Cholinergic Bronchomotor Tone and Airway Caliber in Insulin-Dependent Diabetes Mellitus

doi:10.1378/chest.101.4.1038

Chest

Volume 101, Issue 4, April 1992, Pages 1038-1043

https://doi.org/10.1378/chest.101.4.1038 Get rights and content

It has been suggested that the autonomic bronchomotor tone may be altered in diabetes. In the present study, we assessed the cholinergic bronchomotor tone in 34 insulin-dependent diabetic patients and in a control group of 32 healthy subjects (group C). As an index of the intensity of cholinergic tone to the airways, we measured the increase in specific airway conductance (Gaw/VL) induced by aerosol administration of atropine sulfate. In all of the patients and normal individuals the autonomic cardiovascular activity was also evaluated by the tilting test and by the magnitude of the respiratory sinus arrhythmia (RSA). In 19 patients without symptoms of autonomic neuropathy (AN) (group D-1), the autonomic cardiovascular activity was comparable to that of group C. The other 15 patients presented with at least one symptom of AN and a depressed heart rate (HR) control when submitted to the tests of autonomic activity (group D-2). Before atropine administration, Gaw/VL was significantly higher (p<0.05) in group D-2 (2.48 ±0.12 s^–1·kPa^–1 [mean±SE]) than in group D-1 (2.11 ±0.10 s^–1·kPa^–1). Aerosol atropine caused a significant increase (p<0.001) in airway caliber in all three groups; however, the increase in Gaw/VL was significantly lower in group D-2 (0.26 ±0.05 s^–1·kPa^–1) when compared with group D-1 (0.63 ± 0.09 s^–1·kPa^–1; p<0.01) and group C (0.67 ± 0.06 s^–1·kPa^–1; p<0.001). A weak but significant (p<0.02) correlation was observed between the increases in Gaw/VL provoked by atropine and the magnitude of RSA. Our findings suggest that the reduction in parasympathetic bronchomotor tone may cause an increase in basal airway caliber in diabetic patients with AN, compared to patients without AN.

Section snippets

Subjects

We studied 34 insulin-dependent diabetic patients aged 18 to 45 y and a control group of 32 healthy individuals aged 23 to 35 y. The diabetic patients were divided into two groups on the basis of clinical manifestations of AN and the responses to the two tests of autonomic cardiovascular activity, ie, the tilting test and the magnitude of RSA (see procedures for details). The first group of diabetic patients (group D-1) consisted of 19 subjects with no AN symptoms and with circulatory autonomic

Autonomic Cardiovascular Activity

The results obtained during the study of the autonomic cardiovascular activity are given in Table 2. In the resting supine position the patients of group D-2, as compared with the other two groups, had significantly higher values of HR (p<0.001). The increase in HR at 5 s of tilting test was significantly lower in group D-2 than in group C (p<0.001) and group D-1 (p<0.001). Similar HR results were observed at 10 s of the tilting period, with smaller variation in group D-2 than in group C

DISCUSSION

On the basis of clinical and functional criteria used in the present study, the diabetic patients were divided into two groups in terms of ANS involvement. Patients of group D-1, with no clinical manifestation of AN, behaved like group C in terms of circulatory responses to the tilting test and RSA magnitude. On the other hand, group D-2 of patients with AN symptoms showed intense depression of the parasympathetic autonomic control of the heart, as judged by the higher HR observed under basal

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Cited by (19)

The association between blood oxygen saturation and baroreflex sensitivity in adults with type 1 diabetes with and without albuminuria
2023, Journal of Diabetes and its Complications
Low baroreflex sensitivity is an indicator of early cardiovascular autonomic neuropathy. We explored the association between baroreflex sensivity and blood oxygen saturation (SpO₂) in type 1 diabetes and various degrees of microvascular disease.
In this Danish-Finnish cross-sectional multicentre study, baroreflex sensivity and SpO₂ (pulse oximetry) were examined in persons with type 1 diabetes and normoalbuminuria (n = 98), microalbuminuria (n = 28), or macroalbuminuria (n = 43), and in non-diabetic controls (n = 54). Associations and differences between groups were analysed using regression models and adjustment included age, sex, smoking, HbA_1c, blood haemoglobin, urine albumin creatinine ratio, body mass index, and estimated glomerular filtration rate.
In type 1 diabetes, higher baroreflex sensitivity was associated with higher SpO₂ before adjustment (% increase per one % increase in SpO₂ = 20 % (95%CI: 11–30); p < 0.001) and the association remained significant after adjustment (p = 0.02). Baroreflex sensitivity was not different between non-diabetic controls and persons with type 1 diabetes and normoalbuminuria (p = 0.052). Compared with type 1 diabetes and normoalbuminuria, baroreflex sensitivity was lower in micro- (p < 0.001) and macroalbuminuria (p < 0.001). SpO₂ was lower in persons with type 1 diabetes and normoalbuminuria compared with non-diabetic controls (p < 0.01). Within the participants with type 1 diabetes, SpO₂ was not different in micro- or macroalbuminuria compared with normoalbuminuria (p-values > 0.05), but lower in macro-compared with microalbuminuria (p < 0.01).
Lower baroreflex sensitivity was associated with lower SpO₂ in type 1 diabetes. The present study support the hypothesis that hypoxia could be a therapeutic target in persons with type 1 diabetes.
Neuroadrenergic denervation of the lung in type I diabetes mellitus complicated by autonomic neuropathy
2002, Chest
Citation Excerpt :
However, cholinergic bronchomotor tone did not distinguish diabetic patients with and without AN. The last finding is at variance with previous studies252627 showing depressed parasympathetic bronchomotor tone in patients with type I diabetes mellitus complicated by AN. However, Fonseca et al25 studied diabetic patients with lower baseline FEV1, expressed as percentage of predicted, than control normal subjects, whereas no information on the alveolar-capillary permeability was provided by either Bertherat et al26 or Douglas et al.27 This limits comparability of previous and present data.
To verify whether autonomic neuropathy (AN) complicating type I, insulin-dependent diabetes mellitus affected neuroadrenergic bronchopulmonary innervation.
Twenty nonsmoking diabetic patients without respiratory diseases were studied: 11 patients with AN (group AN) and 9 patients without AN (control; group C) diagnosed by standardized criteria.
Patients underwent respiratory function tests and ventilatory scintigraphies with ¹²³I-metaiodobenzylguanidine (MIBG) and with ^99mTc-diethylenetriaminepenta-acetic acid (DTPA) to assess both bronchopulmonary neuroadrenergic innervation and also permeability of the alveolar-capillary barrier to water-soluble tracers. Rates of pulmonary clearance of the two tracers were computed, and correlates were identified by nonparametric statistics.
University hospital.
The AN and C groups had normal respiratory function test results and comparable duration of diabetes and quality of metabolic control. ^99mTc-DTPA clearance did not distinguish the groups. ¹²³I-MIBG clearance was faster in the AN group than in the C group (mean ± SD half-time of the radiotracer time-activity curve [T_1/2], 116.1 ± 22.8 min in the AN group vs 139.5 ± 18.3 min in the C group, p = 0.022), which is consistent with neuroadrenergic denervation in the AN group. ¹²³I-MIBG clearance was independent from ^99mTc-DTPA clearance. Faster ¹²³I-MIBG clearance was significantly associated with worse performance in three of the four autonomic tests.
Neuroadrenergic bronchopulmonary denervation may occur in diabetic patients with AN despite normal clinical and respiratory function findings. Further research is needed to identify clinical and prognostic implications of these findings.
Altered Expiratory Flow Dynamics at Peak Exercise in Adult Men With Well-Controlled Type 1 Diabetes
2022, Frontiers in Physiology
Diabetic lung disease: fact or fiction?
2019, Reviews in Endocrine and Metabolic Disorders
Diabetes and the lungs: What the pneumologist should know
2017, Pneumologe
The diabetic lung
2012, Review of Diabetic Studies

View all citing articles on Scopus

: Manuscript received May 10; revision accepted August 5.

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Chest

Clinical InvestigationsCholinergic Bronchomotor Tone and Airway Caliber in Insulin-Dependent Diabetes Mellitus

Section snippets

Subjects

Autonomic Cardiovascular Activity

DISCUSSION

Mayo Clin Proc

J Auton Nerv Syst

Respir Physiol

Diabetic autonomic neuropathy: a clinical viewpoint

Physiological and clinical correlates of cardiorespiratory reflexes in diabetes mellitus

Diabetes Care

Reduced airway vagal tone in diabetic patients with autonomic neuropathy

Clin Sci

Diminished bronchial reactivity to cold air in diabetic patients with autonomic neuropathy

Br Med J

Bronchial histamine reactivity in diabetic subjects with and without autonomic neuropathy [abstract]

Thorax

Increased bronchial reactivity to histamine in diabetic autonomic neuropathy

Clin Sci

Bronchial reactivity in diabetic patients: relationship to duration of diabetes and degree of glycemic control

Am J Dis Child

Autonomic regulation of airway smooth muscle

Neural control of human airways in health and disease

Am Rev Respir Dis

Effect of an inhaled atropine-like agent in normal airway function

J Appl Physiol

Effects of vagal blockade on lung mechanics in normal man

J Appl Physiol

Postural reflexes in chronic Chagas' heart disease: heart rate and arterial pressure responses

Cardiology

Mechanisms of tachycardia on standing: studies in normal individuals and in chronic Chagas' heart patients

Cardiovasc Res

Mechanisms of initial heart rate response to postural change

Am J Physiol

Evaluation of the autonomic nervous system of the heart in male patients with mitral valve prolapse syndrome using respiratory sinus arrhythmia and dynamic exercise

Cardiology

Manço JC. Efficacy of pharmacological blockade of the cardiac parasympathetic system with atropine in normal men

Braz J Med Biol Res

Standardization of spirometry—1987 update

Am Rev Respir Dis

Reference spirometric values using techniques and equipment that meet ATS recommendations

Am Rev Respir Dis

A rapid plethysmographic method for measuring thoracic gas volume: a comparison with a nitrogen washout method for measuring functional residual capacity in normal subjects

J Clin Invest

A new method for measuring airway resistance in man using a body plethysmograph: values in normal subjects and in patients with respiratory disease

J Clin Invest

Clinical Investigations
Cholinergic Bronchomotor Tone and Airway Caliber in Insulin-Dependent Diabetes Mellitus