Deep inspiration and airway smooth muscle adaptation to length change

In normal subjects a deep inspiration (DI) taken during bronchoconstriction substantially reduces airway narrowing (bronchodilation) and a DI taken prior to bronchoconstriction attenuates subsequent airway narrowing (bronchoprotection). Although the exact mechanism(s) for these phenomena are unclear the time course of these effects supports the hypothesis that they are mediated through actions of airway smooth muscle (ASM). There is convincing evidence that both the bronchodilation and bronchoprotection actions of DI are deficient or absent in asthmatic subjects. Various theories have been proposed such as a failure of transmission of stress and strain to the ASM in asthma, stretch-induced contraction of smooth muscle in asthmatics, a failure to release bronchodilating substances and differential effects on cross-bridge dynamics or contractile element rearrangement. In this brief review we focus on the mechanical consequences of DI on the ASM. We suggest that a failure of plastic rearrangement of the contractile apparatus following DI is at the basis of the abnormal response to DI in asthma.