Positive expiratory pressure: a potential therapy to mitigate acute bronchoconstriction in the asthma of obesity
- 1 December 2021
- journal article
- research article
- Published by American Physiological Society in Journal of Applied Physiology
- Vol. 131 (6), 1663-1670
- https://doi.org/10.1152/japplphysiol.00399.2021
Abstract
Late-onset nonallergic (LONA) asthma in obesity is characterized by increased peripheral airway closure secondary to abnormally collapsible airways. We hypothesized that positive expiratory pressure (PEP) would mitigate the tendency to airway closure during bronchoconstriction, potentially serving as rescue therapy for LONA asthma of obesity. The PC20 [provocative concentration of methacholine causing 20% drop in forced expiratory volume in 1 s (FEV1)] dose of methacholine was determined in 18 obese participants with LONA asthma. At each of four subsequent visits, we used oscillometry to measure input respiratory impedance (Zrs) over 8 min; participants received their PC20 concentration of methacholine aerosol during the first 4.5 min. PEP combinations of either 0 or 10 cmH2O either during and/or after the methacholine delivery were applied, randomized between visits. Parameters characterizing respiratory system mechanics were extracted from the Zrs spectra. In 18 patients with LONA asthma [14 females, body mass index (BMI): 39.6 ± 3.4 kg/m2], 10 cmH2O PEP during methacholine reduced elevations in the central airway resistance, peripheral airway resistance, and elastance, and breathing frequency was also reduced. During the 3.5 min following methacholine delivery, PEP of 10 cmH2O reduced Ax and peripheral elastance compared with no PEP. PEP mitigates the onset of airway narrowing brought on by methacholine challenge and airway closure once it is established. PEP thus might serve as a nonpharmacological therapy to manage acute airway narrowing for obese LONA asthma. NEW & NOTEWORTHY Standard pharmacological treatments are not effective in people with obesity and asthma. We assessed the efficacy of positive expiratory pressure (PEP) as a therapy to mitigate airway hyperresponsiveness in the asthma of obesity. Our results indicate that PEP might serve as a nonpharmacological therapy to manage acute airway narrowing in obese individuals with late-onset nonallergic asthma.Keywords
Funding Information
- HHS | NIH | National Heart, Lung, and Blood Institute (HL-130847)
This publication has 30 references indexed in Scilit:
- Effects of obesity and bariatric surgery on airway hyperresponsiveness, asthma control, and inflammationJournal of Allergy and Clinical Immunology, 2011
- Obesity and asthma: An association modified by age of asthma onsetJournal of Allergy and Clinical Immunology, 2011
- Decreased response to inhaled steroids in overweight and obese asthmatic childrenJournal of Allergy and Clinical Immunology, 2011
- Body Mass Index and Response to Asthma Therapy: Fluticasone Propionate/Salmeterol versus MontelukastJournal of Asthma, 2010
- A Deep Breath Bronchoconstricts Obese AsthmaticsJournal of Asthma, 2010
- Overweight, Obesity, and Incident AsthmaAmerican Journal of Respiratory and Critical Care Medicine, 2007
- Influence of body mass index on the response to asthma controller agentsEuropean Respiratory Journal, 2006
- Effect of Obesity on Clinical Presentation and Response to Treatment in AsthmaJournal of Asthma, 2006
- The allergic mouse model of asthma: normal smooth muscle in an abnormal lung?Journal of Applied Physiology, 2004
- The prediction of pressure drop and variation of resistance within the human bronchial airwaysRespiration Physiology, 1970