COMPARISON OF CLINICAL BENEFIT, ANTIINFLAMMATORY EFFECT

我们已经证明NA经历了肺功能的严重衰退和肺泡组织炎症的增加。因此，我们研究了NA受试者夜间PAR的变化。7名NA和4名非哮喘对照(C)在下午4点和凌晨4点随机接受了两次支气管镜检查。将支气管镜楔入前段，然后插入5号导管。热的、饱和的空气以100 ml/min-1000 ml/min的流速从一个管腔流出导管，并通过第二个管腔测量压力。阻力（Rp）定义为每个受试者在0.3特布他林（tb） SQ之前和之后在两个或两个以上流量水平上的压力/流量平均值。在功能剩余容量时停止流动，并允许压力衰减10秒；最终压力称为闭合压力（Pc）。4 pm和4 am时，NA的Rp显著高于C (4 pm: 0.01110.001 (C) vs. 0.13610.019 (NA) cm H20/ml/min, p=0.008；凌晨4点：0.00910.002 （C) vs. 0.15010.04 (NA), p=0.001）。在NA组中，尽管FEV1在夜间下降了相似的%，但观察到2种不同的反应（表）。Rp组（cm H20/ml/min） Pc(cm H20) %FEV1 %下降FEV1 (hs-4am) A - 4p 0.17710.009 6.613.5 58.314.6 A -4a 0.12510.070 9.515.7 55.017.3 21.614.9 B - 4p 0.10510.021 10.916.9* 71.518.9 B -4a 0.16810.040 26.818.1* 67.516.3 20.316.8 A组表现出“气道”反应，Pc较低，保持不变，FEV1较低，对tb的反应显著。B组表现出“实质”反应，夜间Pc增加，与小气道平行传导单元的丧失一致，FEV1较高，对tb无显著反应（下午4点对tb的反应：F Rp （tb前）：0.16410.005 vs. -0.00510.005 cm H20/ml/min， a组和B组，p=0.03）。这些对PAR的不同贡献可能为哮喘的自然历史和病理生理学提供见解。

We have shown that NA experience profound decrements in lung function and increased alveolar tissue inflammation. Thus, we investigated the changes in PAR at night in subjects with NA. Seven NA and 4 nonasthmatic controls (C) underwent two bronchoscopies in a random order at 4 pm and 4 am. The bronchoscope was wedged in the anterior segment followed by insertion of a size 5 French catheter. Warm, saturated air at flows ranging from 100 ml/min-1000 ml/min exited the catheter through one lumen and pressure was measured through the second lumen. Resistance (Rp) was defined as the pressure/flow averaged over two or more flow levels for each subject before and after 0.3 terbutaline (tb) SQ. Flow was stopped at functional residual capacity and the pressure was allowed to decay for 10 seconds; the final pressure was termed the closing pressure (Pc). The Rp in NA was significantly higher than C at 4 pm and 4 am: (4 pm: 0.01110.001 (C) vs. 0.13610.019 (NA) cm H20/ml/min, p=0.008; 4 am: 0.00910.002 (C) vs. 0.15010.04 (NA), p=0.001). Within the NA group, 2 distinct responses were observed despite similar % overnight falls in FEV1 (table). Group Rp (cm H20/ml/min) Pc(cm H20) %FEV1 % fall FEV1 (hs-4am) A - 4p 0.17710.009 6.613.5 58.314.6 A - 4a 0.12510.070 9.515.7 55.017.3 21.614.9 B - 4p 0.10510.021 10.916.9* 71.518.9 B - 4a 0.16810.040 26.818.1* 67.516.3 20.316.8 Group A exhibited an "airway" response with a lower, unchanging Pc, low FEV1 and a significant response to tb. Group B exhibited a "parenchymal" response with increased Pc at night consistent with loss of parallel conducting units in the small airways, a higher FEV1 and no significant response to tb (response to tb at 4 pm: F Rp (pre-post tb): 0.16410.005 vs. -0.00510.005 cm H20/ml/min in groups A and B, p=0.03). These different contributions to PAR may offer insight into the natural history and pathophysiology of asthma.