Mar 1, 1985 - Pulmonary Epithelial Permeability after. Inhaling Saline, Distilled Water "Fog" and. Cold Air*. Colitl Bor-luttd, M . d.;? Arldreu: Chutt~berluirl, M ...
Pulmonary epithelial permeability after inhaling saline, distilled water "fog" and cold air. C Borland, A Chamberlain, B Barber and T Higenbottam Chest 1985;87;373-376 DOI 10.1378/chest.87.3.373 The online version of this article, along with updated information and services can be found online on the World Wide Web at: http://chestjournal.chestpubs.org/content/87/3/373
Chest is the official journal of the American College of Chest Physicians. It has been published monthly since 1935. Copyright1985by the American College of Chest Physicians, 3300 Dundee Road, Northbrook, IL 60062. All rights reserved. No part of this article or PDF may be reproduced or distributed without the prior written permission of the copyright holder. (http://chestjournal.chestpubs.org/site/misc/reprints.xhtml) ISSN:0012-3692
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Pulmonary Epithelial Permeability after Inhaling Saline, Distilled Water "Fog" and Cold Air* Colitl Bor-luttd, M . d.;?Arldreu: Chutt~berluirl,M . Sc.;$ Bob Barber; M .Sc.;$ utld f i t t l Higetlbottun~,B . S c . , M.D., FC.C.Z?II
It is recogtiized that hyperventilatio~iof cold air and the inhalation of fine mists of distilled water provoke significant b~~onchoconstriction in the asthniatic individual, yet little is known as to how these provocations affect the structural integrity of the alveolar epithelial membrane. In ll normal subjects, the following effects have been studied: cold air
hyperventilation for three minutes, i~ihalationof 80 L of ultrasonically nebulized distilled water "fog," arid 80 L of isotonic saline "fog" on the half time clearance (TYP)from the alveoli of tech~ietiu~n 99m diethyle~ietriamirie penta acetate (DTPA), inhaled as an aerosol. The DTPA TYz provided a of pulnionary epithelial permeability. n~easure~nent
~najorprotective role has beell attributed to pulliio11ary epitheliuln Tight ju~ictiolisadjoi~iiagapical surfaces of epithelial cells act as an eftective barrier to s,~ permeation of protein n ~ a c r o - l i ~ o l e c u l e certain lipids,' and possibly, slnall hydrophilic tracer molecules such as diethylene trialnine penta acetate (I)TPA).J Pul~lioiiaryepithelial per~iieabilitymay ~ i o t only b e altered following inhalation of tobacco smoke," but also after IgE-mediated allergic bro~ichoconstriction.' In addition, histalni~leand methacholine, agents (or their analogs) il~iplicated in allergic brollchoconstriction, call also increase epithelial permeability.'.' A further protective role of pulmonary epithelium is the control of heat and water exchange from the lungs during extremes of environment and exercise.' The surfices of the ailways and airspaces are covered with an actively l~iailltailied surface aqueous fluid layer where electrolyte co~npositionvaries according to the region of the lung.'"" Induction of brolichocolistriction in asthllla by either hypervelitilating frigid airUor ilihalilig filie niists of hypoliypertollic aqueous solution13has beell suggested to be a result of alteratio~~s ill compositiol~of this aqueous surface lining fluid.14 We have questiolled whether hyperveritilatio11 of freezing air or inhalation of fine niists of distilled water alter pul~nonaryepithelial permeability as ~ileasured by the clearance of DTPA. Initially, so as to avoid which ~iiightoccur as possible cha~igcsill per~~ieability or short-ter111alveolar a result of bro~~chocoi~strictio~i hypoxia from bronclioconstriction, the eftect of thebe
provocations has beeii studied in ~ i o r ~ nsubjects. al To decide if tonicity of the aqueous fog is an i~iiportailt fictor, we have compared the itihalation of distilled of norlilal saline fog. Lung water fog with illhalatio~~ epithelial permeability was ~ueasuredusillg the clearance half time of an aerosol of technetiu~n99m chelate to DTPA,3 fro111the right lung.
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*Fro111 the De ) a r t ~ n e ~ i tofs Hespirator) Physiology and Nuclear Medicine, Addrrlbrookei Hospital, Can~bridge,E ~ ~ g l a l l d . tMedical ~esearchfellow. SHesearch fello\\: §Senior physicist. //Consultantphysician. Manuscript received hlarch 1, I-evisio~i acceptcd August 14. Hep'.int r r y u e ~ t s .111: tfigrr~botturrr,A d d e ~ ~ b r - o o kHospitul, rs C u ~ ~ l l r i d gEr ~ . lglu~~d
el eve^^ 111ale 11o1is111okerswere studied, all ~lonasthmatics,as deter~niuedby the absence of history of wheezy breathless~~ess and allergic rhii~itis.Each had gikt.11i~iforniedc o ~ i s ea~ ~ tthe ~ dstudy had the approval of the local hospital Ethics C o ~ ~ ~ ~ i l i Each t t e e .inhaled an d inhaled by a aerosol ofY1""I'cDl.PA ill salilie solutio~r,g e ~ ~ e r a t eand previously described neth hod.^ N~nety-fivepercent of the particle l'he whole body radiation dose for sizes wele belo\v I p in dia~~reter. all studies for each subject was 16 l11re111,within category 1 of the WHO guideli~res." red two Cleara~iceof LH"A fro^^^ the lungs was ~ ~ ~ e a u utiliril~g sci~rtillatio~~ coul~ters,olle positio~~ed ovt.1-the apex of the right luug and the other positioned over the right frliioral artery. A col-rectio11 factor for p u l ~ ~ i o l ~blood a r y DTPA derived using coul~tsover the leg followi~~g all illtravellous iujectio~iof *"'l'c L)l'PA'A.J Siuce the decliue ill l u ~ coulits ~g h e r correctiou for blood backgrou~~d ill the ~e~~tid, ~g to a ~ n o ~ ~ o e x p o ~ avalue field ot'the l u ~ detrctorapproxi~~iates for clearance half time may be derived, a ~ thib ~ dwas used a, the index of pullnonary epithelial pernieability. Each subject was studied 011 b u r w c a s i o ~ ~ sa , c o ~ ~ t r oafter l; h ! p e ~ . \ e ~ ~ t i l a tof io~ ~ air; after breathing tidally tog of distilled cold ial 'l'he 01-der of g of ~ i o r ~ ~saline. water, aud h e r b r e a t h i ~ ~fog p e t i o r l ~ ~ icold ~ ~ gair a ~ distilled ~ d \rater fog challel~geswas ran~ ~ ep~e ~t ito r ~ ~ ~first e d ;end Illeadullrized. The c o ~ ~ t r o~ ln e a s u r e ~ \vas h e r i111ialatio11 of fog s a l i ~ ~last. e Each s u r e ~ ~ ~were e ~ ~pertornled ts c h d l e ~ ~ g\rr* e petior~ned afirr i11te1-tals of at least fi\e da!s. S p ~ ~ o l ~ ~(i.'E\',) e t r ) \vas recorded ill dul)licate before a ~ dficr ~ d ciich c h d l e ~ ~ gu ea i ~ ~a gdry wedge a p i r o ~ ~ ~ e t e l : For the cold air c h a l l e ~ ~ gthe e , bubjects liyperve~~tilatrd ti)r three 111i11utes fro111all adapted deep fi-eere ~ i l a i ~ l t a i ~a11 ~ iair n gtel~~perature of - 21°C, and CO, was added to i~rapiredair to 111ai11tai11 r~~d-tidal CO, at 4.5 Ypa.'" Illspired a ~ l deipired air telupe~aturrs\rere a copper/copper nickel thermistor wit11 i ~ i t e r ~ ~ r i t t e ~ ~ t reco~dedu s i ~ ~ g h e d t i ~ ~tog pre\eut 111isti11g or h u s t ~ ~ ~ hlinute g.'' \ e ~ ~ t i l d t ~i oO~~~U I I I ~ was ~ ~ ~ e i u u rf ei od l ~a~ regularly calilmited IVright r e s p i ~ o ~ ~ ~ e t e r . From these variables, we were able to calculate rate of respiratory CHEST
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inhalation with the mean control clearance value shows no significant change (Table l), while inhalation of distilled water fog led to a significant reduction in the mean DTPA half-time clearance value, a lnean percentage fall of 38 percent.
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