Possible sensory receptor of nonadrenergic inhibitory nervous system

The hypoxic ventilatory response and TRPA1 antagonism in conscious mice

AIM

Recently, TRPA1 channels, richly expressed in both peripheral and central neural systems, have been proposed as novel sensors of changes in oxygen concentration along the hypoxic-hyperoxic continuum. In this study, we investigated the hypothesis that TRPA1 channels blockade should profoundly affect the hypoxic ventilatory response (HVR).

METHODS

We examined the chemosensory ventilatory responses in conscious mice before and after intraperitoneal administration of the specific TRPA1 antagonist HC-030031 in two doses of 50 and 200 (cumulative dose 250) mg kg(-1) . Ventilation and its responses to mild 13% and severe 7% hypoxia, pure O2 , and 5% CO2 in O2 were recorded in a whole-body plethysmograph.

RESULTS

TRPA1 antagonism caused a dose-dependent attenuation of the HVR. Ventilatory stimulation was virtually abrogated in response to the mild, but it remained viable, albeit slashed, at severe hypoxia after the bigger dose of HC-030031. The TRPA1 function seemed specific for the hypoxic chemoreflex as neither the response to pure O2 nor hypercapnia was appreciably influenced by the TRPA1 antagonist.

CONCLUSIONS

The study unravelled the role of TRPA1 in shaping the ventilatory response to low-intensity hypoxia, liable to be mediated by vagally innervated respiratory chemosensors of lower functional rank, but contradicted the TRPA1 being indispensable for the powerful carotid body chemoreflex in face of a severe hypoxic threat.

Neuronal modulation of airway and vascular tone and their influence on nonspecific airways responsiveness in asthma

The autonomic nervous system provides both cholinergic and noncholinergic neural inputs to end organs within the airways, which includes the airway and vascular smooth muscle. Heightened responsiveness of the airways to bronchoconstrictive agents is a hallmark feature of reactive airways diseases. The mechanisms underpinning airways hyperreactivity still largely remain unresolved. In this paper we summarize the substantial body of evidence that implicates dysfunction of the autonomic nerves that innervate smooth muscle in the airways and associated vasculature as a prominent cause of airways hyperresponsiveness in asthma.

Low voltage vagal nerve stimulation reduces bronchoconstriction in guinea pigs through catecholamine release

OBJECTIVE

  Electrical stimulation of the vagus nerve at relatively high voltages (e.g., >10 V) can induce bronchoconstriction. However, low voltage (≤2 V) vagus nerve stimulation (VNS) can attenuate histamine-invoked bronchoconstriction. Here, we identify the mechanism for this inhibition.

METHODS

  In urethanea-nesthetized guinea pigs, bipolar electrodes were attached to both vagus nerves and changes in pulmonary inflation pressure were recorded in response to i.v. histamine and during VNS. The attenuation of the histamine response by low-voltage VNS was then examined in the presence of pharmacologic inhibitors or nerve ligation.

RESULTS

  Low-voltage VNS attenuated histamine-induced bronchoconstriction (4.4 ± 0.3 vs. 3.2 ± 0.2 cm H(2) O, p < 0.01) and remained effective following administration of a nitric oxide synthase inhibitor, NG-nitro-L-arginine methyl ester, and after sympathetic nerve depletion with guanethidine, but not after the β-adrenoceptor antagonist propranolol. Nerve ligation caudal to the electrodes did not block the inhibition but cephalic nerve ligation did. Low-voltage VNS increased circulating epinephrine and norepinephrine without but not with cephalic nerve ligation.

CONCLUSION

  These results indicate that low-voltage VNS attenuates histamine-induced bronchoconstriction via activation of afferent nerves, resulting in a systemic increase in catecholamines likely arising from the adrenal medulla.

Vagal afferents contribute to exacerbated airway responses following ozone and allergen challenge

Brown-Norway rats (n=113) sensitized and challenged with nDer f 1 allergen were used to examine the contribution of lung sensory nerves to ozone (O(3)) exacerbation of asthma. Prior to their third challenge rats inhaled 1.0ppm O(3) for 8h. There were three groups: (1) control; (2) vagus perineural capsaicin treatment (PCT) with or without hexamethonium; and (3) vagotomy. O(3) inhalation resulted in a significant increase in lung resistance (R(L)) and an exaggerated response to subsequent allergen challenge. PCT abolished the O(3)-induced increase in R(L) and significantly reduced the increase in R(L) induced by a subsequent allergen challenge, while hexamethonium treatment reestablished bronchoconstriction induced by allergen challenge. Vagotomy resulted in a significant increase in the bronchoconstriction induced by O(3) inhalation and subsequent challenge with allergen. In this model of O(3) exacerbation of asthma, vagal C-fibers initiate reflex bronchoconstriction, vagal myelinated fibers initiate reflex bronchodilation, and mediators released within the airway initiate bronchoconstriction.

Role of nitric oxide in hyperpnea-induced bronchoconstriction and airway microvascular permeability in guinea pigs

The present study aimed to evaluate the role of nitric oxide (NO) on hyperpnea-induced bronchoconstriction (HIB) and airway microvascular hyperpermeability (AMP). Sixty-four guinea pigs were anesthetized, tracheotomized, cannulated, and connected to animal ventilator to obtain pulmonary baseline respiratory system resistance (Rrs). Animals were then submitted to 5 minutes hyperpnea and Rrs was evaluated during 15 minutes after hyperpnea. AMP was evaluated by Evans blue dye (25 mg/kg) extravasation in airway tissues. Constitutive and inductible NO was evaluated by pretreating animals with N(G)-nitro-L-arginine methyl ester (L-NAME) (50 mg/kg), aminoguadinine (AG) (50 mg/kg), and L-arginine (100 mg/kg) and exhaled NO (NOex) was evaluated before and after drug administration and hyperpnea. The results show that L-NAME potentiated (57%) HIB and this effect was totally reversed by L-arginine pretreatment, whereas AG did not have effect on HIB. L-NAME decreased basal AMP (48%), but neither L-NAME nor AG had any effect on hyperpnea-induced AMP. NOex levels were decreased by 50% with L-NAME, effect that was reversed by L-arginine treatment. These results suggest that constitutive but not inducible NO could have a bronchoprotective effect on HIB in guinea pigs. The authors also observed that neither constitutive nor inducible NO seems to have any effect on hyperpnea-induced AMP.

Sensory nerves and airway irritability

The lung, like many other organs, is innervated by a variety of sensory nerves and by nerves of the parasympathetic and sympathetic nervous systems that regulate the function of cells within the respiratory tract. Activation of sensory nerves by both mechanical and chemical stimuli elicits a number of defensive reflexes, including cough, altered breathing pattern, and altered autonomic drive, which are important for normal lung homeostasis. However, diseases that afflict the lung are associated with altered reflexes, resulting in a variety of symptoms, including increased cough, dyspnea, airways obstruction, and bronchial hyperresponsiveness. This review summarizes the current knowledge concerning the physiological role of different sensory nerve subtypes that innervate the lung, the factors which lead to their activation, and pharmacological approaches that have been used to interrogate the function of these nerves. This information may potentially facilitate the identification of novel drug targets for the treatment of respiratory disorders such as cough, asthma, and chronic obstructive pulmonary disease.

Asthma in humans and cats: is there a common sensitivity to aeroallegens in shared environments?

Cats spontaneously develop eosinophilic airway inflammation and airway hyperreactivity that is very similar to human allergic asthma. In addition, household cats share environmental exposures to aeroallergens with humans. We review the scientific literature concerning the pathophysiology of feline asthma, including similarities to human asthma and evidence regarding environmental aeroallergen triggers. Results of pathophysiological studies suggest important similarities between human and feline responses to inhaled allergens. Only a few studies were found that examined the development of disease in cats to environmental aeroallergens. Limited evidence suggests that some environmental allergens can cause disease in both cats and humans. It appears that there is a need for greater communication between human and animal health professionals regarding environmental causes of asthma. Specifically, additional research into linkages between human and feline asthma using both molecular techniques and clinical epidemiological approaches could lead to improved understanding of the environmental risks. Finally, there should be consideration of use of naturally affected and/or experimentally induced (using clinically relevant allergens) asthmatic cats in preclinical trials for novel therapeutic interventions.

Placebo response in asthma: a robust and objective phenomenon

BACKGROUND

Placebos are hypothesized to exert positive effects on medical conditions by enhancing patient expectancies. Recent reviews suggest that placebo benefits are restricted to subjective responses, like pain, but might be ineffective for objective physiologic outcomes. Nevertheless, mind-body links and placebo responsivity in asthma are widely believed to exist.

OBJECTIVE

We carried out a randomized, double-blind investigation to (1) determine whether placebo can suppress airway hyperreactivity in asthmatic subjects, (2) quantify the placebo effect, (3) identify predictors of the placebo response, and (4) determine whether physician interventions modify the placebo response.

METHODS

In a double-blind, crossover design investigation, 55 subjects with mild intermittent and persistent asthma with stable airway hyperreactivity were randomized to placebo or salmeterol before serial methacholine challenges. Subjects were additionally randomized to physician interactions that communicated either positive or neutral expectancies regarding drug effect.

RESULTS

Placebo bronchodilator administration significantly reduced bronchial hyperreactivity compared with baseline (the calculated concentration of methacholine required to induce a 20% decrease in FEV(1) nearly doubled); 18% of subjects were placebo responders by using conservative definitions. Experimental manipulation of physician behavior altered perceptions of the physician but not the magnitude or frequency of the placebo response.

CONCLUSIONS

Objective placebo effects exist in asthma. These responses are of significant magnitude and likely to be meaningful clinically. The placebo response was not modulated by alterations in physician behavior in this study.

CLINICAL IMPLICATIONS

The placebo response in patients with asthma is important in understanding the limitations of clinical research studies and in maximizing safe and effective therapies. This article confirms the existence of a strong placebo response in an objective and clinically relevant measure of disease activity.

Vagal afferent nerves regulating the cough reflex

Coughing is initiated by activation of mechanically and chemically sensitive vagal afferent nerves innervating the airways. All afferent nerve subtypes innervating the airways can modulate the cough reflex. Rapidly adapting and slowly adapting stretch receptors (RARs and SARs, respectively) innervating the intrapulmonary airways and lung may enhance and facilitate coughing. Activation of intrapulmonary C-fibers has been shown to inhibit coughing in anesthetized animals. Extrapulmonary C-fibers and RARs can initiate coughing upon activation. C-fiber-dependent coughing is uniquely sensitive to anesthesia. Tracheal and bronchial C-fibers may also interact with other afferents to enhance coughing. Recent studies in anesthetized guinea pigs have identified a myelinated afferent nerve subtype that can be differentiated from intrapulmonary RARs and SARs and play an essential role in initiating cough. Whether these "cough receptors" are the guinea pig equivalent of the irritant receptors described in the extrapulmonary airways of other species is unclear.

Reflex regulation of airway smooth muscle tone

Autonomic nerves in most mammalian species mediate both contractions and relaxations of airway smooth muscle. Cholinergic-parasympathetic nerves mediate contractions, whereas adrenergic-sympathetic and/or noncholinergic parasympathetic nerves mediate relaxations. Sympathetic-adrenergic innervation of human airway smooth muscle is sparse or nonexistent based on histological analyses and plays little or no role in regulating airway caliber. Rather, in humans and in many other species, postganglionic noncholinergic parasympathetic nerves provide the only relaxant innervation of airway smooth muscle. These noncholinergic nerves are anatomically and physiologically distinct from the postganglionic cholinergic parasympathetic nerves and differentially regulated by reflexes. Although bronchopulmonary vagal afferent nerves provide the primary afferent input regulating airway autonomic nerve activity, extrapulmonary afferent nerves, both vagal and nonvagal, can also reflexively regulate autonomic tone in airway smooth muscle. Reflexes result in either an enhanced activity in one or more of the autonomic efferent pathways, or a withdrawal of baseline cholinergic tone. These parallel excitatory and inhibitory afferent and efferent pathways add complexity to autonomic control of airway caliber. Dysfunction or dysregulation of these afferent and efferent nerves likely contributes to the pathogenesis of obstructive airways diseases and may account for the pulmonary symptoms associated with extrapulmonary disorders, including gastroesophageal reflux disease, cardiovascular disease, and rhinosinusitis.

Anatomy and Neurophysiology of the Cough Reflex

OBJECTIVES

To describe the anatomy and neurophysiology of the cough reflex.

METHODS

A review of the literature was carried out using PubMed and the ISI Web of Knowledge from 1951 to 2004. Most of the referenced studies were carried out in animals

CONCLUSIONS

Studies carried out in animals provide suggestive but inconclusive evidence that C-fibers and rapidly adapting receptors (RARs) arising from the vagus nerves mediate coughing. Recent studies also have suggested that a vagal afferent nerve subtype that is not readily classified as a RAR or a C-fiber may play an important role in regulating cough. Afferent nerves innervating other viscera, as well as somatosensory nerves innervating the chest wall, diaphragm, and abdominal musculature also likely play a less essential but important accessory role in regulating cough. The responsiveness and morphology of the airway vagal afferent nerve subtypes and the extrapulmonary afferent nerves that regulate coughing are described.

Interactions between vagal afferent nerve subtypes mediating cough

The cough reflex is initiated through activation of vagal afferent nerves. Rapidly adapting receptors fulfill all criteria for the afferents subserving the cough reflex. Bronchopulmonary C-fibres may also initiate cough when activated. C-fibre-mediated cough may depend upon ongoing or initiated activity in rapidly adapting receptors. The interaction between airways C-fibres and rapidly adapting receptors may occur at sites in the periphery or in the brainstem. C-fibre mediated cough must also overcome a coincident inhibitory effect of C-fibre activation on cough, an inhibitory effect that becomes prominent under general anesthaesia.

Evidence for differential reflex regulation of cholinergic and noncholinergic parasympathetic nerves innervating the airways

The hypothesis that cholinergic and nonadrenergic, noncholinergic parasympathetic nerves innervating the airways are subject to differential reflex regulation was addressed. Pronounced contractile and relaxant parasympathetic reflex responses could be evoked by intravenous histamine, laryngeal mucosal application of capsaicin, inhaled capsaicin, or electrical stimulation of the vagal afferent nerves projecting to the esophagus and abdominal viscera. These data suggest that activation of multiple vagal afferent nerve subtypes can initiate both cholinergic and noncholinergic parasympathetic reflexes in the airways. Conversely, hypoxia or activation of the diving response from the nose evoked only cholinergic contractile reflexes. All contractile and relaxant responses evoked by these stimuli were absent in vagotomized animals or in animals pretreated with the ganglionic blocker trimethaphan, confirming their reflex and parasympathetic nature. The data indicate that cholinergic and noncholinergic parasympathetic nerves regulating airway caliber in guinea pigs are comprised of two distinct parasympathetic pathways that are subject to differential reflex regulation. This previously unrecognized complexity of autonomic regulation of airway caliber has potentially important implications for the mechanisms of airways hyperresponsiveness.

Nitric oxide-dependent modulation of smooth-muscle tone by airway parasympathetic nerves

We addressed the hypothesis that noncholinergic parasympathetic nerves modulate airway smooth-muscle (ASM) tone in guinea pigs. The NO synthase inhibitor L-N(G)-nitro-arginine (L-NNA) and the guanylate cyclase inhibitor 1H-[1,2,4]oxadiazolo[4,3-a]quinoxalin-1-one (ODQ) potentiated cholinergic contractions and partly inhibited noncholinergic relaxations of the trachealis evoked by nerve stimulation in vitro or in situ. When delivered selectively to the trachea in situ, L-NNA and ODQ also increased baseline cholinergic tone of the trachealis, and L-NNA potentiated histamine-induced contractions of the trachealis in situ. L-Arginine prevented the effects of L-NNA. Vagotomy or selective nerve blockade with tetrodotoxin (TTX) mimicked the effects of L-NNA on histamine responses. The effects of TTX and L-NNA were not additive, however, suggesting that the two agents have common mechanisms of action, and indicating that other nonadrenergic, noncholinergic relaxant neurotransmitters lack influence under baseline conditions. When reflexly activated by bradykinin, noncholinergic parasympathetic nerves partly reversed histamine-induced contractions of the trachealis. L-NNA failed to inhibit this response, however, and did not potentiate the reflex tracheal cholinergic contractions produced by bradykinin. These results show that noncholinergic parasympathetic nerves modulate ASM tone. The NO-dependent component of this response is most effective at baseline levels of nerve activity.

Multiple mechanisms of reflex bronchospasm in guinea pigs

The mechanisms of histamine- and bradykinin-induced reflex bronchospasm were determined in anesthetized guinea pigs. With intravenous administration, both autacoids evoked dose-dependent increases in tracheal cholinergic tone. Vagotomy or atropine prevented these tracheal reflexes. When delivered as an aerosol, bradykinin readily increased tracheal cholinergic tone, whereas histamine aerosols were much less effective at inducing tracheal reflexes. Also, unlike histamine, bradykinin could evoke profound increases in cholinergic tone without directly or indirectly (e.g., prostanoid dependent) inducing measurable airway smooth muscle contraction resulting in bronchospasm. Neither autacoid required de novo synthesis of prostanoids or nitric oxide to induce reflex tracheal contractions. Combined cyclooxygenase inhibition and tachykinin-receptor antagonism did, however, abolish all effects of bradykinin in the airways, whereas responses to histamine were unaffected by these pretreatments. The data indicate that histamine and bradykinin initiate reflex bronchospasm by differential activation of vagal afferent nerve subtypes. We speculate that selective activation of either airway C fibers or airway rapid adapting receptors can initiate reflex bronchospasm.

Neural regulation of airway smooth muscle tone

Airway smooth muscle is innervated by sympathetic and parasympathetic nerves. When activated, airway nerves can markedly constrict bronchi either in vivo or in vitro, or can completely dilate a precontracted airway. The nervous system therefore plays a primary role in regulating airway caliber and its dysfunction is likely to contribute to the pathogenesis of airways diseases. The predominant contractile innervation of airway smooth muscle is parasympathetic and cholinergic in nature, while the primary relaxant innervation of the airways is comprised of noncholinergic (nitric oxide synthase- and vasoactive intestinal peptide-containing) parasympathetic nerves. These parasympathetic nerves are anatomically and physiologically distinct from one another and differentially regulated by reflexes. Sympathetic-adrenergic nerves play little if any role in directly regulating smooth muscle tone in the human airways. Activation of airway afferent nerves (rapidly adapting receptors, C-fibers) can evoke increases in airway smooth muscle parasympathetic nerve activity, or decreases in parasympathetic nerve activity (through activation of slowly adapting receptors). Extrapulmonary afferents can also modulate nerve mediated regulation of airway smooth muscle tone. In guinea pigs and rats, peripheral activation of tachykinin-containing airway afferent nerves evokes bronchospasm via release of substance P and neurokinin A. This effect of airway afferent nerve activation appears to be unique to guinea pigs and rats. The actions and interactions between the components of airway innervation are discussed.

Regulation of baseline cholinergic tone in guinea-pig airway smooth muscle

1. We quantified baseline cholinergic tone in the trachealis of mechanically ventilated guinea-pigs and determined the influence of vagal afferent nerve activity on this parasympathetic tone. 2. There was a substantial amount of baseline cholinergic tone in the guinea-pig trachea, eliciting contractions of the trachealis that averaged 24.6 +/- 3.5 % (mean +/- s.e.m.) of the maximum attainable contraction. This tone was essentially abolished by vagotomy or ganglionic blockade, suggesting that it was dependent upon on-going pre-ganglionic input arising from the central nervous system. 3. Cholinergic tone in the trachealis could be markedly and rapidly altered (either increased or decreased) by changes in ventilation (e. g. cessation of ventilation; hyperpnoea; slow, deep breathing) and by lung distention (via positive end-expiratory pressure). These effects were not accompanied by marked alterations in blood gases and were abolished by vagotomy or atropine. By contrast, tachykinin receptor antagonists, which abolished capsaicin-induced bronchospasm, were without effect on baseline cholinergic tone. This and other evidence suggests that capsaicin-sensitive nerves have little if any influence on baseline parasympathetic tone. Likewise, while activation of afferent nerves innervating the larynx can alter airway parasympathetic nerve activity, transection of the superior laryngeal nerves was without effect on baseline cholinergic tone. 4. Cutting the vagus nerves caudal to the recurrent laryngeal nerves, thus leaving the preganglionic parasympathetic innervation of the trachealis intact but disrupting all afferent nerves innervating the lungs and intrapulmonary airways, abolished baseline cholinergic tone in the trachea. Sham vagotomy or cutting the vagi caudal to the lungs did not reduce baseline cholinergic tone. 5. The results indicate that baseline airway cholinergic nerve activity is necessarily dependent upon afferent nerve activity arising from the intrapulmonary airways and lungs. More specifically, the data are consistent with the hypothesis that on-going activity arising from the nerve terminals of intrapulmonary rapidly adapting receptors determines the level of baseline airway cholinergic tone.

Autonomic regulation. i-NANC/e-NANC

The excitatory and inhibitory nonadrenergic/noncholinergic (e-NANC, i-NANC) systems have been extensively studied. The terms excitatory and inhibitory apply to airway smooth muscle, but the neurotransmitters also act on other targets-blood vessels, glands, the epithelium-where individual actions may be the opposite. Thus, the nomenclature is unsatisfactory. Of the dozen or more putative NANC transmitters, criteria to establish their roles have been met only for vasoactive intestinal polypeptide (VIP), nitric oxide (NO), and substance P/neurokinin A (SP/NKA). VIP and NO co-localize in vagal motor nerves, but they are also found in sympathetic and sensory nerves. In general they have similar actions on target tissues, and their relative importance may vary with species. SP/NKA, released from sensory nerves, is thought to mediate neurogenic inflammation, a process that may include airway smooth muscle contraction, at least in rodents. The evidence for neurogenic inflammation in humans is weak. On the motor side, and also possibly on the sensory, different nerves seem to contain different selections of neurotransmitters, but it is not known if there are different motor controls for these nerves. Cotransmission presents a major conceptual and experimental problem, since the two or more transmitters may give opposite instructions to the target tissue. Inevitably most of the studies on the NANC systems are on isolated rodent tissues, and although quantitative, they indicate little of what happens in vivo, and certainly not in humans. The cocktail of mediators that must be released from nerves and associated cells in airway tissues during pathophysiologic processes may refresh physiologists, but little is known about the concentrations of the ingredients or about the strength of their actions and their interactions on different target tissues in the mucosa.

Neural mechanisms and axon reflexes in asthma. Where are we?

For many years, asthma has been classified as a "neural" disease, with an imbalance between constrictor and dilator nerves being responsible for the symptomatology. Although, nowadays, asthma is recognized as an inflammatory disorder of the airways, neural mechanisms remain very important; axon reflexes, in particular, have received a lot of attention in recent years. In this commentary, an overview is given on the innervation of the airways and its relevance in asthma, and potential new insights in airways innervation are discussed. In a second part, the role of axon reflexes is highlighted. Although neuropeptides such as substance P and neurokinin A are present in human airways, where they produce many of the features characteristic of asthma, and although there is an elevation of their content in induced sputum from asthmatics, there is still no clear direct evidence for the existence of operational axon reflexes in human airways. Most of the research focused on this subject is performed in guinea pigs, where such an axon reflex clearly operates in the airways. In these animals, different receptors have been identified on C-fiber endings, which, upon stimulation, cause inhibition of neuropeptide release. Some of these receptors have also been identified on human airway nerves. Therefore, it has been suggested that modulation of axon reflexes could be of potential benefit in asthma treatment. Indeed, some drugs (e.g. sodium cromoglycate, nedocromil sodium, and ketotifen), which have been demonstrated to partially inhibit neuropeptide release in guinea pig airways, have anti-inflammatory effects on neuropeptide release in guinea pig airways, do not seem to have any anti-inflammatory effects in human asthma. Other drugs, however, such as beta2-mimetics, which have a much more pronounced inhibitory effect in asthma. In conclusion, although there is a lot of indirect evidence for the existence of axon reflex mechanisms in human airways, most of the data now available are derived from animal studies. The key question of whether axon reflexes are operational in human airways remains unanswered. Hopefully, the near future will bring a solution to this enigma with the introduction of very potent tachykinin antagonists for the treatment of human asthma.

A role for capsaicin sensitive, tachykinin containing nerves in chronic coughing and sneezing but not in asthma: a hypothesis

Images

Bradykinin causes airway hyperresponsiveness and enhances maximal airway narrowing. Role of microvascular leakage and airway edema

The relationship between bronchial edema and airway responsiveness was studied in cats in situ. Five cats were exsanguinated, and the bronchial arteries were perfused. We monitored pulmonary resistance (RL), and the provocative dose of acetylcholine (ACh) required to produce a 300% increase in RL (PD300) was determined. Bronchial vascular permeability was measured by quantifying extravasation of Evans blue (EB) dye. Bradykinin (BK) and ACh were administered via the bronchial arteries to increase leakage and bronchoconstriction, respectively. BK preperfusion (for 30 min) significantly increased bronchial vascular permeability to four times the control values (p < 0.05). BK preperfusion did not alter baseline RL but caused hyperresponsiveness to ACh, with log [PD300 (mole)] of -6.53 +/- 0.42 (mean +/- SD) and -6.90 +/- 0.30, before and after BK, respectively (p < 0.01). Furthermore, the maximal airway narrowing after BK was 58% higher than before BK (p < 0.01). Histologic study showed peribronchial edema after BK. The enhancement of maximal airway narrowing was significantly correlated with the degree of EB dye extravasation. These results suggest that BK causes airway hyperresponsiveness to ACh and increases maximal airway narrowing, possibly because of airway edema.

The Autonomic Nervous System Modulates Dry Air-induced Constriction in the Canine Lung Periphery

To determine the modulatory role of the autonomic nervous system on dry air-induced bronchoconstriction (AIB) in the canine lung periphery, we examined the effect of cholinergic, alpha- and beta-adrenergic, and total autonomic ganglionic blockade on AIB. Pretreatment with atropine significantly attenuated AIB by approximately 30%, indicating that AIB is partially mediated via a vagal reflex. Pretreatment with either phentolamine or propranolol did not affect AIB, indicating that alpha- and beta-adrenoceptors, respectively, were not activated in response to dry air challenge. In contrast, pretreatment with hexamethonium significantly potentiated AIB. In addition, exogenous vasoactive intestinal peptide (VIP), a potential neurotransmitter for the nonadrenergic-noncholinergic (NANC) inhibitory system, significantly inhibited AIB. We conclude that (1) neither alpha- or beta-adrenergic efferents are activated during dry air challenge, (2) total autonomic blockade potentiates the response to dry air, and (3) VIP attenuates AIB. Based on these observations, we speculate that NANC inhibitory activity may be stimulated during dry air challenge and antagonizes AIB.

Chemoreceptor control of the airways

The peripheral chemoreceptors act reflexly not only on respiration, but also on many motor systems in the respiratory tract. They cause a reflex bronchoconstriction, although this may be modified or even reversed by secondary dilator reflexes such as that from pulmonary stretch receptors. They promote a reflex secretion of mucus from submucosal glands in the trachea, and possibly other parts of the airways. They cause systemic reflex vasoconstriction both in nose (with reduction in airflow resistance) and trachea, and probably in the bronchi. There is also a reflex pulmonary vasoconstriction, although the strength of this has not been determined. The larynx dilates during peripheral chemoreceptor stimulation, as does the oropharynx. All these changes affect airway calibre, most components increasing it but some having the opposite effect. In turn these airway responses will affect lung ventilation and blood-gas tensions. The whole respiratory tract seems to be an important target organ for reflexes from the peripheral chemoreceptors.

Sensory receptors and reflex pathways of nonadrenergic inhibitory nervous system in feline airways

The sensory receptors and reflex pathways of the nonadrenergic inhibitory nervous system (NAINS) were examined, using separately ventilated left and right lungs in cats. During bronchoconstriction induced by 5-hydroxytryptamine (5-HT) (50 to 250 micrograms/kg/min, i.v.) infusion after atropine (3 mg/kg, i.v.) and propranolol (2 mg/kg, i.v.), one lung was challenged with (1) citric acid aerosol or (2) capsaicin aerosol or (3) lung volume change (lung inflation). Citric acid or capsaicin inhalation to one lung produced significant bronchodilatation in not only the stimulated lung (SL) but also in the opposite lung (OL). The 5-HT-induced change in pulmonary resistance (RL) was reduced 66.5 +/- 3.3% (mean +/- 1 SE) (SL) and 53.0 +/- 8.1% (OL) by citric acid (20%) and 40.5 +/- 8.9% (SL) and 44.0 +/- 9.9% (OL) by capsaicin (0.1%) inhalation, respectively. These bronchodilatations were abolished by bilateral vagotomy. Inflation of one side of the lung did not reduce the 5-HT-induced change in RL in the OL. These findings indicate that (1) C-fiber and irritant receptors are the possible sensory receptors of the NAINS reflex pathway, and (2) afferent nerve stimulation of NAINS in one lung can produce reflex bronchodilatation in both lungs.

Reflex decrease of histamine-induced bronchoconstriction after laryngeal stimulation in asthmatic patients

The aim of this work was to determine if the nonadrenergic noncholinergic nervous system can be reflexly activated in asthmatic patients by stimulating the vocal cords. The stimulation was produced by a cytology brush passed through a bronchoscope previously introduced transnasally and positioned just above the epiglottis. The subjects were premedicated with cholinergic blockers, and bronchoconstriction was induced by inhalation of histamine. In 11 experiments performed on six patients, vocal cords stimulation resulted in a decreased RL from 8.4 +/- 1.0 to 6.3 +/- 0.8 cm H2O.L-1.s (mean +/- SE) (p less than 0.01). To assess the possible contribution of circulating catecholamines to this decrease, plasma epinephrine and norepinephrine levels were measured in six experiments, before and 30 s, 1, 3, and 5 min after the stimulation. Pulmonary resistance fell from 10.0 +/- 1.3 to 7.6 +/- 0.9 cm H2O.L-1.s (mean +/- SE) (p less than 0.05) 30 s and to 7.9 +/- 0.9 cm H2O.L-1.s (p less than 0.05) 60 s after stimulation. Epinephrine and norepinephrine levels increased slightly but not significantly throughout the experiment. We conclude that in asthmatic patients, as in normal subjects, stimulation of the vocal cords produces a reflex decrease in histamine-induced bronchoconstriction which is modulated by the nonadrenergic noncholinergic nervous system.