicine, University Hospitals of Cleveland, and Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio 44106
  • Rana Hejal
    Division of Pulmonary and Critical Care Medicine, University Hospitals of Cleveland, and Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio 44106
  • Chakradhar Kotaru
    Division of Pulmonary and Critical Care Medicine, University Hospitals of Cleveland, and Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio 44106
  • Mary Skowronski
    Division of Pulmonary and Critical Care Medicine, University Hospitals of Cleveland, and Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio 44106
  • Albert Coreno
    Division of Pulmonary and Critical Care Medicine, University Hospitals of Cleveland, and Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio 44106
  • Elizabeth Lane
    Division of Pulmonary and Critical Care Medicine, University Hospitals of Cleveland, and Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio 44106
  • E. R. McFadden
    Division of Pulmonary and Critical Care Medicine, University Hospitals of Cleveland, and Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio 44106

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<jats:p> To evaluate the influence of cold air hyperpnea on integrated upper and lower airway behavior, 22 asthmatic volunteers hyperventilated through their mouths (OHV) and noses (NHV) while pulmonary and nasal function were determined individually and in combination. In the isolated studies, OHV at a minute ventilation of 65 ± 3 l/min lowered the 1-s forced expiratory volume (FEV<jats:sub>1</jats:sub>) 24 ± 2% ( P < 0.001) and NHV (40 l/min) induced a 31 ± 9% ( P < 0.001) increase in nasal resistance (NR). In the combined studies, oral hyperpnea reduced the FEV<jats:sub>1</jats:sub>(ΔFEV<jats:sub>1</jats:sub> 26 ± 2%, P < 0.001) and evoked a significant rise in NR (ΔNR 26 ± 9%, P = 0.01). In contrast, NHV only affected the upper airway. NR rose 33 ± 9% ( P = 0.01), but airway caliber did not change (ΔFEV<jats:sub>1</jats:sub> 2%, P = 0.27). The results of this investigation demonstrate that increasing the transfer of heat and water in the lower respiratory tract alters bronchial and nasal function in a linked fashion. Forcing the nose to augment its heat-exchanging activity, however, reduces nasal caliber but has no effect on the intrathoracic airways. </jats:p>

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