In order to investigate the conditions of autonomic nervous system and adrenal medullary function of patients with bronchial asthma, changes in urinary excretions of catecholamines (CA), total metanephrine (MN) and vanillyl mandelic acid (VMA) were ovserved in asthmatic patients as well as in rabbits with experimentally induced asthmatic attack, and the following resultes were obtained :
1) Comparison of 24 hour volumes of urinary CA, total MN and VMA excretions among 23 normal persons and 14 asthmatic patients in a stable condition, disclosed no remarkable difference except for a slight increase of noradrenaline (NA) in the latter.
2) Asthmatics in a stable condition show greater daily and diurnal variations in urinary adrenaline (A), NA and VMA excretions than normal persons. In normal persons, urinary A, NA and VMA excretions reach a peak in the afternoon and decrease at midnight, but in asthmatics these diural circles are not seen.
3) The measurement of urinary excretions of CA and their metabolites before, during and after the asthmatic attack revealed the following : (1) Just before the attack, there are no remarkable change in urinary A, NA, total MN and VMA excretions. (2) During the attack, urinary A increases in a few patients and urinary NA in a half of them. There is no patient whose urinary A or NA decreases, but urinary total MN and VMA decrease in almost all of them. (3) In the recovery phase from the attack, urinary A, NA, total MN and VMA increase in all of them.
4) Clinical pictures and urinary CA and VMA are observed after the subcutaneous injection of 0.1% adrenaline hydrochrolide 0.5ml. About 5% of the administered A is excreted without any metabolic change for 3 hours after the injuction, and VMA excreation volume increases slowly in normal persons. The excretion rate of the administered A from the patient who recovers soon after the injection is not different from that of normal persons. But though the excretion rate of unmetabolized A is as high as 6 to 7% in the patients who do not recover well, VMA excretion does not increase in 5 hours after the injection.
5) When adrenocortical hormone or antihistaminies is administered to normal persons, urinary A, NA and VMA do not change significantly. When a teophylline derivative is administered to them, urinary A, NA and VMA increase slightly.
6) When 1% pilocarpine 0.5ml is injected subcataneously into normal persons and asthmatics, urinary A, NA and VMA increase equally in both groups. In no one, however, is induced asthmatic attack by this treatment.
7) Experimental asthma is induced by acetylcholin-, histamine- and ovalbuminaerosol in rabbits. In the cases of the acetylcholin- and histamine-asthma, urinary A and NA increase apparently during the attack and decrease to normal level soon after the attack, but urinary total MN and VMA increase and return to the normal rather than A and NA. In the case of allergic asthma, urinary A and NA during the attack are the same as in the pretreated cases, and urinary total MN and VMA during the attack are less than in the pretreated. All these substances increase after the allergic asthmatic attack.
8) The rabbit group in which asthmatic attack can be induced by ovalbumin as an antigen are compared with a group in which it can not be induced. There is no remarkable difference between the two groups before the treatment. But when an asthmatic attack by acetylcholin- or histamine-aerosol is induced in each group under the same conditions, the grade of the attack and the increase of urinary A, NA, total MN and VMA of the former are more remarkable than those of the latter.
From these results the following conclusions may be reached :
(1) The tension of sympathic nervous system and the adrenal medullary function are labile in patients with bronchial asthma. (2) The asthmatics have latent insufficiency of these functions ; therefore, this is one of the causes of asthmatic attack.
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