岡澤 光芝

Insights into airway mechanics were sought by applying morphometric techniques to rabbit lungs fixed at several lung recoil pressures. Rabbits were treated with either nebulized carbachol followed by iv administration of carbachol or with saline solution (sham). The lungs were held at one of six values of positive end-expiratory pressure (PEEP; 10, 7, 4, 2, 0, and -4 cmH(2)O) while the animal was killed and formalin was circulated through the lungs. The lungs were removed and left in a bath of formalin for 24 h. Standard airway morphometric measurements were made an membranous bronchiole slices taken from representative blocks of tissue. Reductions in PEEP produced the expected reductions in lumen area in the carbachol-treated airways but not in the sham-treated airways for PEEP > 2 cmH(2)O. Sham-treated airways remained more open than expected until they collapsed into an oval shape at PEEPs between 4 and 2 cmH(2)O. The carbachol-treated airways exhibited this behavior at PEEP = -4 cmH(2)O. The smallest airways, which had relatively thicker walls, collapsed less than larger airways. We postulate that this behavior implies that peribronchial stress is greater than lumen pressure on collapse into the oval shape. Resistance to buckling increases with the thickness-to-radius ratio of the airway wall, which explains why the smallest airways are the most open. The development of epithelial folds appeared to follow the theoretical prediction of a previous study (Lambert RK, Codd SL, Alley MR, and Pack RJ. J Appl Physiol 77: 1206-1216, 1994).

A 49-year-old Japanese man with bronchial asthma was admitted to hospital because of acute lobar pneumonia. A diagnosis of acute tuberculous pneumonia was made based on the pathologic findings of lung biopsy specimens and bacteriologic examination. For the 5 years before the onset of pneumonia, the patient had been treated with inhaled beclomethasone dipropionate (600 μg/day) and was well controlled. Laboratory findings revealed no immunosuppressive conditions, nor had the patient used oral corticosteroids for the treatment of his asthma. A tuberculin skin test had been negative approximately 30 years ago and annual chest X-ray examination had shown no evidence of tuberculosis over the past 5 years. Fiberoptic broncoscopic examination showed no evidence of bronchial tuberculosis or perforated lymph nodes. Because acute tuberculous lobar pneumonia in the lower lung field is rare, except in patients receiving oral corticosteroids or with immunodeficiency conditions, in this patient the inhalation of corticosteroids may have predisposed him to the onset of this condition.

Interdependence between airways and the lung parenchyma is thought to be a major mechanism preventing excessive airway narrowing during bronchoconstriction. Because the elastance of the lung increases during bronchoconstriction, the lung's tethering force could also increase, further attenuating bronchoconstriction. We hypothesized that the bulk (kappa) and shear moduli (mu) of the lung increase similarly during bronchoconstriction. To test this hypothesis, we excised rabbit lungs and measured the lung volume, pulmonary elastance, kappa, and mu at transpulmonary pressures of 4, 6, 8, 12, and 16 cmH(2)O using pressure-volume curves, slow oscillations of the lung, and an indentation test. Bronchoconstriction was induced by nebulizing carbachol by using small tidal-volume ventilation to prevent hyperinflation The measurement of kappa and mu was repeated after carbachol treatment. After carbachol treatment, the increase in kappa was significantly greater than that in mu. The estimated value for mu was similar to 0.5 x transpulmonary pressure both before and after carbachol treatment. These data suggest that the tethering effect of the lung parenchyma, which serves to attenuate bronchoconstriction, is not significantly increased during carbachol administration unless there is hyperinflation.

Eosinophilic leukocytes (eosinophils) are important effector cells in allergic inflammatory diseases such as asthma, in which significant accumulation of these cells is observed in the bronchial mucosa. However, there is little information about the relationships between bronchoconstriction and accumulation of eosinophils. We hypothesized that eosinophils are retained in the bronchial vasculature in the inner airway wall during bronchoconstriction because of deformation of the mucosal membrane. To test this hypothesis we induced unilateral bronchoconstriction in open chest guinea pigs by stimulating the right vagus nerve and compared the accumulation of eosinophils in the airway wall of the constricted and contralateral unconstricted lungs using histologic specimens. Results show that the density of eosinophils (number of cells/wall area) significantly increased in the inner wall and decreased in the adventitia of the constricted airways compared with the contralateral unconstricted airways. There was a positive relationship between the amount of smooth muscle shortening and the eosinophil density in the inner wall. On the other hand, this relationship was significantly negative in the adventitia. Atropine completely inhibited the eosinophil accumulation in the inner wall. These data suggest that eosinophils can accumulate in the airway inner wall during bronchoconstriction because of geometrical factors.

Exaggerated airway narrowing in response to bronchoconstricting stimuli is a characteristic feature of asthmatic subjects. It is unknown whether the site of airway narrowing differs in asthmatic subjects from that observed in normal subjects. Increased airway wall thickness has been suggested as a contributing cause for airway hyperresponsiveness in asthma, based on histologic measurements. We measured airway wall thickness and the site and magnitude of airway narrowing in response to inhaled methacholine in normal subjects and in patients with mild to moderate asthma using high resolution computed tomography (HRCT). After a comparable decrease in FEV(1), there were no differences in the site or magnitude of airway narrowing for any category of airway size in asthmatic subjects and normals. However, the results show that the smaller airways of the asthmatic subjects are significantly thickened and that the airway wall area does not change after bronchoconstriction whereas it decreases in normal subjects. We conclude that airway wall thickening and the lack of a change in airway wall dimensions following bronchoconstricting stimuli could contribute to exaggerated airway narrowing in asthma.

Airway wall area is an important determinant of airway narrowing. We hypothesized that in cross-sectioned peripheral airways, the wall area internal to the outer smooth muscle border (inner wall area) would decrease and the airway wall area external to the outer smooth the muscle layer (adventitial area) would increase during bronchoconstriction because of the relocation of blood and/or fluid between these compartments. To test this hypothesis, we used anesthetized open-chest rabbits and measured airway wall dimensions and smooth muscle shortening of membranous airways after carbachol-induced bronchoconstriction using morphometric techniques. Acute (3-min) and sustained (40-min) bronchoconstriction was induced by aerosol nebulization of carbachol and compared with saline treatment. After physiological measurements, the heart base was snared, and the lung and heart were excised en bloc and frozen by using liquid nitrogen while a transpulmonary pressure of 2 cmH(2)O was maintained. The lung was processed for light-microscopic examination by using a freeze substitution technique. Results show that adventitial area was significantly decreased after sustained but not-acute bronchoconstriction. The mechanism of this change, which contradicts our hypothesis, is unclear. However, the decrease of adventitial area could increase rather than decrease the effect of lung parenchymal tethering and attenuate airway narrowing.

There is marked heterogeneity of airway narrowing in intraparenchymal airways in response to bronchoconstricting stimuli. We hypothesized that this heterogeneity results from variations in the structure of the airway wall. Freshly excised dog lung lobes were inflated to transpulmonary pressures (PL) of between 5 and 15 cmH(2)O, and an aerosol containing a high concentration of carbachol was administered. The lobes were fixed and processed for Light-microscopic examination and morphometric analysis of membranous airway dimensions. The relationships of smooth muscle shortening to PL and airway dimensions were analyzed using multiple linear regression. The results show that airway smooth muscle shortening was greater at lower PL and in airways with larger internal perimeter and a greater number of folds per internal perimeter and that it was less in airways with greater inner wall area. We conclude that the magnitude and variability of airway smooth muscle shortening and airway narrowing in response to maximal constricting stimuli are influenced by mechanical factors related to airway wall geometry.

Maximal trachealis muscle shortening in vivo was compared with that in vitro in seven anesthetized dogs. In addition, the effect of graded elastic loads on the muscle was evaluated in vitro. In vivo trachealis muscle shortening, as measured using sonomicrometry, revealed maximal active shortening to be 28.8 +/- 11.7% (SD) of initial length. Trachealis muscle preparations from the same animals were studied in vitro to evaluate isometric force generation, isotonic shortening, and the effect of applying linear elastic loads to the trachealis muscle during contraction from optimal length. Maximal isotonic shortening was 66.8 +/- 8.4% of optimal length in vitro. Increasing elastic loads decreased active shortening and velocity of shortening in vitro in a hyperbolic manner. The elastic load required to decrease in vitro shortening to the extent of the shortening observed in vivo was similar to the estimated load provided by the tracheal cartilage. We conclude that decreased active shortening in vivo is primarily due to the elastic afterload provided by cartilage.