Document Detail

Bronchial hyperresponsiveness to methacholine in patients with impaired left ventricular function.
MedLine Citation:
PMID:  2541334     Owner:  NLM     Status:  MEDLINE    
To elucidate the pathogenesis of bronchospasm in congestive heart failure, we studied 23 patients with chronic impairment of left ventricular function due to coronary artery disease or dilated cardiomyopathy. In 21 of them we found marked bronchial hyperresponsiveness to methacholine. The mean dose (+/- SD) of methacholine that elicited a 20 percent decrease in the forced expiratory volume in one second (FEV1) was 421 +/- 298 micrograms, nearly the same as in patients with symptomatic asthma. In contrast, there was no bronchial response to methacholine in 9 of 10 patients who had coronary artery disease but normal left ventricular function. Administration of the bronchodilator albuterol led to a partial (43 percent) reversal of the methacholine-induced bronchial obstruction. In 12 patients, pretreatment with the alpha-adrenergic agonist methoxamine (10 mg by inhalation), a potent vasoconstrictor, fully prevented the methacholine-induced decrease in FEV1. The protective effect of methoxamine was blocked by the alpha-adrenergic antagonist phentolamine in all six patients who received this agent. We conclude that bronchial hyperresponsiveness to cholinergic agonists is frequent in patients with impaired left ventricular function and may contribute to the wheezy dyspnea commonly observed in such patients. The bronchoconstriction may be mediated at least in part by dilatation of the bronchial vessels.
L R Cabanes; S N Weber; R Matran; J Regnard; M O Richard; M E Degeorges; A Lockhart
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The New England journal of medicine     Volume:  320     ISSN:  0028-4793     ISO Abbreviation:  N. Engl. J. Med.     Publication Date:  1989 May 
Date Detail:
Created Date:  1989-06-15     Completed Date:  1989-06-15     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0255562     Medline TA:  N Engl J Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1317-22     Citation Subset:  AIM; IM    
Department of Physiology, Université René Descartes, Hôpital Cochin, Paris, France.
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MeSH Terms
Albuterol / pharmacology
Bronchi / drug effects*,  physiopathology
Bronchial Provocation Tests
Cardiomyopathy, Dilated / complications,  physiopathology*
Coronary Disease / complications,  physiopathology*
Dyspnea, Paroxysmal / etiology
Forced Expiratory Volume
Heart Failure / complications,  physiopathology
Methacholine Compounds / pharmacology*
Methoxamine / pharmacology
Middle Aged
Receptors, Adrenergic, alpha / drug effects
Reg. No./Substance:
0/Methacholine Compounds; 0/Receptors, Adrenergic, alpha; 18559-94-9/Albuterol; 390-28-3/Methoxamine
Comment In:
N Engl J Med. 1989 Dec 21;321(25):1756-8   [PMID:  2574413 ]

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