Mechanical determinants of intact airway responsiveness
Harvey, Brian Christopher
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Airway hyperresponsiveness (AHR) is a hallmark of asthma where constriction of airway smooth muscle (ASM) causes excessive airway narrowing. Asthmatics, unlike healthy subjects, cannot prevent or reverse this narrowing by stretching their airways with a deep inspiration (DI). Since stretching of isolated ASM causes dramatic reductions in force generation and asthmatics tend to have stiffer airways, researchers hypothesize that reduced ASM stretching during breathing and DIs results in hyperreactive airways. However, counterintuitively, excised measurement on intact airways show narrowing is minimally reversed by pressure oscillations simulating breathing and DIs. We hypothesized that AHR does not result from reduced capacity to stretch the airways; furthermore, each constituent of the airway wall experiences different strain magnitude during breathing and DIs. To test this, we used an intact airway system which controls transmural pressure (Ptm) to simulate breathing while measuring luminal diameter in response to ASM agonists. An ultrasound system and automated segmentation algorithm were implemented to quantify and compare the ability of Ptm fluctuations to reverse and prevent narrowing in larger (diameter=5.72±0.52mm) relative to smaller airways (diameter=2.92±0.29mm). We found the ability of Ptm oscillations to reverse airway narrowing was proportional to strain imposed on the airway wall. Further, tidal-like breathing Ptm oscillations (5-15cmH2O) after constriction imposed 196% more strain in smaller compared to larger airways (14.6% vs. 5.58%), resulting in 76% greater reversal of narrowing (41.2% vs. 23.4%). However, Ptm oscillations applied before and during constriction resulted in the same steady-state diameter as when Ptm oscillations were applied only after constriction. To better understand these results, we optimized an ultrasound elastography technique utilizing finite element-based image registration to estimate spatial distributions of displacements, strains, and material properties throughout an airway wall during breathing and bronchoconstriction. This required we formulate and solve an inverse elasticity problem to reconstruct the distribution of nonlinear material properties. Strains and material properties were radially and longitudinally heterogeneous, and patterns and magnitudes changed significantly after induced narrowing. Taken together, these data show AHR likely does not emerge due to reduced straining of airways prior to challenge, but remodeling that stiffens airway walls might serve to sustain constriction during an asthmatic-like attack.