Dichotomous airway response to exercise in asthmatic patients

The extent and location of airway narrowing in asthmatic subjects are usually inferred from measurements of maximal expiratory flow rates and airway resistance. In the present study, we used the acoustic reflection technique to measure the airway cross-sectional area in 14 asthmatic subjects and 8 normal controls before and following treadmill exercise tests. In normal subjects, exercise caused no significant change in FEV1 and bronchial area, but did cause a significant increase in the intrathoracic tracheal area from 2.0 +/- 0.7 cm2 to 3.1 +/- 0.7 cm2 (p less than 0.002). In the asthmatics, exercise was followed by a 37 +/- 15% reduction in forced expiratory volume in 1 s(FEV1), and a 36% decrease in bronchial area from 8.5 +/- 2.8 cm2 to 5.4 +/- 1.1 cm2 (p less than 0.001); however, extra- and intrathoracic tracheal areas increased significantly. These findings provide direct and quantitative evidence that the bronchi are the main site of airway narrowing in exercise-induced asthma, and draw attention to the phenomenon of tracheal dilatation that occurs concomitant with bronchoconstriction in asthmatic patients.