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Physiologic Dysfunction of the Asthmatic Lung

What's Going On Down There, Anyway?

¹ Department of Medicine, and Department of Physiology and Biophysics, Vermont Lung Center, University of Vermont, Burlington, Vermont

Correspondence and requests for reprints should be addressed to Charles G. Irvin, PhD., Director, Vermont Lung Center, University of Vermont, Professor, Department of Medicine and Physiology, Room 226, HSRF, 149 Beaumont Avenue, Burlington, VT 05405-0075. E-mail: charles.irvin{at}uvm.edu

ABSTRACT

Asthma is a syndrome of lung dysfunction characterized by airflow obstruction, reversibility to bronchodilators, and airways hyperresponsiveness (AHR). There is a growing body of evidence that suggests that the principle defect in asthma is the occlusion of the airway lumen by liquid, fibrin, and mucus. The fall in FEV₁ observed in asthma is best explained by a loss of communicating airspaces and the rise in residual lung volume. Imaging studies in both human patients and experimental animals support this hypothesis. An increased propensity for the airways to close can be a cause of AHR. We conclude that loss of lung volume plays a central role in determining the dysfunction of the asthmatic lung as measured by FEV₁. Together, these recent findings provide a better understanding of the causes of airflow obstruction and AHR, suggesting new avenues for the development of more effective asthma therapies.

Key Words: lung volume • peripheral resistance • FEV₁ • airways hyperresponsiveness • airway closure

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