The responses of asthmatic subjects to isoproterenol inhaled at differing lung volumes

Asthmatics are usually instructed to use pressurized bronchodilator aerosols by delivering a bolus of drug at the beginning of a full inspiration. Because airways are better dilated near total lung capacity, the delivery of the drug near the end of a full breath might allow better penetration of particles into the lung and greater bronchodilatation. To test this hypothesis, 13 asthmatic subjects inhaled 400 μg of isoproterenol at 20% (low) and at 80% (high) vital capacity. The studies were done on 2 separate days when the severity of asthma was the same. Forced vital capacity, 1 sec forced expiratory volume, specific airway conductance, and maximal flow at 50% of vital capacity were measured at frequent intervals after drug administration. Ten min after drug delivery, there was a significantly greater (P <0.05) improvement in 1 sec forced expiratory volume after the drug was inhaled at the high lung volume compared to the response after delivery at the low lung volume. The differences in forced vital capacity, specific conductance, and maximal flow at 50% of vital capacity were not significant. The authors concluded that inhaling a bronchodilator drug at the end of a full inspiration causes relatively greater bronchodilatation than inhaling the same dose at the beginning of inspiration.