Chest
Volume 98, Issue 6, December 1990, Pages 1408-1413
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Clinical Investigations
Clinical Dysautonomia in Patients with Bronchial Asthma: Study with Seven Autonomic Function Tests

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Fifty asthmatic patients and 20 healthy control subjects, carefully age- and sex-matched, were subjected to seven standardized tests to evaluate their autonomic status. Due care was taken to remove factors which could interfere with results. Of the tests concerned with the parasympathetic system, the intravenous atropine test (p>0.10) and heart rate response to standing (p>0.01) which measured the basal parasympathetic tone, did not show a significant difference. Tests requiring stimulation of the parasympathetic system, ie, deep breathing test (p<0.001), Valsalva maneuver (p<0.001), and carotid sinus massage (p<0.001) showed significantly heightened response. Postural fall of blood pressure (p>0.10) and sustained hand grip test (p>0.10), chiefly concerned with the sympathetic system, did not show a significant difference. Of the 50 asthmatic patients, nine were atopic and 41 nonatopic. When the results were compared in the two groups separately, we found that there was no alteration in the measurements except the intravenous atropine test which showed heightened response with atopic subjects (p<0.05). These results suggest that hyperresponsiveness of the parasympathetic system is an important factor in producing bronchial spasm in asthmatic patients, and atopic and nonatopic subjects do not differ much in their autonomic status.

Section snippets

Subjects and Methods

The study included 50 patients with bronchial asthma and 20 healthy volunteers after their written consent was obtained. All the patients had history and clinical features of bronchial asthma as defined by the American Thoracic Society.17

The following criteria were followed while selecting the patients: duration of asthma more than two years, with at least two acute asthmatic exacerbations in any year; patient's age between 15 and 50 years; should not have received any drug modulating the

Results

Of the 50 asthmatic patients studied, nine were atopic and 41 nonatopic. The proportion of men to women control subjects and asthmatic patients was 1.86:1 and 1.94:1, respectively. The mean age of asthmatic patients was 31.75±10.43 years and that of control subjects, 33.22±10.83 years, thus excluding the variables in autonomic tone occurring with age. The duration of asthma in patients ranged from 2 to 30 years. Thirty one patients had disease for ten years, seven had disease for more than 20

Discussion

It has been well documented that dysautonomia in asthmatic patients is generalized.4 Since the rate of discharge of sinoatrial node is under vagal control, the possibility exists that an alteration in autonomic control in airway caliber may be reflected by a parallel change in control of the heart rate,7 and the blood pressure responses mediated by sympathetic nervous system may reflect the altered sympathetic airway tone.

In the preview of vagal hypertonia in asthma,1, 25 alteration in the

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    Manuscript received January 8; revision accepted May 15.

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