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Peripheral airway involvement in asthma assessed by single-breath SF₆ and He washout

¹ Dept of Paediatrics, Central Hospital, Skövde and ² Dept of Paediatric Clinical Physiology, Queen Silvia Children's Hospital, Göteborg, Sweden. ³ Portex Anaesthesia, Intensive Therapy and Respiratory Medicine Unit, Institute of Child Health, London, UK

CORRESPONDENCE: P.M. Gustafsson, Dept of Paediatric Clinical Physiology, Queen Silvia Children's Hospital, S-416 85 Göteborg, Sweden. Fax: 46 31841605. E-mail: pmgmed@artech.se

Keywords: acinar, airway hyperresponsiveness, bronchioli, challenge

Received: June 8, 2002
Accepted January 28, 2003

This study was supported by the Research and Development Council, Central Hospital, Skövde, Sweden.

The aim of the study was to assess how deep into the acinar region the airway response to cold dry-air hyperventilation challenge (CACh) reaches in subjects with asthma of different severity.

Peripheral airway function was measured using a single-breath sulphur hexafluoride (SF₆) and helium (He) washout test and overall airway function by forced expiratory volume in one second (FEV₁) at rest, after CACh and ß₂-therapy in 55 adults with a history of asthma. The normalised phase-III slopes (Sn_III) for SF₆ and He were used to assess peripheral airway obstruction and the (SF₆-He) Sn_III difference to indicate where obstruction occurred. While a greater He versus SF₆ slope increase indicates a response close to the acinar entrance, the reverse indicates a response deeper into the acinar airspaces.

Twelve subjects had a major fall in FEV₁ (20%) after CACh, 16 a minor fall (10–19%), and 27 did not react. Resting He and SF₆ Sn_III were significantly greater in major responders with respect to minor and nonresponders, while resting FEV₁ did not differ between the three groups. The major responders showed marked increases of He and SF₆ Sn_III after CACh, with greater increase for He resulting in a negative (SF₆-He) Sn_III difference.

To conclude, airways close to the acinar entrance participate in the overall airway response to cold-air challenge in asthmatic adults with marked airway hyperresponsiveness to cold, dry air.

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