Effects of acute allergen exposure on posture-induced changes in airway responsiveness to methacholine in asthma.

Abstract

Background: The influence of an allergen challenge on recumbency induced changes in airway responsiveness to methacholine was documented in seven nonsmoking subjects with stable mild asthma (3M, 4F).

Methods: All subjects spent four hours (8 to 12 AM) in the supine position before and 24 hours after an allergen challenge that induced a dual asthmatic response. FEV1 was measured hourly in the supine position and a methacholine challenge was done in the sitting position before and after each 4-hour period. None used bronchial antiinflammatory drugs before or during the study.

Results: The mean maximal fall in FEV1 (+/- SEM) was 31.0 +/- 1.1% within one hour of the last allergen inhalation and 27.5 +/- 4.9% between two and eight hours later. Presupine/postsupine session FEV1 (%pred +/- SEM) was unchanged either at baseline or postallergen challenge sessions, with values of 89.3 +/- 2.7/88.3 +/- 5.1 and 86.6 +/- 4.2/87.4 +/- 5.7. Presupine/postsupine PC20 methacholine was slightly reduced but this did not reach statistical significance (P > .05), with a mean PC20 (mg/mL) of 0.83 +/- 1.44/0.52 +/- 1.46 (preallergen session); 0.55 +/- 1.44/0.39 +/- 1.37 (postallergen challenge session). This delta PC20 (baseline/post-session) did not differ between the two sessions (P > .05). The delta PC20 was not correlated with the magnitude of the late asthmatic response to allergen nor the postallergen increase in airway responsiveness.

Conclusions: We conclude that an acute allergen challenge does not significantly increase recumbency-induced changes in airway response to methacholine in patients with mild asthma. The possibility of a significant influence of pro-inflammatory stimuli on recumbency-induced changes in bronchomotor tone in more severe patients or if the stimulus is repeated should be further assessed.