Increase of alveolar pressure reduces systemic-to-pulmonary bronchial blood flow in humans

Airway endothelial dysfunction in asthma and chronic obstructive pulmonary disease: a challenge for future research

Endothelial dysfunction in the extrapulmonary circulation has been linked to cardiovascular disease. Recent investigations have revealed that in the airway circulation, cigarette smoking, chronic obstructive pulmonary disease (COPD), and asthma are also accompanied by endothelial dysfunction. Inhaled glucocorticosteroids can partially or fully restore normal endothelium-dependent vasodilation in these conditions, thereby identifying the airway endothelium as a novel therapeutic target in the treatment of airway disease. The role of the defective endothelium-dependent vasodilation in the pathophysiology in asthma and COPD is still subject to speculation. However, there appears to be an association between COPD and extrapulmonary vascular dysfunction, and the possibility exists that the use of inhaled glucocorticosteroids has a beneficial effect on cardiovascular disease in COPD as suggested by database studies showing that inhaled glucocorticosteroids reduce the incidence of nonfatal and fatal cardiovascular events in COPD.

Reflex tracheal smooth muscle contraction and bronchial vasodilation evoked by airway cooling in dogs

Cooling intrathoracic airways by filling the pulmonary circulation with cold blood alters pulmonary mechanoreceptor discharge. To determine whether this initiates reflex changes that could contribute to airway obstruction, we measured changes in tracheal smooth muscle tension and bronchial arterial flow evoked by cooling. In nine chloralose-anesthetized open-chest dogs, the right pulmonary artery was cannulated and perfused; the left lung, ventilated separately, provided gas exchange. With the right lung phasically ventilated, filling the right pulmonary circulation with 5 degrees C blood increased smooth muscle tension in an innervated upper tracheal segment by 23 +/- 6 (SE) g from a baseline of 75 g. Contraction began within 10 s of injection and was maximal at approximately 30s. The response was abolished by cervical vagotomy. Bronchial arterial flow increased from 8 +/- 1 to 13 +/- 2 ml/min, with little effect on arterial blood pressure. The time course was similar to that of the tracheal response. This response was greatly attenuated after cervical vagotomy. Blood at 20 degrees C also increased tracheal smooth muscle tension and bronchial flow, whereas 37 degrees C blood had little effect. The results suggested that alteration of airway mechanoreceptor discharge by cooling can initiate reflexes that contribute to airway obstruction.

Systemic to pulmonary bronchial blood flow in heart failure

STUDY OBJECTIVE

The aim of this study was to measure systemic to pulmonary blood flow from bronchial circulation (Qbr[s-p]) in patients with heart failure.

DESIGN

In the absence of pulmonary and coronary flows, Qbr(s-p) is the volume of blood accumulating in the left side of the heart; Qbr(s-p) was measured during total cardiopulmonary bypass for coronary artery surgery; bronchial blood was vented through a cannula introduced into the left side of the heart and its volume was measured.

PATIENTS

Patients were subdivided according to the presence for more than 6 months (group 1, n = 6) or less than 2 months (group 2, n = 7), or the absence of heart failure (group 2, n = 15).

MEASUREMENTS AND RESULTS

Qbr(s-p) was 89 +/- 18* mL/min, 27 +/- 3, 22 +/- 2, in groups 1, 2, and 3, respectively (* = p < 0.01 group 1 vs groups 2 and 3). During total cardiopulmonary bypass, pulmonary venous pressure approximates atmospheric pressure and no differences between groups were observed in systemic artery pressure, extracorporeal circulation pump flow, and airway pressure. Therefore, vascular resistance through the bronchial vessels draining into the pulmonary circulation is reduced in patients with heart failure for more than 6 months (group 1).

CONCLUSIONS

During total cardiopulmonary bypass, Qbr(s-p) is increased in patients with chronic heart failure. Since with elevated pulmonary vascular pressure blood flow through Qbr(s-p) vessels is from the pulmonary to the systemic circulation, the lower resistance observed in group 1 suggests that bronchial vessels might contribute to reduced lung fluid overload in patients with chronic heart failure.

Systemic to pulmonary bronchial blood flow in mitral stenosis

We measured systemic to pulmonary bronchial blood flow [Qbr(s-p)] during total cardiopulmonary bypass in 15 patients with mitral stenosis and elevated pulmonary venous pressure (group A, mean pulmonary wedge pressure = 22.2 +/- 5.4 mm Hg, mean +/- SD) and in 15 patients with coronary artery diseases and normal pulmonary venous pressure (group B). Qbr(s-p) is the volume of blood accumulating in the left side of the heart in the absence of pulmonary and coronary flows. This blood was vented through a cannula introduced into the left atrium and measured. Qbr(s-p) was 76.3 +/- 13.9 ml/min (2.18 +/- 0.37 percent of extracorporeal circulation pump flow) and 22.3 +/- 2.1 (0.63 +/- 0.15) in group A and B, respectively (p less than 0.01). During total cardiopulmonary bypass, pulmonary venous pressure is approximately atmospheric pressure, and no differences in systemic blood pressure, extracorporeal circulation pump flow, and airways pressure were observed between group A and B. Therefore, vascular resistance through the bronchial vessels draining into the pulmonary circulation is reduced in patients with mitral stenosis and elevated pulmonary venous pressure.

Inspired gas relative humidity affects systemic to pulmonary bronchial blood flow in humans

To our knowledge, the effects of humidity of inspired air on bronchial blood flow in humans are unknown. During total cardiopulmonary bypass, we measured systemic to pulmonary bronchial blood flow (Qbr[s-p]) which is the volume of blood accumulating into the left side of the heart in the absence of pulmonary and coronary flow. A cannula was introduced into the right upper pulmonary vein and advanced into the lowermost portion of the left side of the heart. From this cannula Qbr(s-p) was vented by gravity and measured. Inspired gas (10 L/min, endotracheal tube, 50 percent O2 + 50 percent N2O) relative humidity was less than 20 percent and greater than 85 percent in group A (n = 25) and in group B (n = 25), respectively. Mean (+/- SE) Qbr(s-p) was 40.7 +/- 0.06 ml/min or 1.32 +/- 0.12 ml/min (percent cardiac output) in group A and 21.7 +/- 1.8 ml/min or 0.68 +/- 0.06 ml/min in group B. These data indicate that under these conditions Qbr(s-p) is increased by dry gas lung inflation in humans.