CPAP as a novel treatment for bronchial asthma?

“…Several previous studies examining the effect of chronic exposure to increased P tm on airway function all show that chronic inflation suppresses airway narrowing (52,(61)(62)(63). Indeed, continuous positive airway pressure (CPAP) has been suggested as a novel treatment for asthma (43). In vitro, whole rabbit bronchial segments were cultured for 48 h with and without a positive inflationary pressure, which reduced the maximum isometric force produced by the inflated airways (52).…”

Section: Duration Of Length Adaptationmentioning

confidence: 99%

Does smooth muscle in an intact airway undergo length adaptation during a sustained change in transmural pressure?

Ansell

McFawn

McLaughlin

et al. 2015

Journal of Applied Physiology

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In isolated airway smooth muscle (ASM) strips, an increase or decrease in ASM length away from its current optimum length causes an immediate reduction in force production followed by a gradual time-dependent recovery in force, a phenomenon termed length adaptation. In situ, length adaptation may be initiated by a change in transmural pressure (Ptm), which is a primary physiological determinant of ASM length. The present study sought to determine the effect of sustained changes in Ptm and therefore, ASM perimeter, on airway function. We measured contractile responses in whole porcine bronchial segments in vitro before and after a sustained inflation from a baseline Ptm of 5 cmH2O to 25 cmH2O, or deflation to -5 cmH2O, for ∼50 min in each case. In one group of airways, lumen narrowing and stiffening in response to electrical field stimulation (EFS) were assessed from volume and pressure signals using a servo-controlled syringe pump with pressure feedback. In a second group of airways, lumen narrowing and the perimeter of the ASM in situ were determined by anatomical optical coherence tomography. In a third group of airways, active tension was determined under isovolumic conditions. Both inflation and deflation reduced the contractile response to EFS. Sustained Ptm change resulted in a further decrease in contractile response, which returned to baseline levels upon return to the baseline Ptm. These findings reaffirm the importance of Ptm in regulating airway narrowing. However, they do not support a role for ASM length adaptation in situ under physiological levels of ASM lengthening and shortening.

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“…Some observations which might help disentangle seemingly overlapping endotypes might be, for example, differential response to intravenous versus inhaled agonist (Strengell et al, 2013), or perhaps continuous positive airway pressure (CPAP) or positive end expiratory pressure (PEEP) response (e.g. (Pellegrino et al, 2011)). Other possible differentiating measurements include regional measurements (e.g.…”

Section: Synergiesmentioning

confidence: 99%

Phenotype, endotype and patient-specific computational modelling for optimal treatment design in asthma

Donovan

Tawhai

2015

Drug Discovery Today: Disease Models

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Understanding and treatment of asthma is significantly complicated by the heterogeneous spectrum of phenotypes associated with the disease. Recent advances in phenotype classification promise more targeted therapies, but these categories are based on constellations of largely external measurements and are not necessarily indicative of underlying pathophysiology. We propose that computational modelling is a valuable tool that allows the disease spectrum to be decomposed not into phenotypes but rather into groups organized by underlying dysfunction, referred to by some authors as endotypes. By breaking down the asthmatic spectrum in this way, therapies can be targeted more directly to the underlying defects. This would be not only an important improvement in its own right, but also an important step toward the ultimate goal of patient-specific modelling.

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CPAP as a novel treatment for bronchial asthma?

Cited by 10 publications

References 24 publications

Nocturnal continuous positive airway pressure in severe non‐apneic asthma. A pilot study

Nocturnal continuous positive airway pressure in severe non‐apneic asthma. A pilot study

Does smooth muscle in an intact airway undergo length adaptation during a sustained change in transmural pressure?

Phenotype, endotype and patient-specific computational modelling for optimal treatment design in asthma

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